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Physio ‘first contact’ service set to be rolled out next year in GP practices

GP practices may be able to provide patients with direct access to a physiotherapist, rather than with a GP, from next year.

NHS England’s national director of primary care, GP Dr Arvind Madan, told delegates at the RCGP’s Annual Conference last week that it was his ambition to roll the change out nationwide in 2018.

Some areas found piloting self-referral to physiotherapy managed to slash costs by a third, and Dr Madan said that NHS England is working with ‘several partners’ on developing a national scheme, and more details would be presented in future.

NHS England confirmed that physiotherapy services would be based in the community rather than hospital settings and ‘may or may not be in practices’.

The results of a pilot of ‘first-contact’ physiotherapy at Keele University were presented at RCGP conference. It looked at the use of ‘extended scope’ physiotherapists in one GP practice in Cheshire for 10 months and they found 95% of patients who saw them instead of a GP were ‘satisfied’ or ‘extremely satisfied’ with their treatment.

Dr Madan told delegates: ’There are other efforts, such as increasing self care, community pharmacy, social prescribing – which you’ve heard about – and direct access services. 

‘My ambition next year is to start the rollout of first-contact physiotherapy across the country. So that patients with musculoskeletal issues can have direct access to musculoskeletal professionals and they don’t always, necessarily, go by the GP consulting room.’

When asked about potential risk of physiotherapy services being overwhelmed, Dr Madan said this had not been the case in pilots, adding: ’The supply-led demand side, it’s not been the burden it could have been.’

GP leaders said direct access was a ‘no brainer’ but cautioned that practices should not be expected to fund the employment of these new professionals.

Doncaster LMC medical secretary Dr Dean Eggitt said they did not have the scheme locally but he was aware of areas – like Wakefield – that have implemented it.

He told Pulse: ‘I think it’s a no brainer, but I just don’t want to employ them because they’re not going to give me the money to invest.’

Dr Eggitt drew a parallel to other NHS England initiatives for bringing non-GP health professionals into practices to help relieve the workload burden, such as the clinical pharmacist scheme.

GP leaders have raised concerns that the funding for clinical pharmacists is phased out after three years, meaning practices have to cut costs elsewhere to maintain the service.

Dr Eggitt said: ‘If it works like the pharmacy scheme, then don’t bother.’

At the same RCGP conference session, Dr Madan said two practices are closing a week, despite ‘working at scale’ initiatives aimed at merging or federating practices to allow them to better absorb pressures

He said: ‘We’ve got examples of practices where they would have folded had they not been part of these collectives that have helped them get through difficult patches.

’Nevertheless we’re still losing two practices a week and we need to be working very fast to rescue those in that situation.’

How it could work

Around a fifth of all GP consultations are for musculoskeletal skeletal conditions and the idea behind ‘first contact’ schemes is that these patients may benefit from seeing a physiotherapist instead.

The most successful models involve ‘first contact’ physiotherapists working within the GP practice team and also being part of a larger physiotherapy service in a secondary care or community setting to ensure they are adequately supervised.

More physiotherapy student places are being provided by universities from 2017/18 and ‘first contact’ physiotherapy roles in general practice are also being developed from within the existing workforce, with physiotherapists from triage or interface services, and hospital outpatients transferring to primary care and GP practices – either in full or part-time roles.