What did you know about the first contact practitioner (FCP) model before moving to the UK?

Actually, I was not aware of the FCP model of practice prior to moving to the UK in September 2019.

I was working as a locum at St George’s Hospital in Tooting, London, when COVID-19 hit. 

In April–May 2020, the outpatient physiotherapy clinics within hospitals for which I worked temporarily closed as musculoskeletal (MSK) physiotherapists were redeployed around the hospitals to assist with the ever-growing pandemic.

I was out of work for eight weeks and was frantically looking for any job when I stumbled upon an FCP role for Surrey Physio on an internet job page.

What was your role as an FCP? What did your daily practice look like?

My job as an FCP was to assess and triage patients who presented to primary care services, with some patients presenting without prior contact with their GP.

As most FCP appointments were booked through reception, you would encounter many patients who had not considered seeing a physiotherapist in the first instance.

This brought about some patients presenting with non-MSK conditions.

My role was not to provide a course of physiotherapy and rehabilitation but to safely triage the patient and to navigate the best possible management and referral pathway depending on their presentation.

In layman’s terms, I was a diagnostic and triage specialist for MSK presentations.

The FCP position allowed me to interpret and directly refer for diagnostic investigations including imaging and blood pathology and/or refer to secondary care including orthopaedics and rheumatology services.

If a patient needed ongoing physiotherapy, a referral would be sent for physiotherapy management, which was undertaken in the outpatient clinics of National Health Service hospitals or by private physiotherapists contracting for the National Health Service.

Patients who were assessed and deemed suitable for self-management within primary care, about 80 per cent of patients, would be provided with advice, education and some self-management tools, including mobile applications.

Tell us more about the apps and how they work.

The apps were employed as a way to bridge the gap between clinician and patient, with a focus on education and self-management, which were particularly useful during the pandemic.

The getUBetter app is an evidence-based digital self- management support for patients presenting with the most common MSK conditions including low back pain, shoulder pain and knee pain.

The app connects patients to local services if further support or treatment is needed, including physiotherapy.

The Rehab My Patient app is another useful tool that allows the FCP to tailor an individualised exercise program to the patient.

What about the variety of conditions and presentations? Is it similar to what you find in private practice?

Conditions and presentations were quite similar to what you would encounter in private practice but with a higher percentage of non-MSK presentations.

The major difference was managing a complex caseload with patients presenting with chronic conditions, comorbidities and multifactorial needs.

Conditions or presentations that were inappropriate for MSK care would be redirected to the GP or relevant health provider or management pathway.

Using the same medical record system as the GPs allowed you instant access to the GP if necessary, generally via the GP on call.

How was your relationship with the GPs you worked with?

Daniel Hiep practised as a first contact physio in the UK.

My relationship with GPs within the practices where I worked was overall positive.

The majority of GPs were excited to have FCPs within the same practice and enjoyed the multidisciplinary structure, which ensured the best care for the patient.

FCPs would run in-services for the GPs and vice versa, which provided an opportunity for upskilling on various MSK presentations and management pathways.

Most GPs were happy to collaborate and discuss difficult presentations with FCPs and other allied health providers to ensure the best care and treatment pathway for the patient.

Overall, how do you feel about the FCP model of care?

Like any new position in its infancy, it did bring some challenges and frustrations.

Depending on the area in which you were an FCP, the systems and pathways would be slightly different.

Working across different boroughs of London meant adapting to different referral protocols and triaging nuances.

Having worked in outpatient clinics at major hospitals prior to my FCP position, I had seen the long wait times for access to physiotherapy.

Patients could wait up to six months for their appointments and these long wait times had numerous negative effects, including high cancellation rates and acute conditions becoming chronic.

FCP allows early access and the opportunity for touchpoints while the patient waits for physiotherapy or secondary care.

What are the benefits of the FCP model for patients? Are there any downsides?

The major benefit is that more people have quicker and greater access to expert MSK physiotherapists, with MSK conditions accounting for between 20 and 30 per cent of all GP appointments.

Providing publicly funded physiotherapy can help break down accessibility and affordability barriers, enabling patients without private health insurance to receive high-quality care with no out-of-pocket expenses.

Accessing this level of care sooner can ensure that patients have the best management for their presentation, which helps prevent chronicity.

Having FCPs in primary care can also reduce health service costs through more efficient use of imaging and referrals and through reducing prescription costs for MSK presentations.

Would you like to see an FCP model implemented in Australia?

I would love to see a similar FCP model implemented within Australia.

It would make sense to create FCP roles in primary care to help address the high percentage of patients presenting to primary care with MSK issues.

FCPs in primary care can help better manage an ageing population (including the number of people living with arthritis) and ease the current strain on the healthcare system.

The FCP pilot studies from the UK have been vastly positive, with evidence showing the immense benefits of early physiotherapy access including saving healthcare costs through reducing unnecessary imaging and referrals and ultimately reducing GP workloads.

The UK criteria for FCP includes working as a physiotherapist for five years, with a minimum of three years of MSK experience.

Most FCPs work at a band 7 level, according to the National Health Service grading system.

A similar model to the UK could be adapted in Australia to give physiotherapists the necessary training, support and guidance to ensure the best possible evidence-based practice and patient outcomes.

I’m not sure what this would look like but it may include additional training, postgraduate study or providing a portfolio of relevant evidence in order to practise at the FCP level, similar to current APA titling pathways.