First Contact Physiotherapy
Original Editor - Carina Therese Magtibay
Top Contributors - Carina Therese Magtibay and Kim Jackson
Introduction[edit | edit source]
Musculoskeletal (MSK) conditions are among the leading causes of years lost to disability[1], with an annual loss averaging 30 million working days in the UK[2]. The demand for MSK healthcare continues to rise as the number of General Practitioners (GPs) across the UK declines[3]. With a considerable fraction of the total GP consultations being MSK in nature, approximately 20-30% in England,[4] one of the solutions to address this growing need is the employment of First Contact Physiotherapists (FCPs)[5].
First Contact Physiotherapy Model[edit | edit source]
First Contact Physiotherapy is a primary care model where expert MSK physiotherapists undertake the first patient consultation, to enhance MSK-patient care and free-up GP capacity[5]. FCPs are mainly Extended Scope Physiotherapists (ESP) which are advanced physiotherapists with many years of experience and are typically under band 7 in the NHS grading system[6].
According to the NHS Long Term Plan, 98% of Sustainability and Transformation Partnerships have confirmed pilot sites for FCP and 55% of pilots are already underway. It is projected that by 2024, all adults in England will be able to see MSK first contact physiotherapist at their local GP practice without being referred by a GP[7].
Roles of FCPs[8]:
- Assess, diagnose and treat patients independently
- Order diagnostic tests
- Administer steroid injections
- prescribe medication, such as analgesia or anti-inflammatories for MSK conditions
- Refer patients accordingly
Benefits of FCP:
- Immediate access to physiotherapy
- Reduced GP workload
- Reduce health service costs
- Increased time allotted for consultation
- Increased patient satisfaction
- Improved primary healthcare quality
- Reduced sickness absences
Challenges of Implementing FCP[9]:
- The imperative of effecting a cultural change – including management of patient expectation with particular reference to the belief that GPs represented the ‘legitimate choice’, re-visioning contemporary primary care as a genuine team approach, and the physiotherapists’ reconceptualisation of their role and practices.
- The impact of the service on working practice across all stakeholders – specifically re-distribution of work to ‘unburden’ the GP, and the critical role of administration staff.
- Beliefs regarding the nature and benefits of physiotherapeutic musculoskeletal expertise – fears regarding physiotherapists’ ability to work autonomously.
Future of FCP[edit | edit source]
Currently, FCP is showing promising results which can help improve the global quality of physical therapy services. Further studies are required to confirm this approach and determine whether the findings of the present overview can be replicated in different countries and healthcare systems.[10]
References[edit | edit source]
- ↑ Steel N, Ford JA, Newton JN, Davis AC, Vos T, Naghavi M, Glenn S, Hughes A, Dalton AM, Stockton D, Humphreys C. Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2018 Nov 3;392(10158):1647-61.
- ↑ Office for National Statistics (2017) Sickness absence in the UK labour market: 2016. Available from: https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/sicknessabsenceinthelabourmarket/2016
- ↑ https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice-data-analysis#:~:text=September%202015%20to%20October%202022,-Partners&text=This%20has%20created%20a%20net,in%20the%20last%20year%20alone.
- ↑ Thomson J, Syme G. Allied health professional (AHP) musculoskeletal pathway framework: national minimum standards. Scottish Government; 2014. https://www.gov.scot/publications/allied-health-professional-ahp-musculoskeletal-pathway-framework-national-minimum-standard/pages/2/
- ↑ 5.0 5.1 Goodwin R, Moffatt F, Hendrick P, Stynes S, Bishop A, Logan P. Evaluation of the First Contact Physiotherapy (FCP) model of primary care: a qualitative insight. Physiotherapy. 2021 Dec 1;113:209-16.
- ↑ https://firstcontactpractitioner.org.uk/what-are-first-contact-practitioners/
- ↑ https://www.england.nhs.uk/gp/expanding-our-workforce/first-contact-physiotherapists/
- ↑ Downie F, McRitchie C, Monteith W, Turner H. Physiotherapist as an alternative to a GP for musculoskeletal conditions: a 2-year service evaluation of UK primary care data. British Journal of General Practice. 2019 May 1;69(682):e314-20.
- ↑ Moffatt F, Goodwin R, Hendrick P. Physiotherapy-as-first-point-of-contact-service for patients with musculoskeletal complaints: understanding the challenges of implementation. Primary health care research & development. 2018 Mar;19(2):121-30.
- ↑ Piano L, Maselli F, Viceconti A, Gianola S, Ciuro A. Direct access to physical therapy for the patient with musculoskeletal disorders, a literature review. Journal of physical therapy science. 2017;29(8):1463-71.
