There is ‘unwarranted variation’ in how first contact physiotherapy (FCP) services are commissioned, delivered and governed across England, a review has found.
The differences in approach identified may impact quality, safety, value and sustainability, the review carried out by the Getting it Right First Time (GIRFT) programme found.
First contact physiotherapists (FCPs) work in primary care delivering clinical assessment, triage and management of people presenting with undifferentiated and undiagnosed musculoskeletal problems, without the need for prior assessment by a GP.
But an analysis of survey responses from 229 practice managers, PCN leads and others within primary care found that there was variation in how the FCP role was operationalised and the extent to which staff could use the skills they had, which could limit the benefits.
The report found that there was ‘significant variation’ in awareness and application of CQC regulatory guidance and education standards. Overall, 26.6% of participants were unaware of the CQC guidance for working with FCP roles.
Assurance that practitioners had completed the FCP roadmap was also ‘inconsistent’ and alternative mechanisms for confirming capability and patient safety were not always clearly defined. ‘This represents a potential risk to both quality and consistency of care,’ the report found.
Support is needed for commissioners, providers and PCNs to ‘strengthen quality, safety and value’ in the service, it concluded.
In a series of recommendations, the report said the role of FCP should be clearly understood by all stakeholders to ensure appointments are used appropriately as part of general practice multidisciplinary teams, ‘without duplication of care or delay in referral to alternative or GP-led services where clinically appropriate’.
Unwarranted variation in FCP access to diagnostic imaging, secondary care referral pathways, injection therapy and prescribing need to be fully understood, the report added.
And all primary care services need to have ‘formal, regularly reviewed, governance processes in place to oversee the quality and safety of FCP services’.
The review concluded: ‘This national FCP evaluation demonstrates substantial unwarranted variation across multiple aspects of FCP service delivery.
‘While most primary care services report that FCPs provide valued musculoskeletal (MSK) expertise and contribute meaningfully to primary care capacity, the findings indicate inconsistent assurance of training completion and variability in scope of practice.
‘This includes marked differences in access to, or delivery of, fit note certification, diagnostics, prescribing and job planned supervision.’
Andy Saunders, GIRFT’s community MSK clinical adviser for FCP, who led the review, said: ‘This survey and the strong engagement it has seen have enabled us to gain a better understanding of the current provision of FCP services, highlighting where unwarranted variation is occurring and identifying opportunities for improvement.
‘We hope the report, and the recommended enablers of good practice it contains, will now support commissioners, providers and oversight bodies in improving the consistency, effectiveness and safety of FCP services within England.’
Sue Hayward-Giles, assistant director of practice and development at the Chartered Society of Physiotherapy, said: ‘This is an important piece of work that provides a valuable insight into how the role is operating across England.
‘The rapid expansion of FCP has been highly beneficial to patients but has inevitably led to variation and it was important for us to understand that in greater detail.’
A version of this story first appeared on our sister title Pulse.
