Understanding the difference between a First Contact Physiotherapist and a physiotherapist in a traditional rehabilitation pathway is essential to fully benefit from their distinct roles.
Specialist MSK First Contact Physiotherapy Practitioners
The First Contact Practitioner role was introduced widely with the NHS Long Term Plan, published in 2019. The goal of First Contact Practitioners was to allow regulated allied health professionals to assess and help manage untriaged patients who attend primary care in their first consultation. There are several different roles that are able to provide first contact practitioner appointments including physiotherapists, occupational therapists, paramedics, dieticians, and podiatrists. Workforce data shows that physiotherapists followed by paramedics are the two most common first contact roles in primary care respectively.
Specialist First Contact Physiotherapy Practitioners primarily focus on managing musculoskeletal conditions. Research from NHS England shows that up to 30% of primary care workload is musculoskeletal in nature. By incorporating a first contact physiotherapy service, we can effectively address this growing need.
Pure Physiotherapy played a key role in the early trials of first contact physiotherapy in 2016, and since then, we have been collecting and providing data to NHS England through Clinical Commissioning Groups (CCGs) and Integrated Care Boards (ICBs). Currently, we treat over 80,000 patients each month in primary care. Our data shows that more than 90% of patients seen in our musculoskeletal first contact practitioner clinics do not require further clinical input from other primary care clinicians after their consultation.
The combination of high levels of self-management—through education, advice, and exercise programmes—and excellent patient satisfaction demonstrates the positive impact that first contact physiotherapy services can have in primary care. These services not only reduce pressure on healthcare practices but also enhance the overall patient experience.
The role of the first contact musculoskeletal practitioner was established based on research-backed trials to achieve two main goals:
- Reduce the pressure on primary care caused by an aging population and the increasing prevalence of musculoskeletal issues.
- Enhance the value for patients seeking primary care for musculoskeletal problems by allowing them to see specialised clinicians in musculoskeletal management, typically provided by specially trained and highly experienced physiotherapists.
The establishment of the first contact practitioner role in physiotherapy led to the creation of training documents and governance profiles by Health Education England, which are now managed by NHS England. These documents, known as the Roadmaps to Practice, were first published in 2020 and serve as the governance framework that all first contact practitioners should follow.
The Roadmaps to Practice outline the clinical and organisational competencies required, including musculoskeletal-specific skills, advanced clinical reasoning, safety netting, and a focus on primary care in managing population health.
By allowing patients with musculoskeletal issues to see specialised clinical experts, typically highly trained and experienced physiotherapists, we can enhance the value of primary care services.
First contact specialist physiotherapy practitioners can see untreated patients directly from care navigation teams or through direct booking, eliminating the need for a GP visit first. They are regulated healthcare professionals who can make independent diagnoses and management plans for patients under the regulatory framework of the Health and Care Professions Council and NHS England’s roadmap to practice governance documents.
From a patient’s perspective, FCPs can quickly assess, diagnose, advise, and educate patients on the best self-care practices. They can also arrange appropriate imaging when necessary and refer patients to further pathways, such as physiotherapy rehabilitation, orthopaedic triage, and direct orthopaedic referrals, as well as other community or secondary care services.
What is a specialist FCP MSK physiotherapist?
- The first choice for patients with musculoskeletal pain (muscles, tendons, arthritis, joints and back issues).
- FCPs reduce the pressure on practice clinical teams and add value to patients with musculoskeletal problems.
- Provide early access to specialist MSK knowledge and assessment.
- Usually, one appointment is all that is needed.
- Able to assess, diagnose, and organise onward management independently.
- FCP is NOT a course of rehab Physiotherapy – if ongoing rehabilitation is needed, FCP’s can refer on just as a GP may do.
What does a rehab pathway physiotherapist do?
Rehabilitation pathways have been established across the UK for many decades. These pathways are typically provided by physiotherapists with varying levels of experience and seniority, aimed at supporting people with musculoskeletal issues during their physiotherapeutic rehabilitation.
Rehab pathways generally receive referrals from primary or secondary care for musculoskeletal problems, whether acute or chronic, as well as for patients recovering from surgery or hospital stays. A typical rehab pathway includes multiple physiotherapists, ranging from junior staff (usually Band 5 within the NHS) to highly experienced clinical specialists (Band 8A and above). This mix of experience and skills allows for more cost-effective rehabilitation, addressing the high volume of patients requiring ongoing support for musculoskeletal issues.
Patients attending rehab pathways are usually triaged in primary or secondary care to rule out potential red flag pathologies, such as cancer risks or non-musculoskeletal pain sources, like cardiac issues that may refer pain to the left shoulder and arm. As a result, patients seen in rehab pathways typically have multiple points of contact within the healthcare system before entering this stage. This is in contrast to the first contact practitioner role in primary care, where practitioners often see untriaged patients and must remain vigilant for red flags or internal organ issues that can present as musculoskeletal pain.
All physiotherapists are regulated by the Health Care and Professions Council. However, unlike first contact practitioners, who are subject to additional regulations and governance through NHS England’s Roadmaps to Practice, rehab physiotherapists do not have this extra level of governance and accreditation.
Rehab pathways usually allow patients to be seen repeatedly over time to create a rehabilitation plan supervised or delivered by physiotherapists. In contrast, first contact practitioners typically see a patient once, with occasional follow-ups if absolutely necessary, though this is uncommon. If a first contact practitioner believes that a course of rehabilitation is needed, they will refer the patient to the rehab pathway instead of trying to duplicate existing services in primary care. It is crucial that first contact roles do not attempt to replicate or undermine established pathways designed for longer-term rehabilitation. The differences between a first contact practitioner and a rehab physiotherapist are substantial; their roles and focuses are distinctly different, as outlined above.
Learn more about First Contact Practitioners
