First Contact Physiotherapy: Difference between revisions
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== Introduction == | == Introduction == | ||
Musculoskeletal (MSK) conditions are among the leading causes of years lost to disability<ref>Steel N, Ford JA, Newton JN, Davis AC, Vos T, Naghavi M, Glenn S, Hughes A, Dalton AM, Stockton D, Humphreys C. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605509/ 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.</ref>, with an annual loss averaging 30 million working days in the UK<ref>Office for National Statistics (2017) Sickness absence in the UK labour market: 2016. Available from: https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/sicknessabsenceinthelabourmarket/2016</ref>. The demand for MSK healthcare continues to rise as the number of General Practitioners (GPs) across the UK declines<ref>https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice-data-analysis#:~:text=September%202015%20to%20October%202022,-Partners&text=This%20has%20created%20a%20net,in%20the%20last%20year%20alone.</ref>. With a considerable fraction of the total GP consultations being MSK in nature, approximately 20-30% in England,<ref>Thomson J, Syme G. [https://www.gov.scot/publications/allied-health-professional-ahp-musculoskeletal-pathway-framework-national-minimum-standard/pages/2/ Allied health professional (AHP) musculoskeletal pathway framework: national minimum standards. Scottish Government;] 2014. <nowiki>https://www.gov.scot/publications/allied-health-professional-ahp-musculoskeletal-pathway-framework-national-minimum-standard/pages/2/</nowiki></ref> | Musculoskeletal (MSK) conditions are among the leading causes of years lost to disability<ref>Steel N, Ford JA, Newton JN, Davis AC, Vos T, Naghavi M, Glenn S, Hughes A, Dalton AM, Stockton D, Humphreys C. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605509/ 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.</ref>, with an annual loss averaging 30 million working days in the UK<ref>Office for National Statistics (2017) Sickness absence in the UK labour market: 2016. Available from: https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/sicknessabsenceinthelabourmarket/2016 | ||
(Accessed 27/11/2022)</ref>. The demand for MSK healthcare continues to rise as the number of General Practitioners (GPs) across the UK declines<ref>British Medical Association. NHS delivery and workforce. Available from:https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice-data-analysis#:~:text=September%202015%20to%20October%202022,-Partners&text=This%20has%20created%20a%20net,in%20the%20last%20year%20alone. | |||
(accessed 27/11/2022)</ref>. With a considerable fraction of the total GP consultations being MSK in nature, approximately 20-30% in England,<ref>Thomson J, Syme G. [https://www.gov.scot/publications/allied-health-professional-ahp-musculoskeletal-pathway-framework-national-minimum-standard/pages/2/ Allied health professional (AHP) musculoskeletal pathway framework: national minimum standards. Scottish Government;] 2014. <nowiki>https://www.gov.scot/publications/allied-health-professional-ahp-musculoskeletal-pathway-framework-national-minimum-standard/pages/2/</nowiki></ref> one of the solutions to address this growing need is the employment of First Contact Physiotherapists (FCPs)<ref name=":0">Goodwin R, Moffatt F, Hendrick P, Stynes S, Bishop A, Logan P. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8612276/#bib0005 Evaluation of the First Contact Physiotherapy (FCP) model of primary care: a qualitative insight.] Physiotherapy. 2021 Dec 1;113:209-16.</ref>. | |||
== First Contact Physiotherapy Model == | == First Contact Physiotherapy Model == | ||
{{#ev:youtube|nkfGekREHeE}} | {{#ev:youtube|nkfGekREHeE}}<ref>NHSEast ofEngland. What is a first contact physiotherapist? Available from: https://www.youtube.com/watch?v=nkfGekREHeE [last accessed 27/11/2022] </ref> | ||
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<ref name=":0" />. 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<ref name=":1">First Contact Practitioner. Why FCPs. Available from:[https://firstcontactpractitioner.org.uk/what-are-first-contact-practitioners/ /https://firstcontactpractitioner.org.uk/what-are-first-contact-practitioners/] | |||
(accessed 27/11/2022)</ref>. | |||
According to the [https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf NHS Long Term Plan], 98% of Sustainability and Transformation Partnerships have confirmed pilot sites for FCP and 55% of | According to the [https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf NHS Long Term Plan], 98% of Sustainability and Transformation Partnerships have confirmed pilot sites for FCP and 55% of initial implementations are already ongoing<ref>National Health Service (NHS). NHS Long Term Plan v1.2 August 2019. Available from: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf | ||
[Accessed 27/11/2022].</ref>. 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<ref>NHS England. First Contact Physiotherapists. Available from<nowiki/>https://www.england.nhs.uk/gp/expanding-our-workforce/first-contact-physiotherapists/ | |||
* | (Accessed 27/11/2022) </ref>. | ||
==== Roles of FCPs ==== | |||
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:<ref name=":2">Downie F, McRitchie C, Monteith W, Turner H. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478452/#b5 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.</ref> | |||
* Evaluate, diagnose and treat patients independently | |||
* Order diagnostic tests | * Order diagnostic tests | ||
* Administer steroid injections | * Administer steroid injections | ||
* Refer patients accordingly | * Prescribe medication (analgesia or anti-inflammatories for MSK conditions) as needed | ||
* Refer patients accordingly | |||
==== Benefits of FCP ==== | |||
There are many benefits associated with employing a model that advocates FCPs including:<ref name=":0" /><ref name=":1" /><ref name=":2" /> | |||
* Immediate access to physiotherapy | * Immediate access to physiotherapy | ||
* Reduced GP workload | * Reduced GP workload | ||
| Line 31: | Line 42: | ||
* Improved primary healthcare quality | * Improved primary healthcare quality | ||
* Reduced sickness absences | * Reduced sickness absences | ||
* | ==== Challenges of Implementing FCP ==== | ||
A study by Moffatt et al identified the following challenges of implementing FCPs such as:<ref>Moffatt F, Goodwin R, Hendrick P. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6452956/ 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.</ref> | |||
* 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 == | ||
Currently, FCP is showing promising results which can enhance the global quality of [[Physiotherapy / Physical Therapy|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.<ref>Piano L, Maselli F, Viceconti A, Gianola S, Ciuro A. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574358/ Direct access to physical therapy for the patient with musculoskeletal disorders, a literature review]. Journal of physical therapy science. 2017;29(8):1463-71.</ref> | |||
== References == | == References == | ||
<references /> | <references /> | ||
[[Category:Primary Contact]] | |||
[[Category:Rehabilitation]] | |||
Latest revision as of 06:07, 27 January 2024
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]
- ↑ 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.
- ↑ Office for National Statistics (2017) Sickness absence in the UK labour market: 2016. Available from: https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/sicknessabsenceinthelabourmarket/2016 (Accessed 27/11/2022)
- ↑ British Medical Association. NHS delivery and workforce. Available from:https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice-data-analysis#:~:text=September%202015%20to%20October%202022,-Partners&text=This%20has%20created%20a%20net,in%20the%20last%20year%20alone. (accessed 27/11/2022)
- ↑ Thomson J, Syme G. Allied health professional (AHP) musculoskeletal pathway framework: national minimum standards. Scottish Government; 2014. https://www.gov.scot/publications/allied-health-professional-ahp-musculoskeletal-pathway-framework-national-minimum-standard/pages/2/
- ↑ 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.
- ↑ NHSEast ofEngland. What is a first contact physiotherapist? Available from: https://www.youtube.com/watch?v=nkfGekREHeE [last accessed 27/11/2022]
- ↑ 7.0 7.1 First Contact Practitioner. Why FCPs. Available from:/https://firstcontactpractitioner.org.uk/what-are-first-contact-practitioners/ (accessed 27/11/2022)
- ↑ National Health Service (NHS). NHS Long Term Plan v1.2 August 2019. Available from: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf [Accessed 27/11/2022].
- ↑ NHS England. First Contact Physiotherapists. Available fromhttps://www.england.nhs.uk/gp/expanding-our-workforce/first-contact-physiotherapists/ (Accessed 27/11/2022)
- ↑ 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.
- ↑ 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.
- ↑ 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.
