The Role of the Primary Care Network First Contact Physiotherapist

Here at THC Primary Care, we provide a range of resources for Primary Care Network leaders, which includes guiding you through some of the newer (and less new) additional roles.

In one of our recent webinars, I was delighted to meet Chris Hedges, Pure Physiotherapy’s Sports Clinical Lead, Paediatric Specialist musculoskeletal (MSK) physiotherapist and First Contact Physiotherapy (FCP) Team Lead.

Chris offers us a really clear and articulate understanding of the First Contact Physiotherapist role as a whole, focusing on the benefits of First Contact Physiotherapy from the point of view of PCN leaders who may be keen to learn more, patients and also, existing physiotherapists who may be considering (or just beginning) a career in Primary Care.

In this blog we cover:

1. The role and remit of a First Contact Physiotherapist (FCP)

2. The difference between an FCP and a more mainstream physiotherapist

3. Why FCP services are needed in Primary Care

4. Service Structure and Accessibility

5. Procurement of an FCP service and third-party providers (Case Study)

6. Establishment of an FCP service – top tips for PCN leaders

7. Advice for FCPs working in general practice

8. How Pure Physiotherapy can help

9. Where to find out more

Let’s jump in!

1. The role and remit of a First Contact Physiotherapist (FCP)

Put simply, a First Contact Physiotherapist is an experienced physiotherapy practitioner working within Primary Care who is qualified to assess and manage patients without a prior referral from a GP. Within general practice, FCPs, rather than GPs, can be the very first point of contact for patients requiring advice, support, and treatment of musculoskeletal issues (or concerns).

FCPs do not offer a course of physiotherapy. It is a one-stop shop service model (two appointments as an absolute maximum) to immediately triage and recommend next steps. They aim to support patients with early assessment, provision of MSK specialist knowledge (and education), and advice on self-management to ensure a quicker resolution can be realised and / or before the patient’s condition escalates further.

2. What’s the difference between an FCP and a more mainstream physiotherapist?

Within the context of the first (and usually singular) appointment, an FCP will conduct a thorough assessment and triage of the patient’s concern, making a set of recommendations which will either enable the patient to better manage their condition themselves, or signposting onwards for further intervention. For example, an FCP may offer advice on simple exercises to improve the patient’s complaint but also have a sufficient level of knowledge and experience to advise on the need for secondary care involvement, an assessment by their GP and / or whether imaging is required.

A more traditional physiotherapy service, by contrast, will operate within an ongoing programme of rehabilitation following referral in from another provider. They may offer a series of follow up appointments to support the patient in better managing their condition both in-clinic and at home, over a defined period of time.

3. Why FCP services are needed in Primary Care

At present, it is estimated that one third of GP appointments relate to MSK concerns. This is coupled with a shortage in GP numbers, GP appointments and long community services waiting lists. Comparative costs of a GP appointment versus that of an FCP are also significant.

In line with the NHS Long Term Plan, First Contact Physiotherapy services can:

• Bridge the gap between Primary and Community Care

• Ease the burden on secondary care services

• Reduce waiting times and waiting lists

• Provide Primary Care with a broader skillset to ease the existing burden on GPs

• Offer a population health focus, and a more community-based approach (in line with the move towards integrated care)

• Support with the adoption of the personalised care agenda

Across wider healthcare, FCP pilot studies have evidenced the following outcomes following a successful implementation of FCP services:

✅ An overall decrease in the number of referrals for x-rays and scans

✅ An overall decrease in numbers of prescriptions issued for management of related conditions

✅ A reduction in the numbers of referrals into secondary care for related conditions

✅ An increase in appropriate surgical referrals

…. all leading to significant overall cost savings within the NHS at large.

4. Service Structure and Accessibility

The First Contact Physiotherapy service is available to all Primary Care-registered patients who meet the FCP inclusion criteria as follows:

​Inclusion	Exclusion
All soft tissue injuries, sprains, strains or sports injuries	Acutely unwell
Arthritis - any joint	Children under 14
Possible problems with muscles, ligaments, tendons or bone (e.g. tennis elbow)	Medical management of rheumatoid conditions
Carpal Tunnel Syndrome, Achilles Tendinopathy	Women's health, antenatal and postnatal problems
Spinal pain including lower back pain, mid-back pain and neck pain	House-bound patients
Spinal-related pain in arms or legs, including nerve symptoms (e.g. pins and needles or numbness)	Medication reviews for non-MSK conditions
Post-orthopaedic surgery	Neurological / respiratory conditions
	Acute mental health crises
	Patients who do not want to see an FCP

There is no need for a formal referral in, or to see a GP in advance. Patients can be booked in directly with the FCP who will be able to offer the following:

➡️ Specialist assessment and screening of serious medical condition red flags

➡️ Information on self-care and enablement of / support for behaviour changes

➡️ Advice on personal exercise

➡️ Discussion and support with fitness to work assessments

➡️ Support for specific elements of social prescribing

➡️ Support with better management related to physical activity levels and general health such as smoking cessation, weight management and physical activity

guidelines

➡️ Referrals for physiotherapy and podiatry treatment

➡️ Referrals to orthopaedic, rheumatology and / or pain services

➡️ Requests for targeted investigations (either via GP or local arrangements)

In terms of appointment structure, a standard 8.5-hour day would usually comprise of 20 patient appointments of 20 minutes each, with appropriate administration time allocated in between.

5. Procurement of an FCP service and third-party providers [Case Study]

I had the pleasure of working in partnership with Chris and Pure Physiotherapy in setting up an FCP service in Kent. Although the PCN in question already had some understanding and experience of utilising FCPs, like many PCNs up and down the country, their supervision infrastructure and educational roadmap was such that onboarding and supporting a new service in-house might prove to be too much of a challenge at that time.

Having analysed their population health datasets and via the medium of some robust discussions between practices and GP partners on establishment of the service (including the approach to their Additional Roles Reimbursement Scheme strategy more widely), they made the decision to employ a third-party provider to manage implementation of the FCP service.

The PCN reached out to potential providers via social media and consequently held meetings with three potential candidates to assess how well they might be able to meet their needs. Testimonials from each were requested in addition and from here, the PCN Clinical Directors were able to shortlist to two.

The remaining candidates were subsequently invited to present at a PCN Board meeting, and a final decision was taken on who to appoint.

⚠️ Disclaimer: Many PCNs may not require the assistance of a specialist provider in setting up services and providing staff. Equally, there will be subtle nuances in the way each PCN handles the procurement of services. This is an overview of how we handled the process in one area, and can be used as a point of reference for others who may be considering a similar approach.

6. Establishment of an FCP service – top tips for PCN leaders

No PCN is the same and everyone does things slightly differently however these are the fail-safe, ‘lessons learned’ Chris swears by when setting up a service...

🎯 Don’t destabilise what’s currently in place, either internally or more widely within local community services. Take time to map and understand existing pathways, where there are gaps and what is actually needed before you begin.

🎯 If you can, try to get experience of the service by reading, researching, and reaching out to other providers for their insights.

🎯 If you’re considering employing the services of a third-party provider such as Pure Physiotherapy to embed an FCP or an FCP service, work through actual cost implications of their costs versus how much you are entitled to claim. It may be more affordable than you think.

🎯 Consider mobilisation times and be realistic in how much effort you have available to dedicate to embedding the service. A good strategy is to start with one FCP and ramp up from there.

🎯 Receptionists are key. Consider their role within any new process and involve them in conversations about service design and patient flow, and when considering individual training needs.

🎯 Take your patient groups along for the journey and ensure you have a robust communications strategy in place to support your patient population in their understanding of the service, and the benefits on offer.

🎯 Work out how you are going to benchmark and measure success (both from a staffing and patient perspective). As well as data collection and audit, open discussions and verbal feedback are also important.

🎯 Linked with above, make sure you have a process in place for addressing any issues / making improvements if and when required.

How can I best support my new FCP as an individual?

Many FCPs are brand new to Primary Care and as with any of the ARRS roles, time, investment, and patience is required to allow them to flourish in their roles.

✅ Before establishing any new service (or employing staff), make sure it’s fully in line with your PCN roadmap and vision so that everyone is aware of where they fit and what the end-goal is.

✅ Having a clear distinction of roles and responsibilities both within the core PCN and practice team, and the wider ARRS team members goes a long way in embedding effective referral mechanisms and in sharing clinical information and training.

✅ Ensure that regular 121s are set up to allow dedicated time to focus on concerns, support learning and generally guide staff through the first weeks and months within their new environment.

✅ As above, build in protected time within the working week to allow for CPD and supervision.

✅ Encourage and support staff to access any CPD-related learning events, research opportunities and leadership training (surplus to the one hour’s protected time which is recommended for CPD each week).

Practice what you preach! Get your colleagues involved in team fitness challenges (and related social activities) so that staff have an opportunity to step away from their desks, come together and get to know each other. 😊

7. Advice for FCPs working in general practice

Whether you’re brand new to Primary Care or working in practice already, here are some more fantastic tips from Chris to get the most from your role and in your work environment:

🎯 Take time to understand the PCN landscape and the current needs

🎯 Ask to shadow other staff so you can build a full picture of how the system works in your immediate area

🎯 Invite and be open to mutual feedback

🎯 Offer to present any relevant data or findings to wider PCN staff to support their understanding of your role and to draw out areas of opportunity, improvement and /or mutual benefit

🎯 Consider how you can be instrumental in successfully embedding First Contact Physiotherapy within the PCN and which meetings you could get involved in (and at what level)

🎯 Share any relevant MSK bulletins / new research and / or write a piece for your PCN newsletter (e.g.)

🎯 Think strategically and try to anticipate and identify issues before they happen

Check out the available resources (including self-help tools) for FCPs and patients alike on the dedicated Pure Physio MSK website.

Above all, get involved in PCN life!

8. How Pure Physiotherapy can help...

Pure Physiotherapy offers a range of resources to support PCNs and their FCPs, including (and not limited to):

➡️ Provision of mentorship to support FCPs with a specialist interest

➡️ Online networking events and lunchtime virtual drop-in sessions to enable peer support

➡️ Anytime, online access for FCPs who may require advice on more complex cases

➡️ Extended learning and guides for PCN leaders on how to structure and deliver clinical supervision for their FCPs

They also record and report on key metrics of the PCN’s choosing, such as:

1. Number of consultations per defined period

2. Number of GP hours saved

3. Number of patients seen who did not subsequently require a GP appointment, numbers of onward GP referrals

4. Number of patients requiring imaging

5. Information on the areas of the body assessed, and can even flag where additional capacity may be needed going forwards.

Check out the Pure Physiotherapy website, which contains information for both FCPs and PCNs here.

To find out more about the Founder & Director of Pure Physiotherapy Phin Robinson please click here to download the episode today. Tara & Phin discuss;

✅ How Pure Physio support Primary Care Networks currently.

✅ Phin's advice about how to approach workforce planning, and funding a service with non-recurrent funding.

✅ The importance of peer support and clinical supervision.

✅ Why hiring a team who challenges you and helps you to grow is key.

9. Where to find out more

• Health Education England guidance on First Contact Physiotherapists

• Health Education England guide to training hubs

• Pure Physiotherapy guidance for FCPs and PCNs here.

• More information on the NHS England Looking After Your Team coaching offer can be found here.

• The Association of Chartered Physiotherapists in Occupational Health and Ergonomics / FCPrelated webinars are accessible here.

We hope this is helpful! 😊

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Find out more about THC Primary Care at www.thcprimarycare.co.uk

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About the Author

I'm Tara; I am the founder of THC Primary Care, an award-winning healthcare consultancy specialising in Primary Care Network Management and the host of the Business of Healthcare Podcast, where we have now published over 250 episodes.

I have over 20 years of project management and business development experience across the private and public sectors, and I have supported over 120 PCNs by providing interim management, training and consultancy.

I have managed teams across multiple sites and countries; I have an MBA in Leadership and Management in Healthcare, I'm published in the London Journal of Primary Care, and I am the author of over 250 blogs.

I have 3 children. My eldest has Asthma, my middle child has a kidney condition called Nephrotic Syndrome, and my youngest daughter has Type 1 Diabetes, so outside of work, healthcare plays a huge role in my life.