In Queensland, addressing the overwhelming demand for specialist musculoskeletal services in public healthcare settings has long been a challenge. 

This was especially true in orthopaedics, where significant wait times have historically affected patient access to care. 

To meet this need, a pioneering service run by Queensland Health—the Musculoskeletal Physiotherapy Screening Clinic and Multidisciplinary Service (MPSC and MDS)—was introduced and trialled as an advanced practice model led by physiotherapists. (Service names differ across individual facilities in Queensland but collectively these services form the MPSC and MDS network.)

Now led by Titled APA Musculoskeletal Physiotherapist Maree Raymer MACP, who is the chair of the APA Advanced Practice (including Emergency Department) national group, and her team, the service aimed to improve patient flow and clinical outcomes and to reduce wait times for patients with complex musculoskeletal problems referred for a specialist medical opinion. 

Advanced practice physiotherapists were able to provide frontline care— triaging and handling cases that were traditionally managed by specialist medical practitioners. 

They provide assessment, diagnosis, management pathway planning and consultancy, generally for people with conditions in the semi-urgent and non-urgent triage categories. 

Uniquely, the service also has designated multidisciplinary allied health teams to provide follow-up non-surgical care for patients who do not need surgical consultation. 

The service model has since grown significantly, becoming integral to the public health landscape across Queensland and now operating statewide at 20 facilities and across five different medical specialties.

The initial pilot phase of the service was introduced in 2005, with three diverse sites across Queensland chosen to assess how well the model could be implemented in different regions and healthcare settings. 

Having recently celebrated the 20th anniversary of the service, Maree says its blueprint is detailed in the paper ‘Developing and embedding an advanced practice musculoskeletal physiotherapy service in public specialist outpatient services in Queensland: A health service masterclass’, co-authored with fellow physiotherapists Patrick Swete Kelly and Shaun O’Leary. 

The paper describes the experiences and success of embedding the service statewide and its expansion in scale and reach from its inception to the milestone anniversary, offering a rare insight into the birth and evolution of an idea that has become a gold standard.

‘The pilot hospitals were chosen carefully,’ Maree says, noting that the pilot sites were a major metropolitan hospital, an outer metropolitan hospital and a regional hospital. This allowed the team to evaluate how the model functioned in varying clinical environments. 

While the goal was to establish a scalable approach that could eventually be rolled out across the state, Maree says there was no certainty at the time that it would be expanded beyond those first three sites.

However, given Queensland Health’s increased focus on reforming specialist outpatient services and reducing waiting lists, the timing was right for broader implementation. 

This alignment of the program outcomes with the healthcare policy objectives of the day, combined with effective advocacy from the original program manager (David Smith, Director of Physiotherapy at Ipswich Hospital), strong support from executive sponsors and evidence of impact, ultimately secured additional funding, allowing the service to be expanded statewide.

Dr Patrick Swete Kelly FACP, a Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapists in 2007), reflected on the transformative impact of the program. 

‘This was one of the first programs to integrate advanced practice roles in allied health on such a scale in Queensland, setting a precedent not only in physiotherapy but across allied health in Queensland.’

As the model matured, it became clear that advanced scope physiotherapists are well equipped to provide musculoskeletal assessments and manage complex cases. They complement the specialist outpatient services, providing a well-structured and well-managed non-surgical pathway, and escalate care for patients where an urgent surgical consultation need is identified.

‘In the early days, and as part of building trust in the service, nearly all cases would be discussed with a medical specialist. 

'Now the majority of those decisions are made independently,’ Maree says, emphasising the model’s success in fostering both clinical competence and trust among staff.

An essential component of the program’s success has been its focus on workforce development—a priority from the outset to support long-term growth and sustainability. 

The program has used a multi-pronged approach that has targeted physiotherapists’ development towards advanced roles. 

This has included activities to promote interest in musculoskeletal practice in public health services where more acute care is the predominant focus and strategies to encourage uptake of postgraduate clinical physiotherapy master’s programs, enhancing the foundational clinical knowledge and skill required. 

Further targeted, work-integrated, role-specific education and training has been developed and implemented through a collaborative statewide program to support physiotherapists to develop the additional skills required for advanced practice roles. 

This initiative, Maree says, was critical to building a sustainable workforce capable of meeting the high demand for specialist outpatient services.

The program’s expansion and sustainability have also been underpinned by a strong commitment to research and data collection.

From the start, a standardised dataset was implemented across all sites, allowing the team to track patient outcomes and service metrics systematically.

Associate Professor Shaun O’Leary FACP, who is a Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapists in 2008) and the research fellow for the program, highlighted the importance of this approach. 

‘The collection of informative metrics has been somewhat novel for this type of advanced practice service and it’s provided a robust evidence base that demonstrates the service’s effectiveness,’ Shaun says. 

This data has been crucial in securing ongoing support from both healthcare executives and policymakers. 

The program’s outcomes have consistently shown positive results, demonstrating clinical and cost effectiveness, with reductions in wait times and high patient satisfaction rates, solidifying its value within the healthcare system.

One of the program’s strengths is its flexibility. Initially focused on orthopaedics, the model has since expanded to other specialties including neurosurgery, rheumatology, maxillofacial and neurology headache clinics. 

This adaptability has allowed the program to meet the needs of various patient populations, improving patient flow and offering non-surgical treatment options and comprehensive management for patients with complex musculoskeletal problems, frequent health comorbidities and often disabling pain.

‘The expansion into new areas reflects the versatility of the model and the expert knowledge that our clinicians bring to different types of musculoskeletal cases,’ Patrick says. 

The addition of these advanced roles has reinforced the program’s role in providing high-quality, patient-centred care in Queensland’s public health system.

Throughout its journey, the program has maintained a strong focus on stakeholder engagement and transparency. Its leaders recognised early on that involving a broad range of stakeholders would be essential to its success. 

Maree emphasised the value of this approach, noting that ‘being transparent with all stakeholders was key to building trust and securing buy-in’. 

By keeping executives, medical specialists and community representatives informed and involved, the program established a collaborative environment that has supported its growth and longevity. 

This stakeholder engagement was particularly evident in the steering committee established during the pilot phase, which included representatives from diverse fields and provided a platform for ongoing feedback and advocacy.

The MPSC and MD services recently celebrated their 20-year anniversary, a milestone that they say underscores the model’s resilience and impact and the achievements of the program.

The event brought together more than 200 attendees including current and former staff, healthcare executives and community stakeholders.

Reflecting on the significance of the anniversary, Maree says, ‘It was an opportunity to celebrate the progress we’ve made and to acknowledge the many staff working in the service and all the people who have contributed to this journey.’ 

The event also highlighted the program’s influence beyond Queensland.

Maree envisions further expansion and integration of the advanced practice physiotherapy model within Queensland’s healthcare 
framework. While it is now well embedded as ‘business as usual’, there are still many opportunities to expand its potential impact.

‘We want to reach a point where all patients who could benefit from this model are able to access it,’ Maree says. 

Achieving this vision will require continued advocacy and investment, not only in secondary and tertiary care but also in primary care settings, where early intervention could prevent many musculoskeletal issues from reaching the stage where people need specialist services.

The success of the program model offers a compelling example of how physiotherapists can play a transformative role in public healthcare. 

By empowering physiotherapists to operate at an advanced practice level, the program has expanded access to essential services, improved patient outcomes and reduced strain on specialist services.

‘The biggest lesson has been the importance of having the right people and the right evidence to support what we’re doing,’ Maree says. 

With its robust foundation and commitment to continuous improvement, the program is well positioned to make a difference in the lives of Queenslanders for years to come.