The idea may be simple, but a helpline for those with back pain is proving priceless, as Health Editor Barry Nelson finds out.

IT seems blindingly obvious now but when Caroline Hodgson set up her Physio Direct helpline to help patients with back pain it was probably the first of its kind in the country.

Cutting out the middle man was the essence of the scheme. If you suddenly developed a bad back, instead of fighting for an appointment at your local doctor's surgery or waiting to see a hospital consultant you could pick up the phone and speak directly to a trained physiotherapist.

For the vast majority of the people who used this service, the specialist advice and directions given over the phone meant that they recovered on their own and had no need to use any other NHS service.

Apart from a lot of satisfied customers, the Physio Direct approach has also kept large numbers of people out of busy GP clinics, freeing up more appointments for other patients.

It has taken quite a few years for Caroline's first advice line, in Northallerton, to spread across Hambleton and Richmondshire but there are now hopes that the patient-friendly service could spread beyond the boundaries of North Yorkshire.

Caroline's bright idea - which now involves eight physiotherapists and has helped more than a thousand people - won her the Allied Health Professional of the Year title in the national Health and Social Care Awards in mid December. It also landed her team a cheque for £15,000, which will be used to further develop the service and spread the Physio Direct gospel through the wider NHS.

It all goes back to the mid 1990s, when GPs were experimenting with 'fundholding', using NHS money to improve local NHS services - an idea which is about to come around again as part of health service reforms which will put GPs back in charge of spending.

"The doctors at the Mowbray House surgery in Northallerton decided they would like to have a physiotherapist based in their clinic giving advice to patients on the phone," says Caroline, who is now community superintendent physiotherapist with Hambleton and Richmondshire Primary Care Trust.

"We thought it would be helpful to people to give them a bit of advice while they were waiting for treatment. Fifty per cent of our work as physiotherapists is with back problems. If you told people some pretty basic things, such as not exercising if you have an acute back problem and how to protect your back, many simply got better without the need to see the doctor."

Initially, Caroline took referrals from GPs at the practice and contacted people but it soon became apparent that the system worked more efficiently if patients could refer themselves directly to the physio by ringing a dedicated number supplied by the receptionist. It was self-referral which turned the Mowbray House practice pilot into a runaway winner with patients, doctors and physiotherapists.

The success of the advice line led to it being extended across Hambleton and Richmondshire, with increasing numbers of physiotherapists deployed on the service. Physio Direct has now been running for about six months covering the whole PCT area, a population of around 125,000 people.

"People ring the line, we take their details then ask questions, lots of questions. Part of what we do is to exclude serious health problems which will have to be seen by a doctor," Caroline says.

About 69 per cent of all Physio Direct callers are dealt with by phone only. "It is efficient, it is good for the patients and it means that people living in rural areas get a decent service as well," Caroline says.

In a minority of cases, physios make an appointment to visit patients and if necessary, they can be referred to hospital specialists for further treatment.

"Instead of people being off work for weeks or months, after advice many people are able to return after a few days," Caroline says. "We tell people they should do two simple things if they have a bad back: either lie down or potter gently about. People with a back problem should slow down and be more back-conscious in what they do," she adds.

"We also explain to people that there is a particular position they should lie in, which is on their side with a pillow between their legs. We talk them through it but in some cases we make home visits and physically put them in the right position."

A survey of patients treated by Physio Direct showed that two thirds of those contacting the service did not need any further treatment. "With a bit of advice, most people just got better in a shorter time, it is as simple as that," Caroline says.