Securing direct access in Norway

In Norway, we supported the Norwegian Physiotherapist Association to secure direct access in 2018

Gerty Lund, director of the Norwegian Physiotherapist Association, explains how they campaigned for direct access with World Physiotherapy’s support.

“There has been no specific referral requirement for people treated by a physiotherapist working outside the public healthcare system or for people treated by a manual therapist who is part of the public healthcare system.

“But on 1 January 2018 the specific referral requirement for those who wish to have their physiotherapy treatment covered by the National Insurance Scheme was lifted.

“We had been working towards this full direct access goal for years, emphasising the financial and practical benefits of such a reform for both society (it offered potential savings as there would be fewer GP consultations) and, obviously, for physiotherapy patients. It also highlighted the established professional autonomy and strong competence of Norwegian physiotherapists.

“We were fortunate to be able to refer to the positive experiences of those Norwegian physiotherapists offering manual therapy, who had had self-referral patients for nearly two decades. It meant we were in a position to reassure both health officials and other health professions that there was no cause to worry about any adverse health effects where people were not seeing a GP before being examined by a physiotherapist. 

We were able to draw on World Physiotherapy's resources and materials on direct access to make our views known to central government, key politicians and health officials.
Gerty Lund, Norwegian Physiotherapist Association directorTweet this

“An obvious challenge was assuring politicians, health officials and other health professions that this patient-oriented health reform would not compromise patient safety or any other legal or professional requirement in any way. We were pleased to see that convincing them of this was less challenging than anticipated.

“We were also fortunate to be able to draw on World Physiotherapy's resources and advocacy material on direct access. In our efforts, we concentrated on making our view on direct access known to central government, key politicians and health officials.

“In 2014, we invited the Norwegian health minister to a big physiotherapy and manual therapy clinic in Oslo to meet both therapists and patients. We wanted the health minister see for himself and fully understand the smooth workings of direct access since 2006 for manual therapists and the obvious benefits for patients. We believe this event actually was a turning point, a real breakthrough towards reaching our goal!

“In May 2015, direct access along the lines advocated by us was first proposed by the Ministry of Health and Care Services in a government white paper. It was later decided upon by the government and then voted upon favourably by the Norwegian parliament in 2017. When the direct access proposal (which needed a legal amendment) was circulated for comment, it received overwhelming support among associations, other interested parties and the general public.

“Clearly, perceived benefits for patients and potential GP social security savings played its part in the government's decision, and we made good use of arguments that were in tune with health ministry rhetoric on creating a patient-centred healthcare system.”

Find out about our advocacy for direct access