Seeing a Physiotherapist Without a GP Referral: How It Works in the Netherlands

Do you need a referral from your GP?

No. Since 2006, patients in the Netherlands can go directly to a physiotherapist without going through their GP first. This is called Direct Access Physiotherapy (Directe Toegankelijkheid Fysiotherapie, or DTF). You book your own appointment, the physiotherapist screens your complaint at the first session, and treatment starts from there, or you are referred onward if that turns out to be necessary.

At Physical Studio, all our physiotherapists are also qualified personal trainers. You can book directly via /afspraak, no note from your GP required beforehand.

This route has been in place for well over fifteen years and is now widely used by people with musculoskeletal complaints. The idea behind it is simple: for muscle, joint and tendon complaints, you can often be seen sooner and start a targeted approach sooner when you don't have to go through your GP first. Your GP stays fully in the loop either way, just via a different route than before.

Physiotherapist or GP: how do you choose?

For most complaints involving muscles, joints and tendons, the physiotherapist is the logical first stop: back pain, neck pain, shoulder pain, sports injuries, RSI and overuse complaints, for example. These typically respond to movement, education and a structured, progressive treatment plan, which is exactly what physiotherapy is built around.

Your GP remains the right first contact for complaints that are not clearly related to the musculoskeletal system, when the cause of your symptoms is unclear, or when medication, blood tests or referral to a medical specialist might be needed. A physiotherapist does not make medical diagnoses outside the physiotherapy domain and does not prescribe medication.

Not sure which applies to you? That is exactly what the screening at your first appointment is for.

A couple of examples from practice

If you've had a stiff neck for a few weeks after a lot of screen time, a physiotherapist is a sensible starting point: together you'll look at posture, load and targeted exercises. If you have unexplained fatigue alongside pain, or pain that keeps showing up in different parts of your body, your GP is usually the better starting point, since that pattern can call for broader investigation than physiotherapy alone provides.

What does the Direct Access Physiotherapy screening involve?

Before treatment starts, the physiotherapist carries out a short screening. This is a standard part of every first DTF appointment and covers a few steps:

• A series of questions about your complaint: since when, how it started, what makes it better or worse.
• Questions about your general health and medical history.
• A check for so-called red flags: signals that may point to something outside the physiotherapy domain.
• A brief physical examination, supplemented where relevant with ultrasound imaging or clinical tests, similar to our VALD Force Decks assessments.

If the screening shows your complaint fits within physiotherapy, you move straight into the intake and a treatment plan is drawn up. If not, the physiotherapist refers you back to your GP, with a clear explanation why.

The screening itself usually takes just a few minutes and is part of your first appointment, so you don't need to book a separate session for it. Once it's clear physiotherapy is the right route, the fuller part of the intake begins: a conversation about your goals, how you're loaded in daily life or during sport, and a first outline of your treatment plan.

When do you still need a referral?

In a few specific situations, a referral is either required or practically useful:

• Some health insurers require a referral for reimbursement under certain supplementary packages. Always check your policy first, for example through the InsuranceChecker on our site, or call your insurer directly.
• After surgery, the physiotherapist often coordinates with the treating specialist, and a referral or surgical report helps shape a targeted rehabilitation plan.
• If there is any doubt about the cause of a complaint, the physiotherapist can still refer you to your GP for further investigation, even after the initial screening.

Note: physiotherapy is generally not covered under the basic Dutch health insurance (basisverzekering), apart from a limited set of exceptions (such as conditions on the chronic list). Coverage usually runs through supplementary insurance and depends on your individual policy. Personal training is never covered by insurance, referral or not.

Because policies vary widely, both in the number of reimbursed sessions and in whether a referral is required, we recommend checking this in advance. That way you avoid surprises later and know where you stand before treatment starts.

Red flags: symptoms that should send you to your GP first

For most back, neck, shoulder or joint complaints, going straight to a physiotherapist is safe and appropriate. Contact your GP first, or call emergency services for acute situations, if you notice any of the following:

• Unexplained weight loss combined with pain symptoms.
• Fever combined with severe back or joint pain.
• Sudden, severe pain that does not ease with rest or a change in position.
• Loss of strength, sensation, or bladder or bowel control, particularly with lower back symptoms.
• Chest pain, shortness of breath, or pain radiating into the arm or jaw.
• Symptoms following a serious accident or fall, particularly where a fracture is suspected.

These are not everyday complaints, and the screening at your first appointment is specifically designed to catch signals like these. If you are already unsure about one of these signs at home, do not wait for an appointment. Contact your GP or an out-of-hours GP service.

Outside of these red flags, moving carefully and gradually is generally sensible for most musculoskeletal complaints. When in doubt, a simple rule of thumb helps: stop if pain clearly increases during an exercise or activity, then build back up more gently. Your physiotherapist will help you shape that build-up at your first appointment, based on your specific complaint.

Does the physiotherapist coordinate with your GP?

Yes. Direct access does not mean your GP is left out of the loop. After the screening and, where relevant, after treatment concludes, the physiotherapist informs your GP with a short report, with your consent. That way your GP stays up to date on your physiotherapy care, even if you started without a referral.

For more complex complaints, or where there is doubt about the diagnosis, the physiotherapist also consults with your GP, or a medical specialist where needed, during the course of treatment.

Booking directly: how quickly you can be seen

At Physical Studio you can come in for physiotherapy and manual therapy without a referral. You book online via /afspraak, and at your first session you go through the intake and screening described above.

Common complaints we see include back pain, neck pain, shoulder pain and sports injuries. Across all of these, targeted exercise therapy can contribute to a smoother return to your usual activities, depending on the nature and duration of your specific complaint.

Our approach follows three phases: Recover, Prevent, Perform. Recover focuses on reducing your symptoms and restoring basic function. Prevent looks at the underlying cause, so the complaint is less likely to return. Perform, where it fits your situation, builds further on strength and load capacity, for example through personal training. Each phase is tailored to what you need at that point in your recovery.

Unsure about coverage, or which complaint belongs with which type of care provider? Get in touch, or check your policy first through the InsuranceChecker. Our physiotherapists are happy to think it through with you.