As one of only two physiotherapists currently working within a Nurse Practitioner-Led Clinic (NPLC) in Ontario, Andrea Harrison-Hercun is demonstrating the value of physiotherapy in team-based primary care. 

Working three days per week at the Georgina Nurse Practitioner-Led Clinic (GNPLC), Andrea provides physiotherapy services to patients who might otherwise face significant barriers to accessing care. Patients are typically referred by the clinic’s nurse practitioners (NPs), usually when they do not have extended health benefits or have exhausted publicly funded post-surgical or other OHIP rehabilitation services. 

“I am the only physiotherapist at our clinic” Andrea explains. “If one of the nurse practitioners has a patient who they feel requires physiotherapy, they refer them to me if they do not have extended health benefits.” 

The clinic has also built flexibility into its referral process to ensure patients with urgent needs can be seen quickly. Andrea maintains dedicated urgent appointment slots for conditions such as vertigo, paediatric concerns, and patients at high risk of falls. 

A Natural Fit for Team-Based Care 

Andrea’s path to primary care physiotherapy was shaped by years of experience across multiple practice settings. She has worked in: 

• hospital outpatient services,  

• the neonatal intensive care unit (NICU),  

• school-based care through the Children’s Treatment Network,  

• and private practice. 

Her interest in primary care grew through her work alongside physicians and through conversations about the challenges many patients face when trying to access physiotherapy services. 

Andrea reflected on conversations with the many physicians she has worked with over her career, including even her own family physician: 

 “We would have [conversations] about his frustration with recommending physio and some patients not being able to access physio if they didn’t have benefits and didn’t qualify for OHIP,” she says. “It made so much sense to me that physiotherapists should be part of a primary care team!” 

When an opportunity became available at the Georgina Nurse Practitioner-Led Clinic, Andrea knew it was the right fit –  “I jumped at the chance to apply!” 

Expanding Access to Care 

One of the most significant advantages of having physiotherapy embedded within primary care is improved access for patients who may otherwise go without treatment. Andrea sees firsthand how physiotherapy services within an NPLC can bridge gaps in care, particularly for patients with chronic musculoskeletal conditions, mobility challenges, arthritis, balance concerns, and those recovering from surgery. 

According to Nurse Practitioner and Clinic Director John Holbrook, the addition of a physiotherapist has strengthened the clinic’s ability to serve patients with complex needs:  

“Adding a physiotherapist has enhanced our ability to accept and retain patients with complex musculoskeletal and mobility-related needs,” John says.  

“Having a physiotherapist available within the clinic increases confidence that we can provide comprehensive care without relying solely on external referrals, making attachment more sustainable and improving the overall patient experience.” 

The impact extends beyond access alone. John notes that the clinic has observed: 

• faster access to assessment and treatment,  

• earlier intervention for musculoskeletal concerns,  

• improved patient function and mobility,  

• more appropriate use of diagnostic imaging and specialist referrals, 

• and increased patient satisfaction through coordinated team-based care. 

Collaboration in Action 

Perhaps the most distinctive feature of Andrea’s role is the close collaboration she shares with nurse practitioners and other healthcare professionals. “Our team is great at working together,” Andrea says. 

As a valued member of the team, Andrea is frequently consulted by nurse practitioners when assessing musculoskeletal concerns, reviewing imaging results, or determining whether physiotherapy may be an appropriate treatment option. Likewise, Andrea can connect patients directly with other team members when concerns arise outside her scope of practice. 

“If I see a patient and they start talking about their stress at home and I am concerned about them, I can talk to our social worker and get them seen; or if a patient has questions about wanting to lose weight or eat better to manage their blood pressure, we can book them with our dietitian.” 

This collaborative environment allows patients to receive timely support from multiple providers without navigating separate referral pathways or lengthy waitlists. 

John notes that Andrea “has become a key clinical partner in managing musculoskeletal conditions.” He adds that “as a nurse practitioner, I can focus on diagnosis, medical management, and complex chronic disease care while collaborating with the physiotherapist on rehabilitation, exercise prescription, mobility assessments, and functional improvement plans.” 

Redefining Physiotherapy in Primary Care 

Working directly alongside primary care providers has also changed how Andrea delivers care. In traditional practice settings, communication with physicians often involved writing reports and waiting for responses, whereas within the NPLC model, those conversations happen in real time. 

“If I think they need imaging, all I have to do is ask and they order it” Andrea explains, “and if I think cortisone could be a good idea, it usually gets done.” 

The ability to collaborate directly with nurse practitioners allows concerns related to pain management, medication, inflammation, imaging, or specialist referrals to be addressed quickly and efficiently. This integrated approach supports earlier intervention and helps patients access the right care at the right time. 

Beyond Individual Patient Care 

Andrea’s role extends beyond one-on-one treatment. She contributes to a variety of health promotion and education initiatives offered through the clinic. 

The team currently runs the GLA:D® program for arthritis management and has offered educational sessions for parents on topics such as tummy time, safe sleep, infant feeding, and infant CPR. The clinic also hosts summer cooking camps and other community-focused programming. The clinic also collaborates with nearby Family Health Teams on educational initiatives, highlighting the unique role physiotherapy plays within the NPLC model. 

Rewards and Challenges 

For Andrea, the greatest reward is knowing that she is helping people who might otherwise be unable to access physiotherapy services. At the same time, being the clinic’s sole physiotherapist can occasionally present challenges, such as not having intra-professional colleagues with whom she can brainstorm and learn from. 

Advice for Physiotherapists Considering Primary Care 

For physiotherapists interested in working in collaborative healthcare settings, Andrea’s advice is simple: “Do it! Primary care is an amazing setting to work in, and being able to work directly with doctors and nurse practitioners is such a refreshing change.” Andrea adds that “working with a team of social workers, dietitians, and occupational therapists is rewarding when you can offer team-based care.” 

As one of only two physiotherapists currently embedded within Ontario’s Nurse Practitioner-Led Clinics, Andrea’s experience and contributions highlight the important role physiotherapists play in improving access, enhancing collaboration, and strengthening primary care for patients and communities alike. 

Check out Andrea highlighting physiotherapy at GNPLC during National Physiotherapy Month on Instagram. 

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Elizabeth Benny’s journey as a physiotherapist began in India, where she completed her Bachelor of Physiotherapy in 2007. She started her career in a quaternary care hospital, working for four years within a multidisciplinary rehabilitation team.

“This setting provided me a strong clinical foundation and exposure to complex inpatient and outpatient populations across orthopaedics, neurology, cardiopulmonary care, oncology, medical and cardiothoracic ICUs, neonatal and neurosurgical ICUs, and organ transplant services,” says Elizabeth.

She later joined a university hospital under the Bahrain Defence Force, where she helped develop an orthopaedic triage unit. Reflecting on this phase, Elizabeth explains that the role strengthened her clinical reasoning, assessment, and diagnostic skills and introduced her to an early model of first-contact physiotherapy.

After immigrating to Canada and completing the licensing process, Elizabeth began working at a Community Health Centre (CHC). At the time, she says she had only a limited understanding of what a CHC truly represented. “The transition from a fast-paced corporate healthcare system to one characterized by long waitlists and patients facing profound medical and social complexity was challenging” she says. “Yet the work felt deeply familiar, echoing my upbringing in a village in Kerala, India.”

Discovering Primary Care

At the CHC, Elizabeth encountered patients living with chronic pain complicated by psychosocial stressors, trauma, economic hardship, and marginalization. “I quickly realized that physiotherapy alone was insufficient; meaningful care required addressing the social determinants of health,” she says.

This realization shaped her professional direction and led her to pursue a Master’s Degree in Physiotherapy. Her research focused on chronic pain management and resulted in a peer-reviewed publication, Ontario Musculoskeletal Physiotherapists’ attitudes and beliefs about managing chronic low back pain (Physiotherapy Canada, 2020). Over the following decade, Elizabeth’s role expanded to more than hands-on treatment.

“My role expanded beyond clinical treatment to include conducting programs, patient education, self-management strategies, behaviour change, outcome measurement, referral coordination, interprofessional collaboration, and case management when needed,” she explains. “For me, the question shifted from why I came to primary care to why I stayed.”

For Elizabeth, working in a CHC is about purpose. “While I may not always eliminate pain, I can consistently offer support, continuity, and compassionate care, and that has proven deeply meaningful,” she says.

Physiotherapy in a Primary Care Setting

Elizabeth currently works full-time as a physiotherapist at CommunitiCare Health. She primarily sees adult patients with musculoskeletal conditions, many of whom live with chronic pain, and she is also trained in vestibular rehabilitation.

Elizabeth explains that primary care physiotherapy relies heavily on a biopsychosocial model. “Many patients have experienced significant adversity, including displacement from war-torn regions, interpersonal violence, discrimination, substance use challenges, or systemic inequities,” Elizabeth says. “These lived experiences profoundly influence pain, recovery, and function.”

She recalls a patient with persistent knee pain who did not improve despite appropriate rehabilitation. Further discussion revealed the patient was climbing eight flights of stairs multiple times a day because she feared using her building’s elevator due to Islamophobic abuse. With support from a social worker and police, the patient was able to safely use the elevator, fully participate in rehabilitation, and experience gradual pain reduction.

In another case, an elderly patient disclosed he slept in a chair because he did not own a bed. “A referral to a community health worker addressed this basic need, making rehabilitation possible,” Elizabeth explains. These experiences reinforce a central principle of primary care: “Pain and function cannot be separated from lived experience,” she says. “Physiotherapy extends beyond exercise prescription to advocacy, collaboration, and addressing root causes.”

Elizabeth works within a robust interprofessional team that includes physicians, nurse practitioners, occupational therapists, kinesiologists, psychotherapists, social workers, chiropodists, dietitians, and community health workers. Care is delivered through both individual appointments and group-based programs.

“This is only possible through cohesive teamwork,” she notes.

First-Contact Physiotherapy in Action

Elizabeth played a key role in implementing first-contact physiotherapy within her team. She explains that success depended heavily on interprofessional collaboration. “I advocated for direct access to allow all team members to book patients directly into my schedule and reduce a growing waitlist,” she says. This included the reception staff who were trained to book patients presenting with MSK issues directly into the physiotherapist’s schedule.

As the model developed, waitlists were gradually eliminated and administrative burden decreased, allowing more time for patient care. Elizabeth notes that benefits to this model included timely access to musculoskeletal care, reduced burden on family physicians, early identification of red flags, improved patient flow, and early activation to prevent falls and injury.

Challenges such as role ambiguity and managing complex presentations were addressed through clear communication, standardized documentation, and close collaboration with physicians.

Expanding Scope of Practice

Elizabeth’s role pushes beyond traditional perceptions of physiotherapy in Ontario: “My role extends beyond addressing physical impairments to actively considering psychosocial factors such as stress, emotions, beliefs, and social context,” she says.“ Functioning as a first-contact provider, triage clinician, case manager, and patient advocate is essential within a primary care framework,” she explains.

Impact on Underserved Populations

Chronic pain management has been the most impactful area of Elizabeth’s practice: “My approach is grounded in the biopsychosocial model and often begins with motivational interviewing, sometimes starting with something as simple as encouraging a patient to return to their favourite coffee shop,” she says. Elizabeth is particularly focused on developing expertise in chronic pain and vestibular rehabilitation for underserved populations.

“For many patients, even the cost of public transportation is a barrier to care, making private vestibular rehabilitation inaccessible,” Elizabeth explains. “Everyone deserves the right care.” She adds, “I deeply empathize with individuals living in constant fear of pain, dizziness, imbalance, and falls, all of which are conditions that significantly restrict participation and quality of life.”

Improving Access and System Efficiency

When Elizabeth joined her CHC, the physiotherapy waitlist was nearly two months long. Limited discharge capacity meant only a small number of initial assessments could be completed each month.

By pursuing additional education in chronic pain management and implementing group-based programs, the team transformed service delivery. As a result, patients were discharged sooner with improved outcome measures, assessment capacity increased, and the waitlist was reduced to under 48 hours. Twenty-four-hour urgent appointments were also introduced for post-surgical, post-fracture, and prenatal patients.

Through a first contact model, Elizabeth explains, patients were often seen by physiotherapists faster than by family physicians for musculoskeletal concerns. “Physiotherapists functioned as a triage service, escalating care when red flags were identified and initiating treatment when appropriate,” she says. This approach preserved physician capacity and contributed to reduced emergency department utilization.

Strengthening Attachment to Primary Care

Elizabeth describes the Community Health Centre as a patient’s healthcare home: “This model ensures that no patient in need is denied access to physiotherapy and strengthens attachment to primary care teams,” she explains.

Rather than focusing solely on a diagnosis, the team considers the full context of each patient’s life. “This is what a CHC represents,” she adds. “Healthcare delivered under one roof, with dignity, continuity, and compassion.”

Looking Ahead

Elizabeth believes that focused advocacy is required to expand primary care physiotherapy roles in Ontario: “Primary care physiotherapy is a niche that requires maturity, accountability, empathy, ongoing skill development, and strong ethical grounding,” she says.

Despite their impact, many roles remain vacant due to low remuneration and high turnover. Elizabeth emphasizes the need for appropriate compensation, recognition of advanced scope, sustainable funding models, and education about primary care physiotherapy.

Reflecting on lessons learned, she highlights the importance of leadership, strong networks, standardized practices, ongoing evaluation, and continuing education aligned with community needs. “Above all, a strong support system is critical,” Elizabeth says. “Managing complex care in primary care settings can be emotionally demanding, and having a trusted team for guidance and encouragement is indispensable.”

Are You our Next Member Spotlight?

Do you want to be featured? Are you in an innovative role? Spoken about physiotherapy in a podcast or the news? Published an article? Or represented the physiotherapy profession through advocacy?

We want to celebrate you as a physiotherapist, PT or PTA student or PTA!