A guide for integrating physiotherapists in a primary care team.

The Current State and Opportunities

Physiotherapists can significantly increase attachment and access to primary care. In 2025, there are 90 known physiotherapist positions in primary care teams in Ontario,¹ including Family Health Teams, Community Health Centres, Nurse Practitioner Led Clinics and Aboriginal Health Access Centres. However, this represents only about 30% of existing teams in Ontario.²

The current Primary Care Action Team funding provides the opportunity to add physiotherapists to every team in Ontario to support achieving 100% attachment to primary care in Ontario.  

1. First Contact Physiotherapy

Physiotherapists are direct access healthcare providers who can make a diagnosis. 

This means that patients do not need a physician referral to see a physiotherapist. Physiotherapists have a broad scope of practice and are experts in the assessment and management of musculoskeletal conditions, including low back pain, osteoarthritis, and shoulder pain, which comprise 20-30% of all visits to primary care. ^3,4 Therefore, patients presenting with these conditions to primary care can be effectively assessed and managed by a physiotherapist. In “First Contact Physiotherapy,” all musculoskeletal conditions presenting to primary care are booked directly with a physiotherapist. Physiotherapists are trained to complete a comprehensive assessment, including the identification of red flags that could be indicative of more serious pathology, and which warrant a referral to the physician or to the emergency department. 

First Contact Physiotherapy directly offloads visits with the physician, creating more access for patients, and therefore more attachment. In fact, it is estimated that for a roster size of 1800 patients, first contact physiotherapy could add an estimated 425 additional patients.⁵ This approach has gained significant momentum in the UK, where a physiotherapist is attached to every family physician practice, and studies have shown that less than 1% of physiotherapy assessments required a referral to the physician.⁶ 

The First Contact Physiotherapy model has been extended in some primary care teams in Ontario, where physiotherapists have medical directives for ordering diagnostic imaging. Diagnostic imaging was approved to be within physiotherapist’s scope of practice in Ontario in 2008. However, legislative changes have not yet been made to fully implement the changes to scope. Once this scope is implemented, there will be greater efficiency added to the first contact role, as physiotherapists will be able to directly order imaging, eliminating the need to refer the patient back to the physician. This not only removes unnecessary appointments, but it also expedites diagnosis and management. 

2. Physiotherapy Across the Lifespan

In primary care teams, physiotherapists support patients across the lifespan, from prenatal to pediatric to palliative. Physiotherapists are trained not only in the assessment and management of musculoskeletal conditions, but also in the assessment of:

• cardiorespiratory conditions

• neurological conditions

• and other conditions, working to assess and restore optimal function and mobility, no matter the underlying cause. 

3. Acute & Chronic Conditions

Physiotherapists offer support and management for both acute and chronic conditions in primary care, including (but not exhaustive): 

Chronic Pain, Diabetes, COPD, Heart Failure, Osteoporosis, Osteoarthritis: 63% of Ontarians have at least one chronic disease.⁷ Physiotherapists support patients with cardiovascular and respiratory conditions (COPD, chronic heart failure) and metabolic disorders (Diabetes), and neurological conditions (Parkinson’s, MS, Stroke and Long Covid). 

Parkinson’s, MS, Stroke: Approximately 10% of Canadians live with a neurological disorder.⁸ Physiotherapists play a significant role in supporting individuals with neurological conditions by maintaining mobility, improving balance, reducing falls risk, and supporting independence.  

Dizziness, Headaches and Concussions: Over 200,000 concussions occur every year in Canada, while nearly 10% of Canadians suffer from headaches.⁹ Physiotherapists support these individuals with symptom management and reduction, progressive return to occupation, and improving overall quality of life through education and exercise.¹⁰  

Pelvic Health Care: Nearly 10% of the population in Canada experience some form of incontinence.¹¹ Health Quality Ontario recommends that pelvic floor muscle training be publicly funded to ensure access.¹² Physiotherapists deliver pelvic floor muscle training as part of comprehensive rehabilitation programs. 

Falls Prevention: 20 to 30% of older adults fall every year.¹³ Physiotherapists work to prevent falls through education, strengthening, and balance training. They can also treat dizziness and incontinence, both of which are significant contributors to falls in seniors. Physiotherapists support seniors’ mobility and independence which keeps them safe and at home as long as possible.

Cancer and Palliative Care: 42% of Canadians are expected to be diagnosed with cancer in their lifetime.¹⁴ The physical impacts of cancer are complex and diverse, and physiotherapists play a significant role at all stages of one’s journey, including adjunctive care during cancer treatment, as well as pre- and post-treatment rehabilitation.¹⁵ Furthermore, physiotherapists play a key role in maintaining independence, supporting comfort, and promoting quality of life as part of the palliative care team.  

4. Upstream Access to Physiotherapy Reduces Health System Costs

Having access to physiotherapy in primary care promotes upstream management of conditions, which can significantly reduce the pressures on the system. In fact, in a program evaluation in central Toronto in 2017, physicians and nurse practitioners reported that having a physiotherapist in the primary care team had: 

• reduced the number of appointments for pain management/reduced function/mobility (76%)

• reduced the amount of pain medication prescribed (58%)

• resulted in more appropriate referrals to specialists (76%), and reduced the need for diagnostic imaging (42%).¹⁶ 

5. Considerations for Implementation of Physiotherapy Services

Space, Equipment and Supplies: It is a common misconception that large sets of equipment and gym space are required for physiotherapists to provide care. Education, exercise, and mobility training, among several other therapy approaches, can safely and effectively be performed in regular clinic office spaces. While it is preferable that a hydraulic treatment table is available for accessibility and ergonomics, additional equipment requirements are relatively low and may include some weights, exercise bands, or acupuncture needles, depending on the skillset of the physiotherapist and patient needs. With larger spaces, equipment such as stationary bikes or treadmills may be employed. 

Group and Virtual Care: Physiotherapists deliver individual or group care, and in person or virtual care. Examples of groups include Low Back Pain Management, Living Better with Pain (Chronic Pain), GLAD Hip and Knee Osteoarthritis, Falls Prevention, Peri-Natal Education. This type of programming requires a larger space for group exercise. There are several models in Ontario where teams have partnered with community spaces (gyms, recreation centers, churches, seniors centers) to deliver programming, if they do not have the space onsite. 

Service Utilization: Program evaluation data has shown that on average, a patient attends 4 to 5 physiotherapy visits¹⁵ in primary care. However, this will vary depending on the patient’s needs. Physiotherapy treatment includes activation and self-management strategies. Outcomes can be monitored using validated patient reported outcome measures, such as the Patient Specific Function Scale and the Global Rating of Change which are applicable across various populations and conditions. 

System Navigation: Physiotherapists connect patients to community resources and rehabilitation programs. Some examples include the Arthritis Society, pools, and community centres to support their recovery and management.

6. Physiotherapy Models to Leverage Health Human Resources

To ensure optimization of all physiotherapy services available, some primary care teams in Ontario are prioritizing patients who otherwise would not have access to physiotherapy care. This means that primary care patients who have insurance through WSIB, motor vehicle accident insurance, extended health insurance, Interim Federal Health, or who are eligible for Community Physiotherapy Clinics, are supported to access physiotherapy in the appropriate setting.   

In rural and remote communities where there are significant health human resource challenges, some primary care teams are establishing service contracts with community clinics and/or with community hospitals to provide physiotherapy for rostered patients. As part of this model, teams must consider how to ensure the required communication between team members to promote coordinated and collaborative care. For example, all health care providers may have access to a shared electronic medical health record, or health care providers may have team meetings or case conferences to promote understanding of roles and scope, and to support comprehensive care.  

Additional Resources

There are several existing resources available to support the integration of physiotherapists within primary care teams: 

Preparing Physiotherapists for Team Based Primary Care: Eight educational modules designed to prepare physiotherapists for working in team based primary care. Modules 5 and 6 are also great resources for team members and health care leaders. 

Realizing the potential of community based rehabilitative care: A resource developed by the Rehab  Care Alliance to support the integration of community-based rehabilitation.  

First Contact Physiotherapy: A resource to support the roll out of the first contact physiotherapy initiative in the UK developed by the Chartered Society of Physiotherapy.

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Contact Us for More Information 

If you are looking to add physiotherapy to your team, and would like individual support on strategy, recruitment or operations, the Ontario Physiotherapy Association is here to help. Please send enquiries to physiomail@opa.on.ca. 

References

1. College of Physiotherapists of Ontario, Public Register. Accessed June 2025 at: https://portal.collegept.org/en-US/public-register/
2. Association of Family Health Teams of Ontario. Accessed December 2025 at: https://www.afhto.ca/find-team-near-you
3. MacKay C, Canizares M, Davis AM & Badley EM. Health care utilization for musculoskeletal disorders. Arthritis Care & Research. 2010; 62(2): 161–169 
4. Power JD, Perruccio AV, Paterson JM, Canizares M, Veillette C, Coyte PC et al. Healthcare utilization and costs for musculoskeletal disorders in Ontario, Canada. J Rheumatol. 2022; 49(7): 740-747 
5. Hondronicols, A. Ontario Physiotherapy Association, April 2025. 
6. Littlewood SJ, Franks PJ, Spaul S. Physiotherapist as an alternative to a GP for musculoskeletal conditions: a 2-year service evaluation of UK primary care data. British Journal of General Practice, 2019. 
7. Health Quality Ontario. 2013 Yearly Report on Ontario’s Health System. Toronto: Health Quality Ontario; 2013. 
8. Appireddy R, Jalini S, Shukla G, Lomax LB. Tackling the burden of neurological diseases in Canada with virtual care during the COVID-19 pandemic and beyond. Canadian Journal of Neurological Sciences. 2020 Sep;47(5):594-7. 
9. Ramage-Morin P, Gilmour H. Prevalence of migraine in the Canadian household population. Health Reports. 2014 Jun; 25(6):10–16. Available from: https://www150.statcan.gc.ca/n1/en/pub/82-003-x/2014006/article/14033-eng.pdf
10. Robertson MK, McLoughlin J. The role of the physiotherapist in concussion. S Afr J Physiother. 2024 Apr 30;80(1):2013. doi: 10.4102/sajp.v80i1.2013. PMID: 38725965; PMCID: PMC11079349. 
11. The Canadian Continence Foundation. Accessed December 7 2025: https://www.canadiancontinence.ca/faq
12. Health Quality Ontario. Pelvic Floor Muscle Training for Stress Urinary Incontinence, Fecal Incontinence and Pelvic Organ Prolapse. Accessed December 7, 2025 at https://www.hqontario.ca/Portals/0/Documents/evidence/reports/recommendation-pelvic-floor-muscle-training-for-stress-urinary-incontinence-fecal-incontinence-and-pelvic-organ-prolapse-en.pdf
13. Ontario Agency for Health Protection and Promotion (Public Health Ontario). Environmental scan: Prioritization of older adult fall prevention indicators in Ontario. Toronto: Queen’s Printer for Ontario; 2022. Available from: https://www.publichealthontario.ca/-/media/Documents/P/2022/prioritization-older-adult-fall-prevention-indicators-ontario.pdf?rev=e415b96bfa5245659f87af3787d59115&sc_lang=en
14. Canadian Cancer Statistics Dashboard [Internet]. Canadian Cancer Statistics Dashboard; c2025 [cited 2025 Dec 05]. Available from: https://cancerstats.ca/
15. Adriaenssens N, Strimpakos N, Rotem N, Sheill G, Cannone M, Gigli L, Tiesnese L, Descloux A, MacKenzie A, Navarro MP, Garcia AC. THE ROLE OF PHYSIOTHERAPY IN CANCER CARE IN THE EUROPE REGION: A POSITION PAPER OF THE CANCER WORKING GROUP OF EUROPE REGION WORLD PHYSIOTHERAPY. Journal of Cancer Rehabilitation. 2023 Jun 23;6(2):70-9.). 
16. The Four Villages Community Health Centre. (2021). Rehabilitation in Primary Health Care Teams in the Toronto Region. Slide Presentation. 
17. Woolf, A. D., & Pfleger, B. (2003). Burden of major musculoskeletal conditions. Bulletin of the World Health Organization, 81(9), 646–656.