Advertisement

Provision of first contact physiotherapy in primary care across the UK: a survey of the service

      Abstract

      Background

      First Contact Physiotherapy (FCP) is an emerging model of care whereby a specialist physiotherapist located within general practice undertakes the first patient assessment, diagnosis and management without a prior GP consultation. Despite institutional and professional body support for this model and NHS commitment to its implementation, data regarding current FCP provision are limited.

      Objectives

      To identify current FCP service provision across the UK, including models of provision and key professional capabilities.

      Design

      Cross-sectional online survey, targeting physiotherapists and service managers involved in FCP.

      Methods

      Recruitment involved non-probability sampling targeting those involved in FCP service provision through emails to members of known clinical networks, snowballing and social media. The survey gathered data about respondents, FCP services and the role and scope of physiotherapists providing FCP.

      Results

      The authors received 102 responses; 32 from service managers and 70 working in FCP practice from England (n = 60), Scotland (n = 22), Wales (n = 14), and Northern Ireland (n = 2). Most practitioners were NHS band 7 or 8a (91%, n = 63), with additional skills (e.g. requesting investigations, prescribing). 17% (12/70) worked 37.5 hours/week; 37% (26/70) ≤10 hours; most (71%, 50/70) used 20-minute appointments (range 10–30 minutes); varying arrangements were reported for administration and follow-up. Services covered populations of 1200 to 600,000 (75% <100,000); access mostly involved combinations of self-booking and reception triage. Commissioning and funding arrangements varied widely; NHS sources provided 90% of services.

      Conclusions

      This survey provides new evidence regarding variation in FCP practice across the UK, indicating that evidence-informed, context specific guidance on optimal models of provision is required.

      Keywords

      To read this article in full you will need to make a payment
      Subscribe to Physiotherapy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Murray C.J.
        • Vos T.
        • Lozano R.
        • Naghavi M.
        • Flaxman A.D.
        • Michaud C.
        • et al.
        Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010.
        Lancet. 2012; 380: 2197-2223
        • Vos T.
        • Flaxman A.D.
        • Naghavi M.
        • Lozano R.
        • Michaud C.
        • Ezzati M.
        • et al.
        Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010.
        Lancet. 2013; 380: 2163-2196
        • Office for National Statistics
        Sickness absence in the labour market.
        2016 (Available from: https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/sicknessabsenceinthelabourmarket/2016 [accessed July 2017])
        • Right Care
        The NHS atlas of variation in healthcare. Reducing unwarranted variation to increase value and improve quality.
        Right Care. 2011;
        • Department of Work Pensions
        Autumn statement 2016.
        2016 (Available from: https://www.gov.uk/government/publications/autumn-statement-2016-documents/autumn-statement-2016 [accessed August 2017])
        • Jordan K.P.
        • Kadam U.T.
        • Hayward R.
        • Porcheret M.
        • Young C.
        • Croft P.
        Annual consultation prevalence of regional musculoskeletal problems in primary care: an observational study.
        BMC Musculoskelet Disord. 2010; 11: 144
        • Roberts C.
        • Adebajo A.O.
        • Long S.
        Improving the quality of care of musculoskeletal conditions in primary care.
        Rheumatology. 2002; 4: 503-508
        • Goodwin R.W.
        • Hendrick P.
        Physiotherapy as a first point of contact in general practice: a solution to a growing problem?.
        Prim Health Care Res Dev. 2016; 6: 489-502
        • King's Fund
        Understanding pressures in general practice.
        2016 (Available from: https://www.kingsfund.org.uk/publications/pressures-in-general-practice [accessed July 2016])
        • ICM Unlimited
        British medical association national survey of GPs. The future of general practice 2015 full report.
        British Medical Association, 2015
        • NHS Digital
        General and personal medical services in England 2006–2016: experimental statistics.
        2017 (Available from: http://digital.nhs.uk/catalogue/PUB23693 [accessed July 2019])
        • Chartered Society of Physiotherapy
        First contact physiotherapy posts in general practice. An implementation guide (England).
        2018 (Available from: https://www.csp.org.uk/system/files?file=001404_fcp_guidance_england_2018.pdf [accessed July 2018])
        • Ludvigsson M.L.
        • Enthoven P.
        Evaluation of physiotherapists as primary assessors of patients with musculoskeletal disorders seeking primary health care.
        Physiotherapy. 2012; 98: 131-137
        • The Scottish Government
        The 2018 general medical services contract in Scotland.
        2017 (Available from: https://www.gov.scot/publications/gms-contract-scotland/ [accessed January 2020])
        • Welsh Government/Llywodraeth Cymru
        Our plan for a primary care service for Wales up to March 2018.
        2014 (Available from: http://www.wales.nhs.uk/sitesplus/documents/986/Our%20Plan%20for%20Primary%20Care%20in%20Wales%20up%20to%20March%202018.pdf [accessed January 2020])
        • British Medical Association
        Responsive, safe and sustainable: our urgent prescription for general practice.
        2016 (Available from: https://www.bma.org.uk/collective-voice/influence/key-negotiations/training-and-workforce/urgent%20prescription-for-general-practice [accessed January 2020])
        • Chartered Society of Physiotherapy
        Think physio for primary care: policy briefing England July 2017.
        2020 (Available from: https://www.csp.org.uk/professional-clinical/improvement-innovation/first-contact-physiotherapy/physiotherapy-primary-care [accessed January 2020])
        • Chartered Society of Physiotherapy
        Think physio for primary care: policy briefing Northern Ireland 2017.
        2020 (Available from: https://www.csp.org.uk/professional-clinical/improvement-innovation/first-contact-physiotherapy/physiotherapy-primary-care [accessed January 2020])
        • Chartered Society of Physiotherapy
        Think physio for primary care: policy briefing Scotland 2017.
        2020 (Available from: https://www.csp.org.uk/professional-clinical/improvement-innovation/first-contact-physiotherapy/physiotherapy-primary-care [accessed January 2020])
        • Chartered Society of Physiotherapy
        Think physio for primary care: policy briefing Wales 2017.
        2020 (Available from: https://www.csp.org.uk/professional-clinical/improvement-innovation/first-contact-physiotherapy/physiotherapy-primary-care [accessed January 2020])
        • Chartered Society of Physiotherapy
        General practice physiotherapy posts: a guide for implementation and evaluation (Wales).
        2018 (Available from: https://www.csp.org.uk/system/files/documents/2019-11/primary_care_guidance_wales_v1.0.pdf [accessed July 2018])
        • Chartered Society of Physiotherapy Scotland
        Advanced practice physiotherapists in GP practices: a ‘how-to’ guide for implementation (Scotland).
        2018 (Available from: https://www.csp.org.uk/system/files/publication_files/Scotland%20FCP_APP%20Implementation%20Guidance_PRINT%5B18963%5D.pdf [accessed July 2018])
        • Health Education England
        Musculoskeletal first contact practitioners services: implementation guide (England).
        2020 (Available from: https://www.hee.nhs.uk/sites/default/files/documents/FCP%20How%20to%20Guide%20v21%20040919%20-%202.pdf [accessed January 2020])
        • NHS
        The NHS long term plan.
        2019 (Available from: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/01/nhs-long-term-plan-june-2019.pdf [accessed January 2019])
        • NHS England
        Investment and evolution: a five-year framework for GP contract reform to implement. The NHS long term plan.
        2019 (Available from: https://www.england.nhs.uk/wp-content/uploads/2019/01/gp-contract-2019.pdf [accessed January 2019])
        • Chartered Society of Physiotherapy
        Innovations case study repository.
        2017 (Available from: https://casestudies.csp.org.uk/ [accessed January 2017])
        • 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.
        Br J Gen Pract. 2019; 69: e314-e320
        • Moffatt F.
        • Goodwin R.
        • Hendrick P.
        Physiotherapy-as-first-point-of-contact-service for patients with musculoskeletal complaints: understanding the challenges of implementation.
        Prim Health Care Res Dev. 2018; 19: 121-130
        • England N.H.S.
        Elective care high impact interventions: first contact practitioner for MSK services.
        2019 (Available from: https://www.england.nhs.uk/publication/elective-care-high-impact-interventions-first-contact-practitioner-for-msk-services/ [accessed January 2019])
        • NHS England
        First contact practitioner evaluation.
        NHS England, 2019
        • NIHR Journals Library
        First contact physiotherapy in primary care (FRONTIER): a realist evaluation of effectiveness and costs.
        2019 (Available from: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/1611603/#/ [accessed May 2019])
        • Pawson R.
        • Tilley N.
        Realist evaluation.
        2004: 2 (Available from: http://www.communitymatters.com.au/RE_chapter.pdf [accessed August 2017])
        • Wong G.
        Getting to grips with context and complexity – the case for realist approaches.
        Gac Sanit. 2018; 32: 109-110
        • Heckathorn D.D.
        Snowball versus respondent-driven sampling.
        Sociol Methodol. 2011; 41: 355-366
        • Health Careers
        Agenda for change – pay rates.
        2019 (Available from: https://www.healthcareers.nhs.uk/working-health/working-nhs/nhs-pay-and-benefits/agenda-change-pay-rates [accessed January 2019])
        • Health Education England
        New musculoskeletal primary care e-learning programme.
        2019 (Available from: https://www.e-lfh.org.uk/new-musculoskeletal-primary-care-e-learning-programme/ [accessed July 2019])
        • Henson G.
        Job opportunities as primary care multi-disciplinary teams come to NI.
        Frontline. 2018; 24: 9
        • Lloyd-Jones K.
        First contact physios get green light in Scotland.
        Frontline. 2018; 24: 23
        • Health Education England
        Musculoskeletal core capabilities framework for first point of contact practitioners.
        2018 (Available from: https://www.csp.org.uk/system/files/musculoskeletal_framework2.pdf [accessed July 2018])
        • Langridge N.
        The skills knowledge and attributes needed as a first-contact physiotherapist in musculoskeletal healthcare.
        Musculoskelet Care. 2019; : 1-8