Primary Care Reattendance Following an FCPP Appointment: A National Retrospective Service Evaluation

Musculoskeletal (MSK) conditions make up to one third of a GP’s caseload. First Contact Practitioner Physiotherapists (FCPPs) have been shown to be a clinically and cost-effective alternative for managing these. However, their real impact on Primary Care workloads requires further evaluation.  

Pure’s approach to data collection and evaluation 

At Pure, one of the things we are particularly applauded on is our collection and use of data to analyse and improve our service. As part of our service to the Primary Care Networks (PCNs) that we work with, we collect monthly key data that demonstrates the effectiveness of our clinical services. We focus on understanding how patients are accessing FCP services, how much time we are saving GPs, and what happens to patients once they have seen an FCP. We benchmark our data against national targets and success criteria, and the results of the data we collect play a vital role in informing service development and improvement initiatives. 

Challenges in measuring GP reattendance 

One measure of FCP effectiveness that is hard to track in “real time” is the percentage of patients that reattend to see a GP once they have seen an FCP.   

This is a question we are regularly asked in service review meetings. A small number of studies have demonstrated that reattendance to a GP following an FCP consultation ranges from 8-25%. However, these findings were based on limited patient samples, sometimes from just one or two practices, and none of the studies clarified the reasons for reattendance. 

A national retrospective service evaluation 

To address this, we conducted a retrospective service evaluation of PCNs across England.  

Our goal was to determine the percentage of patients who return to see a GP after an FCP consultation, and whether the reasons for reattendance varies by time point. 

We collaborated on this project with Dr Rob Goodwin from the University of Nottingham. Rob is a post-doctoral research fellow and trained physiotherapist by background who has published several papers in the field of First Contact Physiotherapy, patient satisfaction, and the integration of FCP into primary care.  

Collaborative research and methodology 

Together with our IT and training development teams, we developed a data collection form to record whether patients reconsulted with a GP after an FCP appointment, the time frame for their return, and the reason for reattendance. 

Comprehensive data collection across England 

We provided training for team leads across the organisation to audit individual practices and collect data covering the period from 01 Jan – 30 April 2024. In total, data was collected from 70 PCNs across England. A key strength of this evaluation is the diversity of participating practices, which included both rural and urban areas, as well as communities with varying levels of social deprivation.  

We were able to collect data from 2,725 patients – making this, to our knowledge, the largest evaluation to date specifically examining reattendance and its causes following an FCP appointment.  

Key findings: FCPs reduce GP workload 

We found that 78.5% of patients who had seen an FCP did not reattend to see a GP, nurse practitioner, or paramedic within three months of their FCP consultation. This percentage is consistent with previous research findings, and well within previously published national success criteria for an effective FCP service. These findings demonstrate that FCPs do help to reduce the burden of MSK conditions on other members of the healthcare team.  

This evaluation further supports the implementation of FCPs into general practice in England and fits the principle of patients being seen by the right person, in the right place, at the right time. 

Understanding the reasons for reattendance 

It was interesting to see that the primary reason for reattendance was for a prescription for pain relief. Several national initiatives – which we at Pure support – aim to upskill the general practice workforce. Our findings support the development of physiotherapists’ skills to meet this patient need. 

Next steps and further research 

Our research manuscript has recently been accepted and published in the esteemed, peer-reviewed journal, Musculoskeletal Care. We are now in the process of developing a protocol for a further study, which will explore whether attendance and outcomes of FCP appointments are influenced by factors such as ethnicity, occupation, and whether the practice or PCN is in an area of high or low social deprivation. 

Watch this space!