First Contact Physiotherapy

Original Editor - Carina Therese Magtibay

Top Contributors - Carina Therese Magtibay and Kim Jackson  

Introduction[edit | edit source]

Musculoskeletal (MSK) conditions are among the leading causes of years lost to disability[1], with an annual loss averaging 30 million working days in the UK[2]. The demand for MSK healthcare continues to rise as the number of General Practitioners (GPs) across the UK declines[3]. With a considerable fraction of the total GP consultations being MSK in nature, approximately 20-30% in England,[4] one of the solutions to address this growing need is the employment of First Contact Physiotherapists (FCPs)[5].

First Contact Physiotherapy Model[edit | edit source]


First Contact Physiotherapy is a primary care model where expert MSK physiotherapists undertake the first patient consultation, to enhance MSK-patient care and free-up GP capacity[5]. FCPs are mainly Extended Scope Physiotherapists (ESP) which are advanced physiotherapists with sufficient expertise through years of experience and are usually under band 7 in the NHS grading system[7].

According to the NHS Long Term Plan, 98% of Sustainability and Transformation Partnerships have confirmed pilot sites for FCP and 55% of initial implementations are already ongoing[8]. It is projected that by 2024, all adults in England will be able to self-refer to MSK first contact physiotherapist at their local GP practice[9].

Roles of FCPs[edit | edit source]

As an experienced physiotherapist with advanced skills, the first contact practitioner (FCP) assesses, diagnoses, and recommends appropriate treatment or referral to other healthcare services. Their roles are:[10]

  • Evaluate, diagnose and treat patients independently
  • Order diagnostic tests
  • Administer steroid injections
  • Prescribe medication (analgesia or anti-inflammatories for MSK conditions) as needed
  • Refer patients accordingly

Benefits of FCP[edit | edit source]

There are many benefits associated with employing a model that advocates FCPs including:[5][7][10]

  • Immediate access to physiotherapy
  • Reduced GP workload
  • Reduce health service costs
  • Increased time allotted for consultation
  • Increased patient satisfaction
  • Improved primary healthcare quality
  • Reduced sickness absences

Challenges of Implementing FCP[edit | edit source]

A study by Moffatt et al identified the following challenges of implementing FCPs such as:[11]

  • Existing patient expectations regarding the first point of contact in primary care setting
  • Complexity of GP caseload as many patients presenting with MSK problems also have co-morbidities
  • More responsibility for FCPs, thus, increased risk for error
  • Issue of GPs potentially being de-skilled in MSK practice

Future of FCP[edit | edit source]

Currently, FCP is showing promising results which can enhance the global quality of physical therapy services. FCP model is still in its infancy and further studies are recommended to increase its level of evidence and to determine if it is feasible to be implemented in other countries.[12]

References[edit | edit source]

  1. Steel N, Ford JA, Newton JN, Davis AC, Vos T, Naghavi M, Glenn S, Hughes A, Dalton AM, Stockton D, Humphreys C. Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2018 Nov 3;392(10158):1647-61.
  2. Office for National Statistics (2017) Sickness absence in the UK labour market: 2016. Available from: (Accessed 27/11/2022)
  3. British Medical Association. NHS delivery and workforce. Available from:,-Partners&text=This%20has%20created%20a%20net,in%20the%20last%20year%20alone. (accessed 27/11/2022)
  4. Thomson J, Syme G. Allied health professional (AHP) musculoskeletal pathway framework: national minimum standards. Scottish Government; 2014.
  5. 5.0 5.1 5.2 Goodwin R, Moffatt F, Hendrick P, Stynes S, Bishop A, Logan P. Evaluation of the First Contact Physiotherapy (FCP) model of primary care: a qualitative insight. Physiotherapy. 2021 Dec 1;113:209-16.
  6. NHSEast ofEngland. What is a first contact physiotherapist? Available from: [last accessed 27/11/2022]
  7. 7.0 7.1 First Contact Practitioner. Why FCPs. Available from:/ (accessed 27/11/2022)
  8. National Health Service (NHS). NHS Long Term Plan v1.2 August 2019. Available from: [Accessed 27/11/2022].
  9. NHS England. First Contact Physiotherapists. Available from (Accessed 27/11/2022)
  10. 10.0 10.1 Downie F, McRitchie C, Monteith W, Turner H. Physiotherapist as an alternative to a GP for musculoskeletal conditions: a 2-year service evaluation of UK primary care data. British Journal of General Practice. 2019 May 1;69(682):e314-20.
  11. Moffatt F, Goodwin R, Hendrick P. Physiotherapy-as-first-point-of-contact-service for patients with musculoskeletal complaints: understanding the challenges of implementation. Primary health care research & development. 2018 Mar;19(2):121-30.
  12. Piano L, Maselli F, Viceconti A, Gianola S, Ciuro A. Direct access to physical therapy for the patient with musculoskeletal disorders, a literature review. Journal of physical therapy science. 2017;29(8):1463-71.