The MSK workforce in the NHS, the social enterprise and voluntary sector and private practice can be utilised within primary care to yield system-wide benefits – reducing the pressure on GPs and making savings in secondary care. An expansion of MSK services within primary care provides an immediate solution to GP shortages and delivers the transformation of primary care needed for a sustainable health system tailored to modern population needs.
Musculoskeletal (MSK) conditions make up to 30% of a GP’s caseload. This rises to 50% for patients over 75. Yet 85% of those do not need to see a GP. This means millions of appointments could be freed up for other patients each year if patients were offered a choice of professional as their first point of contact. GPs are now choosing to bring in MSK Practitioners to work alongside them as the first contact practitioner for their MSK patients.
Within Gloucestershire we have several Advanced Physiotherapist Practitioners working for both practices and for networks and delivering care to our patients in a variety of ways.
The Gloucestershire Advanced Physiotherapist Practitioner’s from the St Pauls Primary Care Network in Cheltenham to the Chartered Society of Physiotherapists have submitted a paper to the Chartered Society of Physiotherapy Innovations.
This video gives an overview of how it has worked in Gloucestershire. For a more personal view of what it’s been like for one of them; you can read Hannah’s Story
Currently, evaluation of the Advanced Physiotherapist Practitioner Pilot within Cheltenham, is being undertaken looking at Risks, Liabilities, Access to Diagnostics, Data recording and collection & Models of Delivery is being undertaken.
As part of the new GP contract, through a new Additional Roles Reimbursement Scheme, Primary Care Networks (PCNs) will be guaranteed funding to meet a recurrent 100% of the actual on going salary costs of additional First Contact Physiotherapists.
The eligible maximum pay against which the 100% reimbursement will apply is the sum of (a) the weighted average salary for the specified Agenda for Change band; plus (b) the associated employer on-costs.
The reimbursement for First Contact Physiotherapists will commence in 2020/21 and will be at band 7-8a level.
The resources below provide further information about how Physiotherapists can work in Primary Care.
International Fellowship – Advanced Practice in Physiotherapy
Hannah Morley is one of Gloucestershire’s fantastic Advanced Physiotherapist First Contact Practitioners who is taking part in an International Fellowship in Australia and New Zealand.
As part of the Fellowship, Hannah has authored an analysis of the education programmes for Advanced Practice Physiotherapists in Queensland, Victoria and Christchurch. The full article can be found here where Hannah explores the range of educational programmes encountered and compares the different approaches in the different locations. Hannah makes several recommendations regarding Frameworks and guidelines, Career Pathways, Educational Coordinators and credentialing, which could be considered when developing the advanced practice educational programme in the UK. Physiotherapists will play a vital part in the skill mix for the Additional Roles in Primary Care, which will be 100% funded.
Find out more about Hannah’s story here; https://glosprimarycare.co.uk/physiotherapists/hannahs-story and there is also a lively and informative blog from Hannah here: https://advancingpractice.home.blog/
Chartered Society of Physiotherapists – CSP Click here >
First Contact Physiotherapy posts in General Practice -A guide for implementation in England. May 2018 CSP- Click here >
“Think Physio for Primary Care”- CSP Click here >
Example Primary Care Physiotherapist Job Description – CSP Click here >
To support the transition of practices working with or employing MSK First Contact Practitioners, a summary of the Implementation Guide developed by HEE can be found here. https://glosprimarycare.co.uk/wp-content/uploads/2020/01/FCP-How-to-Guide-v21-040919-2-HEE-Jan-2020.pdf
Patient Satisfaction Survey https://glosprimarycare.co.uk/wp-content/uploads/2020/04/APP_-_Patient_Satisfaction_Questionnaire.pdf
Advanced clinical practitioners
This website may be useful for more information:
Health Education England – Advanced Clinical Practice Click Here >
These websites may be useful for more information:
NM Prescribing Click here >
University of the West of England Click here >
New Musculoskeletal Primary Care e-learning program
Health Education England e-Learning for Healthcare (HEE e-LfH) has developed the musculoskeletal (MSK) primary care e-learning programme to support clinicians working in primary care as first contact practitioners (FCP).
The programme is as a resource to support clinical competency assessment and sign off through a clinical training programme. The programme provides eight modules that take the learner through a range of primary care issues that are commonly seen as part of a MSK FCP assessment.
The modules have been designed to complement the MSK core capabilities framework that outlines the expected clinical capabilities that a competent clinician should be able to demonstrate when working in this field of clinical practice. All the modules have been produced with a person-centred approach (PCA) and it is recommended that clinicians complete the PCA e-learning modules that are also available on the e-LfH Hub.
The MSK e-learning programme consists of eight modules:
- Module 1 – What is primary care
- Module 2 – Identification of the ill and risk.
- Module 3 – Mental health
- Module 4 – Complex decision making
- Module 5 – Public health
- Module 6 – Persistent pain
- Module 7 – Pharmacology
- Module 8 – Serious pathology
Each module includes self-assessment and a certificate of completion.
The MSK e-learning programme is available on the e-LfH Hub, the Electronic Staff Record (ESR) and via AICC.
For more information about the e-learning programme, including details on how to access, visit: https://www.e-lfh.org.uk/programmes/musculoskeletal-primary-care/.