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A faulty production line

Physiotherapists say they should be able to sign fit notes to ease GP workloads

The Chartered Society of Physiotherapy has called for physiotherapists to be employed in practices, and to be able to sign fit notes in a bid to reduce GPs’ workloads.

Doctors at the BMA’s Annual Representatives Meeting voted that patients should be able to self-certify illness for 14 days, rather than a week as it is currently.

Jenny Nissler, CSP professional adviser said ’providing fit notes adds to GPs’ workloads’, and ’other professionals, such as physiotherapists, have the skills and knowledge to be able do this’.

She added: 'Trained to identify possible serious pathology in the same way as doctors, physiotherapists are physical activity specialists. They can support people in returning to work sustainably, or to avoid an absence in the first place – which is good for people, employers and the economy.

‘By rolling out direct access to physiotherapy, for example in GP surgeries, and potentially optimising the use of fit notes, it is possible to keep people fit for work and ease the strain on general practice.’

Instead of increasing the self-certification period, the CSP suggests giving patients direct access to physiotherapists in GP surgeries.

Karen Middleton, CSP chief executive, said: ‘Our modelling shows that providing direct access in practices would free up GPs to spend an extra five minutes with their patients, as well as saving the average practice £1,000 a week.’

’Patients with a musculoskeletal condition can account for up to 30% of caseloads so it’s no surprise that GPs are increasingly bringing in physios to work alongside them as a first point of contact.’

Readers' comments (5)

  • I am interested to know how a practice can "save" £1000 per week. Who is going to pay the physiotherapists? and how will this system increase the time GPs can spend with, is this an extra 5 minutes per week? 5 minutes per patient????

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  • No NO NO NO NO Nooooooooooooooooooo!

    Please someone get these academics to understand primary function of a health care system is not to supply a sick note but to treat/prevent/monitor illnesses. Making it easier to obtain a sick note is only reinforcing the misconception of the British society that working is an optional past time, reserved for those crazy enough not to live on freebie.

    Some of the phrases professional sick note users say to me;
    "I'm not ready to go to work"
    "I need to recharge my batteries"
    "I want to be off sick until my holiday in 3 weeks"
    "I want to be off till I find a different job"
    "I want a sick note to show them how stressed I am"
    "Working is not for me"
    "It's hard to work with 4 children"
    etc etc

    People need to wake up & smell the coffee - this kind of luxury does not exist out of this island and resources have long run out to keep this luxury going. We are trillions in debt!

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  • It's a great idea to allow them to issue sick/fit notes as Physios will know more or less how long the condition may last and could give patients an explanation of why the duration of sick leave should be as it is. They are good at returning people to work with advice on conditions. It will certainly save unnecessary visits to the GP.
    However, they are welcome to work in Surgeries but directly employed by NHSE without burdening GP finances any further.

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  • Actually having physios as part of the practice team would have a massive impact on workload giving the incidence of musculoskeletal complaints in primary care.

    This suggestion could work well if the physios could see patients at the first point of contact rather than requiring referral down the line.

    The only problem I can see is there not enough physios to take on the demand. One physio in each practice would not be enough as up to 30% of surgeries involve some msk element.

    If we had truly mixed teams in GP surgeries (e.g GP, physio, pharmacist , specialist nurse) with pt's directing themselves to the most appropriate first contact it should help.

    The concern around who would fund the skill mix is a valid one. There is no more fat to trim off general practice so if NHSE wants to fund proper skill mix I am all for it.

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  • The Chartered Society of Physiotherapy would like to respond to the questions asked:

    1) where does the £1,000 come from? This is based on putting national average figures for the proportion of a GP caseload that is MSK through our model. Essentially, if physiotherapists see MSK patients rather than GPs it saves a considerable amount of GP time, such that in some cases GP practices no longer need to employ locums. The saving comes from not spending on locums but instead spending on physiotherapists, which is more cost effective.

    2) where does the 5 minutes come from? If the practice decided to keep the locums to maintain GP hours as well as bringing a physiotherapist onto the practice team, they would therefore have the opportunity to see other patients on average 5 minutes longer. This might mean more complex medical patients can get the care they need from GPs.

    3) In either scenario, cost savings are also achieved by reducing unnecessary orthopaedic referrals, tests and treatment in secondary care

    4) where do the physios come from? In areas where this is implemented we see demand for community MSK physiotherapy services decrease. So although there is a current shortage of physiotherapists across the health and care system, it’s still possible for the current physiotherapy workforce to be deployed differently to provide this capacity in General Practice. i.e. there needs to be a shift of the workforce from secondary to primary care and a shift in service design alongside it.

    5) where does the money come from? There are a number of different funding models for these services. It seems that direct funding from CCGs via co-commissioning is one viable option. In the longer term, new models of business that integrate primary and secondary care should enable services to be funded through the realisation of savings from both secondary and primary care.

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