Advanced Physiotherapists in General Practice
February 8, 2019
Advanced Physiotherapists in General Practice offer safe and effective services that cut secondary referrals, saves money and reduces pressure on GPs
Musculoskeletal (MSK) health issues are the most common cause of repeat GP appointments and account for around 1 in 5 of all GP appointments. Most of them can be dealt with effectively by a physiotherapist without any need to see the GP. With an increasingly ageing population and with more people living with long-terms conditions like osteoarthritis and back pain the demand for MSK services is set to rise. These population trends, combined with GP shortages, are placing ever-greater pressure on General Practice.
In the General Practice Forward View published in 2016, NHS England proposed primary care physiotherapy pilots as a solution to the pressure in General Practice. The BMA, Urgent Prescription for General Practice (2016) makes clear its recommendations that an ‘expanded workforce in and around the practice’ includes physiotherapists. In many regions, change is already happening, with many GPs bringing in experienced physiotherapists to work alongside them as the first point of contact for their MSK patients. The pilot sites have already demonstrated tangible benefits which include:
- Less MSK related appointments
- Reduced need for locum appointments
- More time to manage complex medical cases
- In-house MSK expertise gained
- Quick access to specialist advice
- Accessing the correct care pathway earlier
- Longer appointment times, meaning patients feel
listened to, cared for and reassured
- Opportunity to gain lifestyle/physical activity advice
- Empowered to self-manage their condition
For the NHS
- Less testing and prescribing
- Reduced secondary care referrals
- Shorter waiting time in secondary care
- Improved conversion rate to surgery when referrals
Furthermore, Musculoskeletal disorders are the second largest cause of sickness absence and it is therefore important that fast access to appropriate advice and treatment is available. It is also expected that the government will push ahead with plans to enable physiotherapists to issue Fit Notes which will save further workload for GP’s if physiotherapists are placed at the front of the patients journey in primary care.
Research shows physiotherapists are the most expert professional group regarding Musculoskeletal disorders and increasingly work in advanced practice or consultant roles. They have the same high safety record as GP’s and are trained to identify and act on red flags. They are autonomous, regulated practitioners and hold their own professional liability.
Many advanced practice physiotherapists are qualified to prescribe independently, order investigations, carry out injection therapy and plan complex case management. To support these roles NHS England and Health Education England have created a Musculoskeletal core capabilities framework for first point of contact practitioners which will ensure clinicians are appropriately skilled for such positions.
Self-referral to physiotherapy allows patients to access services directly without having to see their GP or anyone else first. If after this consultation it is felt the patient would benefit from a course of physiotherapy then referral to the existing service could be arranged.
Having a physiotherapist make these decisions about which MSK pathway the patient should follow should lead to the optimal patient journey every time reducing unnecessary variance and increased patient satisfaction.
Expanding the GP’s team
The potential of these roles is being recognised by policy makers across the UK. We have already seen the successful expansion of the team in General Practice with Advanced Nurse Practitioners and Clinical Pharmacists and with the addition of Advanced First Contact Physiotherapists the team approach in General Practice can become a reality. Already over 8 out of 10 GPs have confidence in this model.
The majority of physiotherapy services already within General Practice were set up through pump-priming using the NHS Vanguard funding and the Prime Minister’s Challenge Fund.
GP Practice Funding
GP practices may consider funding their own physiotherapy services. This can be done in the following ways:
- Contracting – where the physiotherapist/s are paid at an
hourly rate for their services
- Directly employing a physiotherapist and paying them a salary
- Inviting a physiotherapist to join the practice as a partner
Co-commissioning aims to support the development of integrated out of-hospital services based around the needs of local people. It is part of a wider strategy to join up care in and out of hospital. So primary care-based physiotherapy services may well be commissioned by local CCGs via co-commissioning in the near future. This would be one way of enabling services that were initially funded through pump-priming to move to business-asusual commissioning.
- MSK complaints account for 1 in 5 of GP appointments
- 8 out of 10 GP’s have confidence in this model
- When actively marketed to 10,000 adults registered in practices in a trial, there was no increase in referral to physio or waiting times.
- Patients in more than four out of 10 CCG areas can see a physiotherapist in a GP practice as their first point of contact with the NHS
- £4.76 billion NHS spending each year on MSK disorders.