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Physiotherapist
There are four main areas where physiotherapists can support in primary care
Musculoskeletal
First contact practice is an increasingly established model of care designed to deliver a streamlined, patient-centred service and support the growing demands on general practice.
Our goals:
- Support GPs by taking on the MSK caseload creating capacity to focus on medically complex patients
- Create an efficient MSK pathway for patients
- Reduce diagnostics
- Improve the quality of referral and conversion rate to surgery in orthopaedics.
"Reduces unnecessary imaging, reduces secondary care referral with increased quality and conversion rate to surgery, reduces prescribing costs and allows more time for GPs to manage medical complexity."
Just 20% of patients consulting the FCP reported visiting their GP for the same problem
54% of patients’ reported less impact of their MSK condition on work performance at 3 months (as measured by the Stanford Presenteeism Scale
Rehabilitation
Enabling and supporting individuals to recover or adjust, to achieve their full potential and to live as full and active lives as possible. Rehabilitation should start as soon as possible to speed recovery, so early rehabilitation in primary care is essential. Research shows it can improve mobility and activity levels, shorten the amount of time spent in hospital or off work and greatly improve the quality of your life. Physiotherapists in primary care support the following activity and benefits:
- Prehabilitation: identification of early indications for rehabilitation and getting fit preoperatively to aid post-operative recovery
- Early intervention prevents acute conditions from becoming a chronic issue and improves the speed of recovery
- Post operative rehabilitation expedites recovery from operative procedures and safeguards against complications
- Rehabilitation prevents deconditioning and safeguards against further problems.
Our goals:
- improve rates and speed of recovery
- prevention of chronic issues
“My first impression, it’s been excellent, it’s had me in and out of here way quicker than it would have done if I’d have had to wait for the GP. And actually [FCP]’s knowledge and expertise is much more specific to the problem …than possibly a GP who again, I’m just stereotyping, who possibly would have focussed on the pain, and the pain relief, rather than the rehabilitation” – Patient
95% of patients received sufficient information from their FCP on self-care relating to their MSK problem
227,000 people per year have a MSK disorder of the back, 215,000 upper limbs and neck and 96,000 of the lower limbs. Evidence shows early rehabilitation reduces the burden on the MSK pathway and enables patients to remain in work.
Frailty
Our goals:
- reduce the number of falls
- reduce unplanned GP visits, 999/111 calls, ED attendances and unplanned admissions
- improved patient mobility and self-care
- improved understanding and concordance with medication
- increased quality of life for patients
- improved links with acute and community providers and 3rd Sector and the wider cross-organisational teams
“intervention improved confidence by 97%. 63% of patients had an overall improvement in condition”
94% of patients reported being ‘Likely’ or ‘Very likely’ to recommend the FCP service to friends and family.
Public health
Physiotherapists positively affect the physical mental and social wellbeing of individuals, communities and populations.
Our goals
- prevention of ill health
- management to support rehabilitation
- reduction in sickness absence
- reduced requests for GP Fit notes
- social prescribing
Patients spoke confidently about the self-management advice they had been given and also described an associated sense of self-efficacy.
“I really love working in the clinics. I feel you’re just getting to people so much quicker and giving them the right information to make changes” - FCP
A story from BOB–Roadmaps to practice for first contact and advanced practitioners in primary care
In the south east region of Buckinghamshire, Oxfordshire and Berkshire, (affectionately known locally as BOB) the integrated care system (ICS) teams are always keen to promote the range of portfolio career opportunities in general practice. A number of our clinical leads have been working with Health Education England (HEE) to develop a set of ‘roadmaps to practice.’ They outline the educational pathway from undergraduate to advanced practice for clinicians who want to work across primary care. They provide a solid governance and quality structure around advanced and first contact roles that give clear guidance. There are five roadmaps on the website covering dietitians, occupational therapists, paramedics, MSK physiotherapists and podiatrists.
No matter how qualified and experienced allied health professionals (AHPs) already are, we knew that employers and workforce planners needed to better understand how the skills and experience this group of clinicians had to offer, could best work in general practice. Most importantly we want to help grow our local workforce and build in greater capacity so that we can offer more patient consultations and provide the best care for our patient populations.
BOB identified two independent companies in the area, who provide first contact physiotherapy services for the NHS and approached them with a plan! Both organisations saw the value in what we were trying to achieve and agreed to train two supervisors-one from each of the companies. This meant we could begin to identify which clinicians were interested in a portfolio type career.
Both Practise Plus Group (PPG) and Principle Medical Limited (PML) found 10 staff who fitted the entry criteria and wanted to give the road map route a try. Supported by funding from HEE and using trained roadmap supervisors, we decided to pilot a pathway with our first cohort, giving feedback to the national roadmap supervisor team as we went along.
Inevitably, the COVID-19 pandemic meant that some of our normal face to face training developed into online but on a positive note that meant we were able to support clinicians across a large geographical area and actually it worked out well. Although some clinicians struggled initially with the concept of evidencing their practical knowledge, they soon began to realise that this was good CPD and feedback showed that both the supervisor and supervisee ended up with a better understanding of each of their roles. One challenge we came across early on, was that if a supervisor became unavailable for any reason, it meant the road map was going to take longer to complete. We quickly concluded it would be best if each clinician could identify a backup supervisor which meant they could continue with appropriate sign off on workplace-based assessments as well as any other portfolio requirements.
We noticed a general lack of supervisors for AHP clinicians in primary care (I think we had known this for some time) so we had to come up with a workable solution –fast. It didn’t take long for our three training hubs within the patch, to ring fence some funding for one year to create and pay for three AHP supervision fellows. They are employed to support and supervise our first contact practitioner (FCP) roadmap candidates, working alongside an existing GP who was on a mid-career fellowship and two other GP fellows. In effect we managed to create a network of appropriate supervisors. Each fellowship post is 1.5 days a week.
Marie-Clare Wadley, AHP, FCP, and AP Education Lead for BOB ICS and Thames Valley, at Health Education England said: “I’m really pleased that this roadmap pilot has proved to be such a success. It’s allowed us to fully understand the value of employing first contact practitioners to provide good, safe patient care in the right place at the right time. It’s made us realise that the formalised structure of critical reflection has long been needed and is now brilliantly supported. If each fellow trains or supervises six first contact practitioners over six months, that means after the years fellowship, we’ll have at least 50 clinicians signed off against stage 2 of the roadmap.” If you’re thinking about taking on first contact practitioners in your practice, get in touch with your local training hub and take that first step.
Useful links
Day in the life - of VR video’s https://hee-vr360.azurewebsites.net/
AHP superpowers - https://www.hee.nhs.uk/our-work/allied-health-professions/ahp-superpowers
Evaluation report on patient outcomes, Roadmap to Practice training and supervision and Qualitative Evaluation - https://healtheducationengland.sharepoint.com/:b:/g/Comms/Digital/EY4ZH6...