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First Contact Practitioners & Advanced Practitioners - Musculoskeletal

The First Contact Practitioners and Advanced Practitioners in Primary Care: (Musculoskeletal) A Roadmap to Practice is a supportive document that provides a clear educational pathway from undergraduate to advanced practice for clinicians wishing to pursue a career in primary care.

Clinicians completing the capability framework will be recognised by Health Education England’s Centre for Advancing Practice and will be placed on a First Contact Practitioner directory.

It clearly articulates the capabilities so that employers and workforce planners can understand what the clinicians can offer to the multi-professional team to enable the best care for their patient population. It also provides clear guidance of the expected supervision needed to support the roadmap to practice and outlines the bespoke supervision training that a supervisor needs to have completed.

It is expected that all clinicians applying for roles in primary care will have completed training and have been recognised by our Centre for Advancing Practice prior to job interview by April 2022.

From April 2021 clinicians should have started either the portfolio route of have started an FCP HEI level 7 module to prospectively and retrospectively to meet this deadline.

By providing a standard of practice there is a solid governance structure around First Contact roles and advanced practice in primary care. This ensures gold standard care and puts our patient’s safety first.

Note: The mandatory e-learning modules for personalised care in the roadmap have moved onto the new personalised care platform

As MSK first contact practitioner (FCPs) move into primary care, Health Education England is funding the development of supervisors and working in partnership with leading clinical organisations to build capacity. Please see drop-down box below for a list and link to register for these courses. 

Access the roadmap under related documents or access editable versions of the appendices and stage one two and three information. 

Why do we need an educational training pathway to First Contact roles and Advanced Practice in Primary care?

FCP roles are different to the community and secondary core sectors as work as diagnostic clinicians who see and manage undifferentiated undiagnosed conditions at the first point of contact and do not have the same support from a large multi- professional team around them. It is important because of this to set a standard of practice to ensure that the roles are properly governed to keep our patients safe.


Is this a tick box exercise?

This is not a tick box exercise. It is a requirement that both stage one and stage two are evidenced with triangulated with written evidence that needs to be verified by your supervisor that maps to the documents at level 7 (masters level). This evidences that you are able to work at this level of practice both academically and that you have the ability to apply that knowledge to practice in the clinical setting. This is a requirement to be recognised as an FCP and to be placed on the FCP directory at the Health Education England’s for Advancing Practice.


Do the portfolio routes and taught routes have the same content and recognised level of practice?

Yes, both the portfolio routes and the Taught routes are mapped to level 7 to the Knowledge Skills and Attributes document and have the two sets of e-learning modules to complete.


Why can’t we just sign off against the MSK core capability framework?

The MSK core capability framework is the primary care specific capabilities required to work in that sector and just one part of the Knowledge Skills and attributes Document. The KSA document is also mapped to our professional MSK standards (IFOMPT standards) and the Multi-Professional Advancing Practice Framework. A framework outlines capabilities and competencies but a standard is a level of academic practice. FCP sits on the Advancing practice pathway so needs to include academic standards as well as frameworks.


Why is working as an AP in primary care different than working as an AP in community and secondary care?

See Question 1


What is the difference between band 7 and band 8a FCPs

Band 7s are FCPs and band 8a are Advanced Practitioners.

Advanced Practitioners have all the same capabilities as an FCP plus everything that is in their column in the table below.

Renumeration is determined by evidenced and verified capability at the level of practice that a clinician is working at.


What about clinicians that are already in the system working as FCPs and APs, will they have to do the training?

Clinicians currently in role will need to retrospectively train. This is because if you create a standard of practice, it needs to work backwards as well as forwards. It is an opportunity for focused CPD and most will cross reference easily without too much work.


What if you are an AP working in community and secondary care, would you be able to apply for a post in primary care working as an FCP?

Yes, but you will need to cross reference to the Knowledge Skills and Attributes document and do the two sets of e-learning modules in Stage 1. This is because it is primary care specific and requires a broader breadth of knowledge than other healthcare sectors as well as MSK.


What about the independent sector? Can they train to be FCPs?

Yes, individual private practitioners and are encouraged to do so. Access to supervisors and portfolio routes to practice can be found by the professional special MSK interest groups; Musculoskeletal Association of Chartered Physiotherapists (MACP), Society of musculoskeletal Medicine (SOMM), the and Advanced Practice Physiotherapy Network (APPN) and over time via a directory held by the Centre for Advancing practice once the Centre is live.

Clinicians in the independent sector can also apply and access level 7 FCP modules in Higher Education institutions in the same way as anybody else.


Why can’t band 5s and 6s be in an FCP role?

To work in an FCP role complex clinical reasoning/ decision making and critical thinking are essential as working with undiagnosed undifferentiated conditions as the first point of patient contact. They need to be able to rule out both MSK red flags and visceral masqueraders, be able to identify early serious pathology, be able to work confidently across all of the MSK spectrum, be able to work with complex co-morbidity and poly pharmacy, and bring knowledge of multiple body systems, mental health, social factors and public health into each consultation. This can only be achieved with time and breadth of experience working as a clinician, it is not something that can be learned academically and put immediately into practice.


Why do you have to have a minimum of 3 years in your area of practice before you start the primary care training?

See above plus: It is recommended if you want to work in primary care to do a rotational post first across specialties (neurology, surgery, mental health, women’s health, respiratory etc) to develop a broad base of knowledge outside MSK, multi-professionally and in different healthcare sectors to gain systems knowledge and local healthcare pathways. As well as being essential knowledge for primary care, FCP is part of the Advancing Practice pathway which as an Advanced Practitioner you work cross boundaries and multi-professionally so a great foundation if you want to work at an Advanced Practice level in the future.


What do you need to complete before applying for a FCP role?

You will need to complete stage one of the portfolio route to FCP or have completed an FCP level 7 module in a Higher Educational Institution before moving into primary care.


As a new FCP when will I be required to have the stage 1 requirements fully signed off before attending an interview for an FCP role?

From April 1st 2022 you will need to provide evidence of either a stage one verification signed by your supervisor, or a certificate of completion of a level 7 FCP module.

From April 1st 2021 you will need to have found a supervisor and start the process of cross referencing to stage one of the portfolio route both prospectively and retrospectively. To make this easier for you, starting gathering triangulated evidence from now will give you plenty of time.

If you want to do an FCP module, now is the time to start looking.


When will existing FCPs have to retrospectively evidence capability by?

By April 1st 2022


Who will supervise clinicians doing the portfolio route to FCP?

There is specific training for supervisor who will be taking clinicians through the portfolio route. They will need to be advanced practitioners or a clinician with a post registration post graduate Masters degree who works at band or above within MSK


Where will you find the relevant on Supervision course?

Initially supervisor training will be found via the APPN, MACP and SOMM, and for those working for large independent NHS providers supervisors will be available within your company. As we move closer to April 2021, supervision courses for FCPs will also be available via your primary care training hubs and /or primary care schools. In which primary care training hubs are integrated.


Can clinicians start to gather evidence against the domains of the KSA document (stage 1) with their current supervisor before the supervisor has done the supervision course?

Yes, evidence can start to be collected with your regular supervisor, but they will not be able to verify the evidence until they have completed the supervision course. It will take a minimum of around 4 months to gather the evidence, so it will allow time for people to train as supervisors.


What are the layers of governance for these roles?

- HCPC registration

- Supervision

- Care Quality Commission

- Department of Health and Social Care


Will an FCP currently in NI, Wales and Scotland and moving into a role into an FCP England  need to do the HEE training?

Yes. They will need to do this to comply with the nationally agrees standard of practice for these roles in England. They can access the Roadmap to Practice whilst living in a different nation and contact the APPN, MACP or SOMM to access a supervisor.


What if an employer says that I don’t need to do the training

If a supervisor says that you don’t need to do the training, you need to direct them to the First Contact Practitioners and Advanced Practitioners in primary care MSK Roadmap.


What if my supervisor says I do not reach the required standard? Is there an appeals process? Can I resubmit?

There will be a process via the Centre for Advancing Practice


What if I need help with the process-is there any support available?

Support will be via a recognised supervisor


Is there any funding for level 7 modules or learning to support my development?

There will be some regional support for level 7 FCP modules, the details are still being finalised. For the portfolio route there should be a mechanism locally within most workplaces to support ongoing CPD


If I want to train to be a supervisor will this need to be face to face? – AH: Can be digital – all digital currently

Currently all courses will be digital due to the COVID-19 pandemic. Face to face courses will be available alongside digital pandemic permitting.


Is there any payment for supervisors?

As an advanced practitioner, supervision is an expected part of a job role and helps to fulfil the currency of the four pillars of practice. This will become more important demonstrate this as the HCPC aligns with the Advancing practice capabilities.


Where do I find a supervisor and what if there is no-one in my area?

A clinician can contact a special interest group (MACP, SOMM, APPN) to access supervision. HEE are continue negotiations with SIGs to broaden access. There will be a directory of supervisors via Center for Advanced Practice once the Centre is live.


How many hours do you envisage the supervision process will entail?

This depends on a clinician’s starting point. Some people will require more hours than others.


Is there a specific portfolio structure or template I need to use?

Not currently – evidence should be kept in an individual file for now. Once the Centre for Advancing Practice portal is live, it will allow evidence to be uploaded.


How do I evidence the knowledge, skills and attributes?

This is outlined in the Roadmap Document in the building the portfolio section.


Can an advanced nurse practitioner be my supervisor?

Yes if they have done the supervisors course, they can supervise stage 2. Stage 1 is MSK specific so would need MSK expertise.


If I’ve done an FCP module at a HEI do I still need to do the stage 1 and 2 sign off?

No, both stage 1 and 2 are incorporated into the module


Do I have to go on to do stage 3 and become an MSK Advanced practitioner?

To be an Advanced Practitioner you do but you do not need to do stage 3 to work as FCP. It is however encouraged to continue working towards stage 3 to become an Advanced Practitioner as guided CPD. There is no stipulated time limit currently.


Do I need to do the primary care e-learning modules? – Yes

Yes, the e-learning modules are a requirement for all routes to practice.


Will I be able to sign fit notes as an FCP?

Recognised FCPs and APs will be able to sign DWP fit notes in time as on the Advanced practice pathway, a specific e-learning module will be designed to support this. In the meantime, an AHP fit note is to be used.


What if my employer does not give me time to do my  training and portfolio?

This needs to be negotiated locally. If there is an issue with access to training, contact your local CSP steward to discuss. It is recommended that employers allow time for CDP.

Eligibility: To be an FCP supervisor you need to work in MSK as an Advanced Practitioner with a post-graduate Masters degree, in a current team lead post in MSK and hold a post-graduate Masters degree in MSK, or work as a consultant physiotherapist working in MSK.

The courses will be able to take a maximum of 14 places and open to a maximum of two supervisors per Trust/CCG. Please note, these are two-day courses, you will need to be available for both days and will only be recognised as a supervisor if both days are completed. 

Advanced Practice Physiotherapy Network 

 - Wednesday 9 and Friday11 December 2020
 - Wednesday 6 and Wednesday 13 January 2021
 - Tuesday 19 and Thursday 21 January 2021
 - Thursday 11 and Monday 22 February 2021
 - Wednesday 10 March and Tuesday 23 March 2021

Contact APPN to book here

Society of Musculoskeletal Medicine 

 - Friday 27 and Monday 30 November 2020
 - Monday 7 and Monday 14 December 2020
 - Friday 8 and Friday 22 January 2021
 - Thursday 11 and Friday 12 February 2021
 - Thursday 11 and Friday 12 March 2021

Contact SOMM to book here

Musculoskeletal Association of Chartered Physiotherapists 

 - Thursday 26 and Saturday 28 November 2020
 - Saturday 12 and Sunday 13 December 2020
 - Monday 14 and Tuesday 15 December 2020
 - Sunday 16 and Saturday 30 January 2021
 - Saturday 6 and Thursday 11 February 2021
 - Monday 22 and Tuesday 23 February 2021
 - Saturday 6 and Monday 8 March 2021
 - Saturday 6 and Saturday 20 March 2021

Contact MACP to book here soon


Access the FCP/AP Roadmap Trainers and Supervisors Survey. 

The purpose of this survey is to establish and record whether you have completed the FCP/AP Roadmap ‘train the trainer’ or ‘supervisor’ course.

This survey is an interim measure that will be superseded by an online portal created by the supplier Axia, in the near future. Your data will be shared with the supplier of the portal. We will use anonymized data for the purposes of research and service improvement.