Creating an efficient and effective First Contact Physiotherapy service for your Primary Care Network
Phin Robinson is the Founder and Director of Pure Physiotherapy, who works with over 220 Primary Care Networks with a team of over 450 First Contact Practitioners. Phin is an Ambassador for Health Education England around the FCP roles, as well as being a national central trainer for HEE for FCP Roadmap training and delivery.
A recent review of the healthcare workforce across England shows that the provision of First Contact Physiotherapy is one of the most highly recruited and delivered services under the Additional Roles Reimbursement Scheme (ARRS) to have been adopted within primary care.
The key goals of a First Contact Physiotherapy service are:
Reduce the musculoskeletal (MSK) pressure on primary care frontline staff:
- Research shows that between 20% and 30% of GP consultations are linked to musculoskeletal pain/pathology and the functional limitations that result from such conditions.
- First Contact Physiotherapy allows patients to be seen by an expert musculoskeletal practitioner as their first point of contact in primary care. Many benefits have been shown from this model, including improved patient satisfaction, reduction in imaging, medication prescriptions, and referrals to secondary care.
- Research demonstrates an improved conversion rate for those patients attending secondary care actually requiring secondary care interventions (eg, orthopaedic surgery, neurological assessments and treatments and rheumatological confirmed pathologies).
Effective First Contact Physiotherapy services should add significant value to patient care and the consultations and interventions undertaken in a primary care setting:
- The road map to practice, published by Health Education England, focuses on the need for quality, patient and practitioner safety, and effectiveness in the role of providing first contact musculoskeletal assessment, advice, education, and onward treatment planning.
- An effective FCP physio service should allow patients access to an expert clinician, who has had specific training and development around musculoskeletal knowledge and pathway integration.
- There is a requirement within Health Education England’s Roadmap to Practice for the ARRS roles to attain feedback from 40 patients. This requirement for patient feedback is targeted at ensuring the FCPs are reflective, and highlights the need for improvement in patient care that people accessing the FCP service should expect.
We have identified key factors for the success and sustainability of an effective First Contact Practitioner service during our years of experience providing FCP services. These are:
- The ability to collect data and evaluate the service.
- Transparency in how the service operates and how data is collected.
- Integration and team working in the wider MDT and primary care.
- Sustainability with retention of teams within primary care.
Quality
As with any service providing healthcare support, quality should be a mainstay focus. As mentioned above, Health Education England’s publication of the Roadmaps to Practice has provided a framework to which all First Contact Physiotherapists working within primary care must adhere. Failure to do so would impact the ability to draw Additional Roles Reimbursement funding, and therefore jeopardises the sustainability of the FCP service.
Since the Roadmap publication’s release, there have been training courses delivered regionally and nationally by Health Education England to support FCPs moving into supervised roles, where they have to evidence their ability to perform certain tasks. These include observed clinical practice, reflective case studies, clinical procedural assessments, patient feedback, and demonstration of competencies across mandatory safety and clinical reasoning processes.
Whilst the FCP Roadmaps have provided a good framework for clinicians to work within, they do not mitigate the need to be vigilant as an individual FCP, as a service provider or a commissioner. Quality, in FCP settings, is focused on delivering the key aims of a high standard of musculoskeletal assessment and management, linked with a sound understanding of the wider primary and secondary care landscape. This includes integration with existing pathways and processes.
Given the autonomous nature of the FCP role, the ability to be a reflective practitioner and self-directed learner is also important. Individuals must also recognise the professional boundaries of a First Contact Physiotherapist. Liaising with other members of the primary care MDT and utilising peer support is essential in maintaining patient and practitioner safety.
Data
To facilitate the evaluation of an FCP service, collecting data and outcome measures on patients using – and professionals referring to the service is, not only required by Health Education England’s Roadmap to Practice; but also important if we are to ascertain the impact First Contact Physiotherapy can have on patients and services.
At Pure Physiotherapy, we believe the feedback from 40 patients required to sign off as an accredited First Contact Practitioner should be the minimum threshold – and patient feedback should be sought on an annual basis. This feedback is used to inform reflective practice as well as being shared with the wider primary care management team to look at how services might evolve or develop, alongside identifying training needs.
We aim to gather feedback from 100 patients each year, per FCP. This has proven useful in maintaining quality, facilitating and identifying training needs, and helping practitioners see the impact their work is having on patients. Patient feedback data collected for a variety of key indicators is highly useful and should be carried out on a routine basis. These would also include identifying the referral source into the FCP service. For example, has the appointment been booked by reception? If so, it is a genuine first contact appointment, and has this achieved the maximum offloading of pressure on primary care? Or has the patient been seen by a General Practitioner already and referred for a second opinion? Whilst adding value to the primary care experience, there has not been a significant reduction in pressure for frontline staff.
The data we collect includes;
- The area of the body that the patient presents with issues
- The level of chronicity the patient presents with
- Age bracketing of the patients accessing the service
- Outputs for referral, self-management
- DNA rates
- Referral into other pathways
- And much more…
Below is an example of how the data we collect for each FCP service is presented back to the PCN each month. By equipping the practitioners and the commissioning PCN with this information, we empower people to make choices and improve workforce planning to best meet patient demand.
Transparency
For a quality First Contact Physiotherapy service to be achieved, not only do the physiotherapist and wider service have to work on specific quality and clinical standards, but these outputs must be demonstrated through data and outcome collection. There also needs to be a clear desire to disseminate information and outcomes with the wider primary care MDT and commissioning PCN. We feel it is vital for the long-term sustainability and analysis of the impact of any service in primary care, where the service provider or FCP is transparent in the support required for physios in post. Where there isn’t clearly defined quality assurance and standards being assessed, or data is not being collected in a consistent manner, transparency and analysis of the service becomes extremely difficult, if not impossible.
Sustainability
If an FCP service has a clear and transparent focus on quality, patient feedback and data analysis (as discussed above), we have found that physiotherapists enjoy the role more, and therefore, are more likely to be retained within the primary care setting. The sustainability of any of the additional roles within primary care has been a challenge for many primary care organisations across England since the implementation of the Additional Roles Reimbursement Scheme. Our experience with over 450 First Contact Practitioner physios is that a strong focus on clinical support, peer support, and established quality standards (which are assessed to identify training needs) is of paramount importance. Responding to the individual needs that promote the quality and transparency we would expect in healthcare allows FCPs to thrive and become more sustainable in their role.
