The ability of a patient to access physiotherapy directly (patient self-referral), although used widely in the private sector, is not the mechanism in use within the NHS where there exists a system of open access controlled by doctors. This study aimed to develop, implement and investigate a direct access physiotherapy service within a primary care setting in a health district of Scotland. The service was introduced and compared to the existing system of open access over a twelve-month period (1997-1998). Demographic and clinical data was collected relating to two samples: Control Year Group: All GP referrals for a year prior to the study year collected retrospectively. Study Year Group: General practitioner (GP) and direct access (DA) referrals. All patients were followed up one-month after discharge, and the number of associated GP consultations collated together with patient, physiotherapist, general practitioner and service non-user views of physiotherapy generally and direct access specifically. There were similar numbers of referrals (339 vs. 340) with no significant differences with regard to patient age or gender between the Control and Study Year Groups. The Study Year Group however revealed significant differences between DA and GP referrals. DA referrals, all of which were appropriate, accounted for 22.4% of total referrals in comparison to 77.6% GP referrals. DA patients were more likely to have been: male, younger, suffering from conditions of a shorter duration, in paid employment with less work absence, who were more compliant with attendance, had fewer physiotherapy contacts, lower reporting of symptom severity at discharge and were more highly satisfied with their physiotherapy care. This group also demonstrated a greater confidence in knowing when to access physiotherapy and were highly supportive of the effectiveness of physiotherapy. DA patients also consulted their general practitioner significantly less often than GP referrals (p = 0.001). Support for direct access was strongly expressed by service users and nonusers, physiotherapists and general practitioners. Direct access to physiotherapy is an example of an innovative, flexible approach to primary care service provision encouraged by current health policy.