First contact physiotherapy

Developing programme theories to understand 'First Contact Physiotherapy' in Primary Care: A rapid realist review (FRONTIER)

First Contact Physiotherapy (FCP) is a new primary healthcare model in which a specialist physiotherapist in Musculoskeletal Disorders (MSKDs) located within general practice, undertakes the first patient assessment, diagnosis and management without the requirement for prior GP consultation. It is intended to provide additional capacity and diversify the primary care workforce to meet the high demand for MSKD appointments and the challenges of recruiting and retaining GP staff. Initial audits of the service propose the FCP model may free up GP appointments, reduce secondary care referrals and scan requests, improve patient satisfaction, and produce cost savings. However, there is a lack of robust research evidence, and limited understanding of how best to implement FCP given contextual variation in general practices across the UK. This rapid realist synthesis generated and refined programme theories to develop insight into “What it is about FCP in Primary Care that works, for whom, in what circumstances, how and why?”. This was the second stage of a four-part project exploring the FCP role.

Identifying Stroke in the Dizzy ED Patient: Development of a Vertigo Assessment Tool by Literature Review

Dizziness is a debilitating symptom reported by 5% of adults per annum and accounts for 2.5% of visits to the Emergency Department (ED) in the US.

The terms dizziness and vertigo are used interchangeably in modern literature and research has focused on categorising symptom timing and trigger to aid diagnosis.

Of dizzy patients presenting in the ED 71% have benign peripheral vestibular dysfunction which closely mimics those with posterior stroke (3-5%). When patients present with “sudden” and “persistent” vertigo the chance of posterior infarct increases to ~25%.

Despite the publication of physical assessment tools such as HINTS+, TiTrATE and the Dix-Hallpike, pitfalls to diagnosis such as overreliance on imaging remain.

It is proposed that a clinical assessment tool, together with an education package, will embed evidence-based assessment in the ED and enable physicians, specialist nurses and physiotherapists to triage and treat this complex condition.

Advanced Physiotherapy Practitioner consultation as an alternative to GP consultation for patients with Musculoskeletal Conditions

General Practice is currently experiencing considerable capacity and sustainability challenges. With General Practice carrying out 90% of patient contacts in the NHS and musculoskeletal (MSK) conditions accounting for 10 - 30% of GP appointments it is essential to explore new ways of coping with this demand.

In Midlothian, half the practices were operating with restricted lists as a result of increasing demand: a demand which is predicted to quickly rise as the influx of new housing has resulted in Midlothian being the fastest growing local authority area in Scotland.

The strategic principle of this work is therefore to redirect appropriate patients from General Practice to MSK APP services with the aim of:

•           improving GP capacity.

•           improving patient outcomes.

•           improving the patient experience.

•           being cost effective and efficient.

•           enabling quick and easy access to highly specialised musculoskeletal input.

•           reducing referrals to secondary care, helping throughput and improving the conversion rate to surgery.

Single-Arm Observational Service Evaluation: Efficacy of a Single Advanced Physiotherapy Practitioner Intervention for Patients with Chronic Musculoskeletal Pain.

Musculoskeletal (MSK) conditions account for a significant portion of General Practitioner (GP) consultations and are therefore a burden on our health service and especially primary care as these conditions are largely managed within primary and community care. Patients with chronic MSK conditions consult with their GP five times more often than those without and as the age of the population increased this burden is expected to add increased pressure to primary care.

First Contact Physiotherapists (FCP) work at an advanced level of practice as first contacts within primary care and provide a possible solution for these patients. The proliferation of these roles over the last few years has been supported in the literature through studies reporting on the impact of FCP services and satisfaction surveys. NHS documents such as the Long Term Plan also promote an increase in FCP roles and organisations such as the Chartered Society of Physiotherapy and the Royal College of General Practitioners have endorsed FCP. Patients find this role to be an acceptable alternative to accessing their GP for specific conditions which supports these roles from the patients’ perspective.

Despite this support there has been very little evidence to demonstrate the efficacy of FCP services on patient outcomes. This service evaluation therefore aimed to determine the efficacy of FCP interventions on patient outcomes.

An FCP consultation may comprise of an assessment, diagnosis, advice and exercise prescription and as these interventions have been demonstrated in the literature to improve pain self-efficacy (SE) it was decided to assess the outcome of FCP services on the pain self-efficacy of patients with chronic MSK pain.

A specialist fitness for work service: Advanced practice physiotherapist working as a first point of contact practitioner

An advanced practice occupational health physiotherapist introduced a new fitness-for-work service to manage clients with work- related or impacting musculoskeletal disorders. The purpose was to shorten waiting times for clients to access specialist physiotherapy, reduce the number of referrals to GPs, OHPs and OHAs and secondary care, reduce sickness absence and improve productivity, and maintain excellent service user satisfaction.

Patient satisfaction and outcomes of MSK pain patients accessing Advanced Physiotherapy Practitioner in primary care

The service objectives are to:

  1. Reduce workload of GPs
  2. Provide assessment and self-management
  3. Provide high quality care and a good patient experience to patients with MSK problems
  4. Support patients to remain in/return to work
  5. Provide staff with a positive experience.

The purpose of this project was to evaluate and monitor the progress and growth of the service against our service objectives

Some of the driving forces behind the Advanced Physiotherapy Practitioner (APP) are the 5 Year Forward View, GP Forward View, local Sustainability and Transformation Partnerships and local GP Cluster priorities. These drivers focused on workforce transformation within primary care and the MSK pathway. This service will enable patients to access a specialist MSK services at the beginning of the pathway.

This project also aimed to examine the outcomes of APP appointments to determine referring habits, changes in referral patterns and effects on GP workload and secondary care referrals.

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