What does data tell us about what we should expect from a First Contact Physiotherapy service in Primary Care?

The Growing Role of First Contact Physiotherapy in Primary Care

Since their widespread introduction in 2019, First Contact Physiotherapy (FCP) services have become an integral part of many primary care teams across England. NHS England reports that up to 30% of primary care workload involves musculoskeletal (MSK) complaints, and experienced MSK physiotherapists are well-positioned to address this need. Numerous studies have shown the safety and effectiveness of these roles in primary care. Not only do FCP services help reduce the strain on other clinical staff, but they also enhance the patient experience in managing musculoskeletal issues. 

The Challenge of Data Collection

However, one challenge for GP practices, Primary Care Networks (PCNs), and Integrated Care Boards (ICBs) is the consistent collection of data to evaluate the impact of FCP services in different areas. Documents such as the GP DES and Roadmaps to Practice governance highlight the need for audit and service improvement, but achieving significant improvements requires appropriate data collection. 

Pure’s Role in FCP Development

Pure Unity Health supports over 220 PCNs across England, having been involved in the early NHS England trials for FCP services since 2016. From the start, we’ve collected data to demonstrate the value of FCP to commissioning bodies, including Clinical Commissioning Groups (CCGs) and now PCNs and ICBs. Our clinical director also lectures on the importance of data in developing FCP services and improving musculoskeletal and chronic pain management for patients. 

Key Metrics for Evaluating FCP Services

To assess the impact of an FCP service, certain key elements must be considered: 

1. Referral Source

Understanding where patients are referred from is crucial. Ideally, most referrals should come from care navigation, direct triage, or digital platforms. If patients are referred to FCP after already seeing a GP or allied health professional, the pressure-relieving benefit of the FCP service is reduced. Monitoring referral sources allows us to provide targeted training to ensure that appropriate patients are directed to the FCP service as early as possible. 

2. DNA (Did Not Attend) Rates

A well-functioning FCP service should maintain a DNA rate below 9%. Regularly tracking and analyzing DNA rates can help identify any trends or issues. If the rate increases, we can improve patient education at both the practice and care navigation levels to ensure patients understand the value of consulting a specialist MSK physiotherapist. Reducing DNA rates maximizes the use of FCP services and alleviates pressure on the system. 

3. Number of Follow-Ups

FCP services differ from traditional physiotherapy rehabilitation pathways. The primary role of FCPs is to provide rapid, first-contact care, rather than ongoing rehabilitation. Follow-up rates should ideally be below 10%, with most patients managed in a single consultation. If follow-up rates exceed this threshold, it limits access to new patients and diminishes the pressure-relieving benefits of FCP. 

4. Referrals Per Practice

Tracking the number of referrals to the FCP service from each practice within a PCN helps ensure equitable access to the service. Practices of varying sizes need to be proportionally represented in their use of the shared FCP service. Monitoring referral patterns helps identify any discrepancies and allows for targeted training to ensure all practices make full use of the service. 

5. Patient Age Range

Collecting data on the age demographics of patients using the FCP service helps identify any disparities in access. Comparing local data to national trends allows practices to adjust their communication and outreach strategies, ensuring all age groups understand the benefits of FCP services and have equal access. 

6. Affected Body Area

Tracking the area of the body the patient presents with allows FCP services to tailor training and support to the local population’s specific needs. This local-focused approach ensures that services are aligned with the unique characteristics of the community, rather than relying solely on national trends. 

7. Chronicity

Chronic musculoskeletal pain, defined as pain persisting for over three months, presents a different treatment challenge than acute pain. Data on the chronicity of MSK issues in a population helps inform long-term planning for clinical services, particularly in integrating with pharmacists, health coaches, and other professionals to support patients with persistent pain. 

8. Critical Incidents and Red Flags

As with any clinical service, FCP teams should regularly review any critical incidents or red flags. These are essential for improving the safety and quality of care provided. 

9. Outcome of FCP Consultations

Collecting data on the outcomes of FCP consultations is vital for understanding their impact on practices, PCNs, and the broader healthcare system. Without this data, the opportunity for service improvement and learning is lost. Most FCP consultations result in patients being managed with advice, education, and self-management strategies, which has proven effective in over 70% of cases. High patient satisfaction scores further highlight the value of the service. 

By understanding the outcome of FCP consultations and onward referrals for imaging, orthopaedics, neurology, and other services, practices can gain a clearer picture of the broader patient experience and the impact of FCP services on the healthcare pathway. 

Conclusion 

As FCP roles continue to be embedded in primary care, collecting and analysing data is essential for ongoing service improvement. By reviewing key metrics such as referral sources, DNA rates, follow-ups, patient demographics, and outcomes, primary care teams can evolve their services to meet the unique needs of their local populations and improve patient care.