THE POTENTIAL ROLE OF CHIROPRACTORS IN TRANSFORMING NHS MUSCULOSKELETAL PATHWAYS

Conflicts of interest: The research was conducted by York Health economics Forum at the request of the British chiropractic Association (BCA). Some colleagues within the authorship are BCA members. Sources of funding: The research was funded by the British Chiropractic Association (BCA). Introduction Musculoskeletal (MSK) disorders are a major contributor to lost productivity in the UK, accounting for 30 million missed workdays yearly. Demand on NHS MSK services continues to rise, reflected in physiotherapy waiting times that average 11 weeks. Although chiropractors are internationally recognised as qualified MSK clinicians, they are not currently incorporated into NHS pathways, despite having the capacity to provide rapid access to care. This study set out to examine how chiropractic care influences return-to-work outcomes relative to usual care and to model the potential economic impact of involving chiropractors in mitigating NHS physiotherapy backlogs. Methods and Results A structured, pragmatic review of MEDLINE and CINAHL produced 1,270 papers, of which 18 satisfied the inclusion criteria. Survey findings were used to estimate available chiropractic capacity, and NHS dataset review provided insight into national waiting times. Economic modelling, including Markov-based approaches, was used to estimate productivity gains associated with shortened delays in returning to work. The evidence indicates that chiropractors achieve return-to-work outcomes comparable to physiotherapists and osteopaths. Chiropractors' unused capacity could accommodate 114,000 additional patients per year, equivalent to 7–12% of present waiting lists and potentially generate £1.07 billion in productivity gains. With chiropractic wait times averaging 1.5 weeks versus 11 weeks for physiotherapy, substantial benefits emerge. Estimated annual productivity gains are £612 million for 11-week waits, rising to £1.46 billion for 24-week delays. Conclusion Bringing chiropractors into NHS MSK pathways could shorten waiting times, increase workforce participation, and deliver meaningful economic benefits. Their integration represents a cost-efficient response to national MSK service pressures. The findings have been previously published and disseminated: World Federation of Chiropractors Conference, Copenhagen, 7–10th May 2025.