First Contact Physiotherapists: A Guide to Their Role in Primary Care
In the evolving landscape of primary care, First Contact Physiotherapists (FCPs) play a crucial role in addressing the growing demand for musculoskeletal care within GP practices across England. These expert clinicians provide patients with rapid assessments, tailored advice, and personalised exercise plans right from their first appointment, significantly improving patient experiences and reducing traditional wait times for physiotherapy.
This blog post explores the responsibilities of FCPs, the benefits they offer to patients and primary care networks, and the challenges they face in their pivotal roles. As NHS England integrates FCPs into the healthcare system, it aims to alleviate the burden on general practitioners while ensuring timely and effective care for musculoskeletal issues, supporting a healthier population overall.
What does a first contact physiotherapist do?
First contact physiotherapists work in GP practices across England, typically under the umbrella of primary care networks.
The role of a first contact physiotherapist is to provide valuable support to patients who visit general practice with musculoskeletal issues and to alleviate the pressure on general practice staff.
First contact physiotherapists are expert musculoskeletal clinicians working in primary care who can offer patients rapid assessment, advice, education, and work collaboratively with patients to create onward management plans.
Research shows that the patient experience for these groups is outstanding.
What are the benefits of FCP in primary care?
First contact physiotherapists (FCPs) working in primary care offer significant benefits not only to the primary care network and GP practices but also to patients.
From the perspective of practices and primary care networks, FCPs help reduce up to 30% of the clinical workload associated with musculoskeletal problems. This alleviates pressure on general practitioners, allowing them to focus on medically unwell patients who require their expertise.
Specialist first contact physiotherapists, being experts in musculoskeletal clinical management, handle the musculoskeletal patient cohort effectively.
Patients benefit from FCPs as they can be seen by an expert clinician during their first visit for a musculoskeletal issue. This enables rapid assessment, advice, and appropriate management from the outset, unlike the traditional model where patients might wait weeks or even months to see a physiotherapist through normal musculoskeletal rehabilitation pathways.
What are the challenges of first contact practitioners?
First contact practitioners face several challenges, primarily related to the need for support, clinical debriefs, and training and development opportunities. These practitioners must be autonomous and confident in managing patients with musculoskeletal problems, and they need to recognise when a seemingly musculoskeletal issue might actually be related to other body systems, such as cardiac, cancer, respiratory, or other internal organ problems.
For the most effective and safe patient management, first contact practitioners should be fully integrated with the GP practices where they work and supported by the clinical team in the practice as well as the employing organisation.
Another common challenge is the time needed to assess and manage patients compared to traditional physiotherapy rehabilitation pathways. Most first contact practitioner appointments are 20 minutes long, whereas musculoskeletal rehabilitation pathways typically allow for 30-minute appointments. This reduced time can make the role quite challenging, requiring expert clinicians with significant experience. The role differs significantly from traditional physiotherapy rehabilitation pathways, and good support from the employing organisation is essential for the success and stability of both the practitioner and the service.
Why are NHS England introducing first contact practitioners?
NHS England introduced first contact practitioners (FCPs) to address the increasing pressure on primary care due to rising musculoskeletal demand. This demand is driven by several factors, including the growing desire for people to stay physically active, enjoy life, and avoid long-term reliance on strong painkillers. The ageing population, with individuals remaining active and independent into their 70s, 80s, 90s, and beyond, contributes to this demand. Maintaining musculoskeletal health and managing issues as they arise is crucial for people to age well and lead active lives for as long as possible.
To address these needs, NHS England introduced the FCP role and provided funding through the Additional Roles Reimbursement Scheme (ARRS), initially introduced in 2019. The goal of FCPs in primary care is to reduce the musculoskeletal workload on GP practices and clinical staff while adding value for patients with musculoskeletal issues such as bad knees, bad backs, osteoarthritis, sciatica, tennis elbow, and many other conditions. These conditions can be effectively managed by expert physiotherapists.
How long do patients have to wait for physiotherapy on the NHS?
The wait time for physiotherapy on the NHS varies significantly across England. However, the introduction of first contact physiotherapists (FCPs) in almost all GP surgeries aims to reduce this wait time. Patients should now only wait a matter of days or a few weeks to see an expert musculoskeletal physiotherapist at their local surgery.
This initiative is part of the NHS Long Term Plan, introduced in 2019, which led to the employment of thousands of physiotherapists as first contact practitioners in primary care and GP surgeries. FCPs can refer patients to existing physiotherapy rehabilitation pathways, where wait times may still be several weeks or months. Nevertheless, after an initial consultation with an FCP, patients receive tools for self-management, helping them start improving their condition immediately instead of waiting on a list without guidance.
Should patients see a doctor or physiotherapist first?
Deciding whether to see a doctor or a physiotherapist in general practice depends on the type of issue the patient is experiencing.
If they have a musculoskeletal problem, such as a pulled knee or back, and their surgery has access to a first contact practitioner, it makes sense to see the expert musculoskeletal physiotherapist. This specialist can rapidly assess, diagnose, advise, and plan appropriate recovery pathways.
However, if the patient has an internal organ issue or a more medical-related problem, such as heart palpitations, persistent diarrhoea, or swallowing difficulties, they should see a doctor within their general practice. Physiotherapists in general practice are not substitutes for experienced general practitioners; they specialise in managing musculoskeletal problems.
The reception and care navigation teams in general practice will typically ask questions to help direct patients to the most appropriate clinician for their specific issue.
Find out more about First Contact Physiotherapy
Phin Robinson BSc (Hons), MSc Advancing physiotherapy, PG Dip Orthopaedic Medicine.
After qualifying in 2001 Phin has worked as an MSK physiotherapist within the NHS and independent sector. He has been an injecting therapist since 2006 and spent 15 years working as an advanced practitioner in MSK between primary and secondary care settings. He heads up Pure Unity Health group and remains passionate about the physiotherapy profession and the positive impacts that can be gained from quality physio lead MSK care. Since 2020 Phin has taught on NHSE accredited FCP courses and works part time in an FCP and ARRS ambassador role.
