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Physiotherapists can reduce MSK caseload burden for GPs, report finds

by Costanza Pearce
24 April 2019

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Advanced physiotherapists can ‘reduce burden’ on GPs by managing the musculoskeletal (MSK) caseload in general practice, a new report has found.

The report, published in the British Journal of General Practice earlier this month (9 April), evaluated the first two years of a service that provides physiotherapists as a ‘first contact’ in general practice for patients with MSK conditions.

The service was launched in November 2015 in two practices in Forth Valley, Scotland, after the practices were unable to recruit the GPs they needed.

Extended scope physiotherapists (ESPs) – advanced physiotherapists who assess, diagnose and manage patients independently – were employed by the practices and took on 8,417 patients with a range of MSK conditions.

Most patients were appointed to the service by reception staff or after phone triage with a nurse and the ESPs only asked for a GP review for 1% of patients in the study.

A prescription was required by 12% of patients and a fit note by 3%, but these were issued by the duty GP without the need for an appointment.

The report said: ‘Given the current crisis, services such as this could reduce burden by managing the MSK caseload within a practice.

‘The patient receives a specialist MSK assessment at first presentation and GP time is released to focus on patients with other medical problems.’

The report found that patients with MSK conditions could be ‘assessed and managed independently and effectively’ by an ESP, representing a ‘significant saving of GP time.’

Improved access

Patients were generally seen on the same day – or within one or two days of requesting an appointment – and 88% of appointments were filled, the report found.

Almost a third, 60%, of patients only needed self-management, such as advice or a brief intervention. The vast majority, 87%, patients were managed within primary care.

Researchers found that referral rates to orthopaedics were ‘substantially reduced’ in both practices, saving an estimated 212 referrals per year.

In England, the new GP contract commits to providing networks with 70% of the funding needed to employ a first-contact physiotherapist from 2020.

NHS England have previously announced plans for better access to first-contact physiotherapists with several pilot schemes underway around the country.

Practice manager ‘key’

Strong leadership from the practice manager, as well as clear communication to both staff and patients, are ‘key factors for success’ when it comes to launching a new service, according to the report.

Other recommendations included for any new posts to be based within the practice and that there should be ‘clarity and clear boundaries regarding the role’.
Study leader Helen Turner, an extended scope physiotherapist at Kersiebank Medical Practice in Grangemouth, said the Forth Valley project had been an ‘excellent example’ of healthcare professionals working together to tackle service pressures and improve local care.

She added: ‘The results from the first two years of our service demonstrate great opportunities exist to use physiotherapy to reduce GP workloads.’

Dr Louise Warburton, a  Shropshire GP with a special interest in MSK and a researcher at Keele University said it was an interesting study but that the results may not be replicable in all services as it was dependent on the experience of the physiotherapist.
She said: ‘This study uses ESPs who are band 7 or 8 experienced physios and independent practitioners. They are used to managing their own caseload and can probably cope well working alone in primary care.’

She added that many pilots in England were using less experienced physiotherapists – band 5 or 6 – and so referral rates and other results would not necessarily be the same.
Additional reporting by Emma Wilkinson