One of the most exciting of all the additional roles that are available to Primary Care Networks (PCNs) are First Contact Physiotherapists (FCPs).  This is because they have the potential to take on a significant amount of the general practice workload, and provide some much needed support to GP practices struggling to cope with the sheer volume of demand.  But what do PCNs need to do to ensure FCPs are able to fulfil this potential?

I spoke recently to Larry Koyama from the Chartered Society of Physiotherapy (CSP) on the podcast (you can listen to the full conversation here).  There is lots of great information on the CSP website about FCPs (e.g. here), but out of my conversation with Larry I took 3 key lessons for PCNs to make the most of their FCP:

1. Ensure the Patient Sees the FCP First

Ok this might sound obvious to some, but there are some places where patients are being referred by the GPs to the FCP.  FCPs are (as described by Health Education England), “Regulated, advanced and autonomous health professionals trained to provide expert MSK assessment, diagnosis and first-line treatment, self-care advice and if required, appropriate onward referral”.  The role of FCPs is not to provide physiotherapy for those patients GPs assess as needing it; rather their role is to provide that initial assessment themselves.

The pathway PCNs need to create is for practice receptionists to be able to book patients directly into FCP appointments.  According to NHS England MSK conditions account for 30% of GP consultations in England, so the potential for workload to be diverted away from GPs via this pathway is huge.

2. Base the FCP at a Single Site

The default guiding principle for GP practices working together is often equity.  Whatever service or scheme is being put in place GP leaders often have to work hard to ensure it is seen as equitable by all of the practices involved.  What this in turn often translates to when it comes to the PCN additional roles is they are split between all the member practices, so they might be at practice A on a Monday, practice B on a Tuesday, practice C on a Wednesday etc.

The problem with this approach is that, while it may well be equitable for the GP practices and their patients, it makes it very difficult for the new roles to feel they really belong anywhere.  Instead they are treated as visiting clinicians by every practice, and they never feel at home.  And when staff feel they do not belong, they do not end up staying very long.

On top of that, FCPs are new roles into general practice.  It is already difficult for the new starters to try and adapt to the general practice environment.  This sense of overwhelm the new recruits feel is exacerbated when they are have to get used to 5 or 6 different GP practices all at the same time.

A better model for PCNs is to establish a “host” practice for the FCP service, and set up a system whereby each practice can book appointments with the FCP for their patients.  It may be more work for the PCN leaders, it may be less popular with the member practices (less equity), but it will make it as easy as possible for the FCP to feel at home in the PCN, to feel supported, and to make the new way of working as effective as it can be for the practices.

3. Link the FCP into the wider MSK system

Larry Koyama reported in our conversation that the CSP had looked at all the employment options for FCPs (including individual GP practices and PCNs) and they recommend that existing providers of NHS physiotherapy services employ FCPs.  This means they think that the best employer is actually the local community or acute trust.  The rationale is that it helps to embed and integrate FCPs across the MSK pathway (where they can access training and peer support), and the provider can ensure service consistency and staff continuity.

Now as well as equity, GPs prefer direct control, and I suspect few PCNs are minded to buy in their FCP service from the local trust.  However, what PCNs can do is make sure that professional training and development, as well as mentoring and peer support, is provided by the existing local provider.  This will ensure their FCP is not isolated, as well as linking them in to the wider local MSK system.

This year PCNs are only able to employ one FCP this year, but that number will go up next year.  By working hard now to support the FCPs they do have, PCNs will be in a great place to attract more FCPs in future and make the most of all they have to offer.