First contact physiotherapists: are they able to reduce the burden on rheumatology services? A critical review of the evidence base

Abstract

First Contact Practitioners have emerged over recent years in response to growing pressures within the National Health Service (NHS) and are now central to primary care musculoskeletal (MSK) services. Within the musculoskeletal field these allied health professionals may be from a range of disciplines including Physiotherapy, Podiatry and Osteopathy. Early referral to rheumatology is key to successful long-term management of many inflammatory musculoskeletal conditions but presents challenges to overburdened services. Evidence supporting the recognition and referral of patients with rheumatological disorders by First Contact Practitioners is lacking, however physiotherapists have been shown to successfully substitute the role of a doctor within the MSK field. This review investigates the value of First Contact Physiotherapists (FCPs) within primary care and their role in early recognition and referral of rheumatological MSK disorders in line with national guidance. FCPs are best placed to fulfil the role of MSK ‘champions’, positively impacting the whole MSK pathway, with the potential to reduce burden on rheumatology services. Planned rapid upscale of FCPs over the next few years will support sustainability of MSK NHS services. Lay Summary First Contact Practitioner (FCP) is a relatively new role within GP practices in the NHS whereby physiotherapists manage patients with musculoskeletal problems such as arthritis. In patients with inflammatory conditions such as rheumatoid arthritis (RA), recognising signs and symptoms as early as possible and referring these patients to rheumatology for treatment is essential, giving the best long-term outcomes. Rheumatology services in the UK are under pressure due to staffing levels not meeting current demands, so it is essential that the right patients are referred. Physiotherapists have been shown to successfully undertake similar roles to a doctor in diagnosing and managing patients with musculoskeletal problems. However, there is no research into the relatively new FCP role in diagnosis and referral of patients with inflammatory musculoskeletal conditions to rheumatology. This review presents the value of FCPs in GP practices and their role in referring the right patients early to rheumatology as advised by national guidelines. FCPs are best placed to first assess patients with arthritis, providing best care and helping to reduce pressure on rheumatology NHS services. Numbers of FCPs are planned to increase over the next few years.

Right clinician, right place, right time: the role of the first contact practitioner from a rheumatology perspective

“…In this issue of Rheumatology Advances in Practice , Golding and Jackson [ 4 ] present a critical review of the evidence base for the FCP role in rheumatology, while reviewing the emerging themes within the MSK field as a whole. Given the large number of FCPs funded and established in NHS primary care positions, this role must be embraced by those of us in rheumatology as we seek to improve the efficiency of rheumatology services with regards to incoming referrals [ 5 ].…”

“…Given the large number of FCPs funded and established in NHS primary care positions, this role must be embraced by those of us in rheumatology as we seek to improve the efficiency of rheumatology services with regards to incoming referrals [ 5 ]. Despite the dearth of application research found in the Golding and Jackson article [ 4 ], frameworks of practice for FCPs do demonstrate good representation of inflammatory condition screening [ 6 ], and the Rheumatology Physiotherapy Capabilities Framework [ 7 ] has a section of capabilities statements dedicated specifically to this role of FCPs, shown in Fig. 1 .…”

“…The review of evidence by Golding and Jackson [ 4 ] highlights the requirement of FCPs to be appropriately skilled and experienced and that the renumeration for this role should reflect that advanced level of practice, describing Band 7 and 8a Agenda for Change pay scale roles associated with this. At initiation, the FCP role was created to place an advanced practice clinician in front of the MSK presentation in primary care [ 2 ].…”

“…There is concern that the current workforce in the FCP role, in reality, is prone to variation in application of this Band 7/8a model, with the potential for some services to recruit those without advanced practice skills [ 9 ]. By expansion of the arguments shared by Golding and Jackson [ 4 ], implementing FCPs without advanced practice may risk both missed cases and delayed diagnosis of inflammatory arthritis, as well as a potential for overreferral to already squeezed secondary care services.…”

“…Featured in this issue of Rheumatology Advances in Practice , the Golding and Jackson article [ 4 ] confirms the emerging role of FCPs within rheumatology pathways in their frontline triage role that is crucial to ensuring that the right clinician is placed there at the right time to spot any early symptoms of rheumatology-relevant diagnoses. Although FCPs will be working across the broad MSK spectrum of conditions, they will undoubtedly see some early and undiagnosed rheumatology presentations.…”