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The waiting game

First-contact physio 'can deal with 99% of MSK patients'

First-contact physiotherapists based in general practice can deal with 99% of patients with musculoskeletal conditions without GP review, a two-year audit has found.

Analysis of data from a service set up in the Forth Valley found that only 1% of 8,417 patients who had been seen by an ‘extended scope physiotherapist’ across two practices had needed GP advice.

Most patients were directed to the physiotherapists by reception staff or after phone triage with a nurse and were seen that day or in the next one to two days.

The new GP contract in England commits to providing networks with 70% of the needed to employ a first-contact physiotherapist from 2020. However, experts warned that the results may not be replicated in England. 

The results of the study published in the British Journal of General Practice, showed that 12% of patients needed a prescription and 3% a fit note but these had been provided by the duty GP without the need for an appointment.

In all 87% of the patients were ultimately managed in primary care and 60% could be self-managed with advice or a brief intervention.

The researchers also found a drop in orthopaedic referrals after the service was put in place - with only 3% passed on to a specialist, with 86% of referrals made by the physiotherapists deemed appropriate.

Physiotherapists were also trained to administer steroid injections and in both practices the numbers of injections being done increased substantially from 43 and 36 in the year before the service was set up to 251 and 169 in the second year.

A survey of 75 patients who had used the service found 97% had confidence in the physiotherapist they had seen and 92% happy with the amount of time provided.

The researchers said while similar services – with patients able to see a physiotherapist without referral from a GP – were starting to emerge throughout the UK, largely in response to doctor shortages, this is the first published data on outcomes.

NHS England have previously announced plans for better access to first-contact physiotherapists with several pilot schemes underway around the country.

Study leader Helen Turner, an extended scope physiotherapist at Kersiebank Medical Practice in Grangemouth, said the project in Forth Valley had been an ‘excellent example’ of healthcare professionals working together to tackle service pressures and improve local care.

‘The results from the first two years of our service demonstrate great opportunities exist to use physiotherapy to reduce GP workloads with up to 25% of a GP’s caseload being related to musculoskeletal conditions.’

Dr Louise Warburton, a GP with special interest in MSK in Shropshire and researcher at Keele University said it was an interesting study but the results may not be replicable in all services as it was dependent on the experience of the physiotherapist.

‘This study uses ESPs who are band 7 or 8 experienced physios and independent practitioners.

‘They are used to managing their own caseload and can probably cope well working alone in primary care.’

She said many pilots in England were using less experienced physiotherapists – band 5 or 6 - and so referral rates, etc, would not necessarily be the same.

‘I would be cautious about extrapolating to all areas as the results would not be as impressive.’

[citation - Br J Gen Pract 2019; DOI:]


Readers' comments (8)

  • Vinci Ho

    Told you so .
    My mother is a woman!
    So why do we still have to wait a year or two to have community physiotherapists attached to GP networks??

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  • Took Early Retirement

    One of the reasons we were told this could no longer work in our area was that there were no generic physios anymore. They had all sub-specialised. Someone was clearly lying to us.

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  • Using physiotherapists as first contact is really not new ! Self referral into physio has been around for over 20 years with good effect. The question that has to be asked is which group of patients are these FCPs seeing? We all know that if you open up a new clinic it will be filled. We hear that a small number were referred to GPs and Secondary Care and this is "evidence" of saving appointments but there is no evidence presented that less GP appointments actually happened. How many would have got better anyway and we have simply added extra face to face capacity and cost? Many self referral services utilise telephone triage and soon to be artificial intelligence. So whilst the move to use physiotherapists more is laudable, exclusive use of highly paid Band-8s seeing un-triaged all-comers may prove a loss leader. we need to have a comparison with established self referral services and direct data on whether FCPs actually reduced GP time!

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  • Band 8 £46K/year-just saying

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  • "This study uses ESPs who are band 7 or 8 experienced physios and independent practitioners."

    Here is the problem. There is a national shortage of physio (just like GPs), let alone finding sufficient band 7/8.

    Add to this the cost of band 8 ESP (circa £50k if on costs included) and it soon starts to become apparent why we have generalists in primary care rather than many specialists!

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  • Physios best placed to deal with their own area of expertise. FFS, cutting edge outcome that.

    How about suggesting opticians better placed to deal with eyes than GPs too. I'll look into that one if you give me the cash to do a 2 year study.

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  • This is nice, and great. It won't reduce GP workload though. Only one thing will do that...

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  • We have them. They are charming individuals. We don't pay them. When the funding dries up I won't be looking to employ one with my own money as they don't actually do very much.

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