Implementation of a provider based musculoskeletal first contact physiotherapy service model: Key points to consider
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Cited by 3 publications
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First Contact Physiotherapy: A 4‐Year Service Evaluation of UK Primary Care Data
BackgroundThe First Contact Physiotherapist (FCP) role offers patients direct access to musculoskeletal (MSK) specialists in primary care settings and is designed to reduce GP workload while providing high‐quality care. Despite positive early evaluations of FCP services, there remains a need for up‐to‐date assessments of their impact.AimTo evaluate the FCP model of care implemented in an NHS Primary Care Network (PCN) against pre‐defined service objectives.MethodA service evaluation was conducted using data from April 2020 to March 2024. Key performance indicators were based on national FCP evaluation criteria. Data included appointment utilisation, wait times, referral patterns, patient and staff satisfaction surveys, and audit results from clinical data.ResultsOver 4 years, 12,185 patients were seen. Of these, 69% of patients were seen as true first contacts. The majority of patients (86.4%) were managed within primary care, with a referral rate of 8.5% to outpatient physiotherapy and 5.1% to orthopaedics. Patient satisfaction was high, with 82% rating their FCP experience as excellent or outstanding.DiscussionThe FCP service successfully met its objectives by reducing GP workload and providing effective care. However, there was an increase in outpatient physiotherapy referrals over the 4‐year period. Staff satisfaction was generally positive, though some highlighted concerns about appointment duration and workload.ConclusionThis evaluation demonstrates that FCP services provide a viable solution for managing MSK conditions in primary care. Future research should explore the most effective MSK service delivery models and incorporate digital solutions for comprehensive outcome and experience measures.
First Contact Physiotherapy: A 4‐Year Service Evaluation of UK Primary Care Data
BackgroundThe First Contact Physiotherapist (FCP) role offers patients direct access to musculoskeletal (MSK) specialists in primary care settings and is designed to reduce GP workload while providing high‐quality care. Despite positive early evaluations of FCP services, there remains a need for up‐to‐date assessments of their impact.AimTo evaluate the FCP model of care implemented in an NHS Primary Care Network (PCN) against pre‐defined service objectives.MethodA service evaluation was conducted using data from April 2020 to March 2024. Key performance indicators were based on national FCP evaluation criteria. Data included appointment utilisation, wait times, referral patterns, patient and staff satisfaction surveys, and audit results from clinical data.ResultsOver 4 years, 12,185 patients were seen. Of these, 69% of patients were seen as true first contacts. The majority of patients (86.4%) were managed within primary care, with a referral rate of 8.5% to outpatient physiotherapy and 5.1% to orthopaedics. Patient satisfaction was high, with 82% rating their FCP experience as excellent or outstanding.DiscussionThe FCP service successfully met its objectives by reducing GP workload and providing effective care. However, there was an increase in outpatient physiotherapy referrals over the 4‐year period. Staff satisfaction was generally positive, though some highlighted concerns about appointment duration and workload.ConclusionThis evaluation demonstrates that FCP services provide a viable solution for managing MSK conditions in primary care. Future research should explore the most effective MSK service delivery models and incorporate digital solutions for comprehensive outcome and experience measures.
Background/Aims Future primary care services in Wales are likely to face higher demand for musculoskeletal ailments because of an ageing population and difficulties retaining and recruiting general practitioners. First contact physiotherapists provide specialist musculoskeletal management within primary care and offer a solution to this issue; however, no studies have yet explored first contact physiotherapist services in Wales. Consequently, little is known about the experience of working as a first contact physiotherapist in Wales. The aim of this study was to explore the experiences of first contact physiotherapists in primary care in south east Wales regarding the implementation, interprofessional collaboration and the facilitators and barriers to providing the service. Methods A qualitative, Heideggerian hermeneutical phenomenological study was performed. A purposive sample of eleven physiotherapists were recruited for the study from an NHS health board in south east Wales, comprising three different first contact physiotherapist models. Data were collected through individual semi-structured interviews. Data analysis was conducted via a three-step format. Results Participants viewed the first contact physiotherapist role as positive as it represented role and career advancement. Adequate training and mentorship were not provided to support the role. Participants perceived that patients and the wider multidisciplinary team did not fully understand the role of the first contact physiotherapist. Inappropriate use of services was common, with first contact physiotherapists often acting as the second contact practitioner, leading to duplication of effort and the development of unnecessary waiting lists. The degree of interprofessional collaboration appeared to influence the clarity of the role of the first contact physiotherapist, with a reduced clarity of role in models where first contact physiotherapists were not often present. Burnout was perceived as a risk for participants with low levels of experience in advanced practice and was dependent on the model worked in. Participants perceived a lack of specific aims for the first contact physiotherapy service and ambiguity over who was responsible for service leadership, leading to inappropriate use of services. Conclusions Clear operational leadership and strategies to increase interprofessional collaboration are required to increase the clarity about the roled of the first contact physiotherapist and ensure service efficacy. There is a need in Wales for a professional development, mentorship and governance framework to ensure sustainability and efficacy of first contact physiotherapy services.
Clinical and cost-effectiveness of first contact physiotherapy for musculoskeletal disorders in primary care: the FRONTIER, mixed method realist evaluation
Background First-contact physiotherapists assess and diagnose patients with musculoskeletal disorders, determining the best course of management without prior general practitioner consultation. Objectives The primary aim was to determine the clinical and cost-effectiveness of first-contact physiotherapists compared with general practitioner-led models of care. Design Mixed-method realist evaluation of effectiveness and costs, comprising three main phases: A United Kingdom-wide survey of first contact physiotherapists. Rapid realist review of first contact physiotherapists to determine programme theories. A mixed-method case study evaluation of 46 general practices across the United Kingdom, grouped as three service delivery models: General practitioner: general practitioner-led models of care (no first contact physiotherapists). First-contact physiotherapists standard provision: standard first-contact physiotherapist-led model of care. First-contact physiotherapists with additional qualifications: first-contact physiotherapists with additional qualifications to enable them to inject and/or prescribe. Setting United Kingdom general practice. Participants A total of 46 sites participated in the case study evaluation and 426 patients were recruited; 80 staff and patients were interviewed. Main outcome measures Short Form 36 physical outcome component score and costs of treatment. Results No statistically significant difference in the primary outcome Short Form 36 physical component score measure at 6-month primary end point between general practitioner-led, first-contact physiotherapist standard provision and first-contact physiotherapist with additional qualifications models of care. A greater number of patients who had first-contact physiotherapist standard provision (72.4%) and first-contact physiotherapist with additional qualifications (66.4%) showed an improvement at 3 months compared with general practitioner-led care (54.7%). No statistically significant differences were found between the study arms in other secondary outcome measures, including the EuroQol-5 Dimensions, five-level version. Some 6.3% of participants were lost to follow-up at 3 months; a further 1.9% were lost to follow-up after 3 months and before 6 months. Service-use analysis data were available for 348 participants (81.7%) at 6 months. Inspecting the entire 6 months of the study, a statistically significant difference in total cost was seen between the three service models, irrespective of whether inpatient costs were included or excluded from the calculation. In both instances, the general practitioner service model was found to be significantly costlier, with a median total cost of £105.50 versus £41.00 for first-contact physiotherapist standard provision and £44.00 for first-contact physiotherapists with additional qualifications. Base-case analysis used band 7 for first-contact physiotherapist groups. A sensitivity analysis was undertaken at band 8a for first-contact physiotherapists with additional qualifications; the general practitioner-led model of care remained significantly costlier. Qualitative investigation highlighted key issues to support implementation: understanding role remit, integrating and supporting staff including full information technology access and extended appointment times. Limitations Services were significantly impacted by COVID-19 treatment restrictions, and recruitment was hampered by additional pressures in primary care. A further limitation was the lack of diversity within the sample. Conclusions First-contact physiotherapists and general practitioner models of care are equally clinically effective for people with musculoskeletal disorders. Analysis showed the general practitioner-led model of care is costlier than both the first-contact physiotherapist standard provision and first-contact physiotherapist with additional qualifications models. Implementation is supported by raising awareness of the first-contact physiotherapist role, retention of extended appointment times, and employment models that provide first-contact physiotherapists with professional support. Future research Determining whether shifting workforce impacts physiotherapy provision and outcomes across the musculoskeletal pathway. Study registration The study is registered as Research Registry UIN researchregistry5033. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16/116/03) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 49. See the NIHR Funding and Awards website for further award information.
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