First contact physiotherapists based in practices are proving to be highly effective, easing the workload burden on GPs and improving access to MSK health services. How can practice managers ensure the role realises its full potential?

Musculoskeletal (MSK) conditions are one of the most common reasons for patients to visit their GP, and with an ageing population and growing demands on the healthcare system, it’s no surprise that MSK care is a significant challenge.

However, there is an effective solution that’s already making a difference: first contact physiotherapists (FCPs). 

FCPs are highly trained, autonomous physiotherapists who are embedded within primary care teams to assess, diagnose, and manage MSK conditions.

They provide the first point of contact for patients presenting with MSK complaints and  are skilled at making immediate diagnoses and offering expert advice right at the start of a patient’s journey.

They also have significant, extensive training, with a specific focus on the recognition and management of non MSK presentations, which includes the identification and onward referral for conditions such as cancers, inflammatory presentations, and neurological diseases. 

Their role is transforming the way MSK care is delivered, offering a range of benefits that not only improve patient outcomes but also reduce pressure on GPs and save healthcare resources. 

Let’s explore why FCPs are such a game-changer in MSK care. 

By diagnosing and managing many MSK conditions in the community, FCPs help to free up GPs, improve patient access to care, and ensure that patients receive the right treatment at the right time. As autonomous practitioners, they can prescribe treatments, provide exercises, and offer advice on managing pain and preventing further issues, all without needing to escalate to more expensive or invasive interventions like surgeries or specialist referrals. 

Research has shown that FCPs are highly effective at managing MSK conditions, reducing the need for GP consultations, keeping patients out of hospitals, and significantly lowering healthcare costs. 

One notable evaluation conducted by a Coventry service between April 2021 and December 2023 found that FCPs successfully handled 33,457 appointments. Of the 24,116 appropriate referrals, 77% were resolved without the need for further treatment, and only 2% required a referral back to the GP. This not only increased capacity within primary care but also ensured that patients received timely care from expert clinicians. 

A study, funded by the National Institute for Health and Care Research (NIHR), further reinforced the value of FCPs. Taking place between 2018 and 2020, it found that patients who saw an FCP had better outcomes than those who saw a GP, with improvements in MSK health, work performance, and a significant reduction in prescription pain prescriptions. Additionally, the cost-effectiveness of FCP-led care was evident, with savings of £61- £64 per patient compared with GP-led care. 

Other findings highlighted the reduction in unnecessary referrals to orthopaedic departments and the high level of patient satisfaction. In fact, 94% of patients said they would recommend their FCP to others, and 80% had not needed to see their GP again for the same problem three months later. 

The importance of integration in MSK pathways 

While FCPs bring great value to the healthcare system, their role must be fully integrated into local MSK pathways for maximum impact. Simply introducing FCPs without a clear plan for their integration with other services risks undermining their potential. 

The preferred model, championed by the Chartered Society of Physiotherapy, is for FCPs to be employed by local MSK service providers and to work collaboratively with GPs and other healthcare professionals in primary care. This integration ensures that FCPs are part of a broader, well-coordinated system where patients receive seamless care from diagnosis to treatment and recovery. 

When FCPs are contracted through independent providers or placed in isolated roles, challenges like high turnover, burnout, a lack of integration with community services can arise, which all impact patient care. Therefore, a successful future model should ensure that FCPs are embedded within NHS community services with the right structures and support in place. 

Tips for practice managers to maximise FCP utilisation 

If your practice is considering or already employing FCPs, here are some dos and don’ts for practice managers in order to get the most out of the role.  

Do: 

•  Educate staff and patients. Ensure that everyone understands the role and capabilities of FCPs. This can boost referrals and reduce misunderstandings. Patients will need to be directed to the FCP service in a streamlined manner. As part of the setting up of these roles, practice staff have a key role in ‘marketing’ or explaining about  the service effectively and offering patients appointments with the FCP. 
• Integrate into workflow. Make FCPs an integral part of the practice’s workflow to streamline patient care.
• Encourage collaboration.Foster communication between FCPs and other healthcare providers to create a cohesive care plan for patients. 

Don’t: 

• Overlook training. Ensure that FCPs are regularly trained and updated on the latest practices and protocols.
• Allow isolation. Don’t let FCPs work in silos; integrate them into the practice culture to enhance teamwork. 
• Neglect feedback. Regularly solicit feedback from both patients and staff to identify areas for improvement. 

The path forward: addressing gaps and supporting growth 

Despite the growing evidence supporting the effectiveness of FCPs, there are still gaps in the system that need to be addressed to fully realise their potential. 

The initial policy goal set out to have 5,000 FCPs across England, (Where was this set out? based on a recommendation of one FCP per 10,000 people. However, as of March 2023, only around 1,894 FCPs were employed in England, far below the target.

To close this gap and expand the role of FCPs, future funding and workforce planning should focus on integrating FCPs into NHS community services, ensuring they are embedded within both primary care networks and the wider MSK pathway. 

Moreover, FCPs need continuous professional development (CPD) opportunities, particularly as the complexity of patient needs increases. Ensuring FCPs are well-supported, both through training and by working within a robust team structure, will help prevent burnout and support the sustainability of this model. 

Ash James is director of practice and development at the Chartered Society of Physiotherapy