What is an FCP?
A First Contact Practitioner (FCP) is a highly trained physiotherapist who is professionally qualified to treat patients without a referral from a GP or other healthcare professionals. FCPs provide the first point of contact whereby those who visit a GP for a musculoskeletal (MSK) problem will instead have an appointment with an FCP physiotherapist.
The role of an FCP is to work within GP surgeries and offer appointments for patients with MSK conditions. This gives the patients immediate access to physiotherapy, as oppose to the traditional process where a patient would have to be consulted by a GP first, then referred on to a physiotherapy department which usually involves long waiting times. Having FCPs work alongside doctors means less GP appointments are required as reception staff can book patients directly in with the FCP, treatment is administered quicker and recovery is expedited. The benefits of FCPs are numerous, FCPs help to lessen the strain on already burdened GP practices and offer a higher quality of care for patients.
FCPs are highly experienced and able to assess, diagnose, treat and manage patients with MSK issues. FCPs are mainly Extended Scope Physiotherapists (ESP) which are advanced physiotherapists with many years of experience.
The new NHS mandate wants GP practices to have an FCP available to reduce the ongoing strain on services. A recent pilot study by Health Education England over a 9-month period showed a high level of patient satisfaction with the new MSK service.
The pilot showed that the MSK specialist being present in the practice opened up lines of communications with the GPs who increased their understanding and knowledge. It identified that the cohort of patients who saw the MSK specialist were prescribed less medication, has fewer investigations and were referred less often to secondary care.
The conclusion was that basing a first point of contact MSK practitioner in a general practice will help with expanding the capacity and it also helps the system by reducing costs. FCP services are reported to deliver a return on investment of £0.81-£2.37 for every £1 spent on implementing FCP services (Davies C, 2017); with some studies suggesting a higher return (Public Health England, 2017).
Is there a demand?
The British Orthopaedic Association estimates that 1 in 4 GP consultations are musculoskeletal in nature.
The chartered society of physiotherapists suggest that 15-30% of GPs caseload is musculoskeletal in origin.
Can any Physiotherapist work in this role?
No. Physiotherapists in this role should be trained to an exceptionally high level. Health Education England have designed an advanced framework to ensure only the most competent practitioners are working at the level this role requires.
Our team have vast experience having worked for Dorset MSK services and having been trained by the Society of Orthopaedic Medicine. We can image patients with the same access as GP’s, place patients on the most appropriate care pathways and inject where indicated.
First Contact Physiotherapist roles created from 31 March 2020 are likely to be funded in part by PCNs through the new Additional Roles Reimbursement Scheme (ARRS). This is detailed in the five-year framework for GP services as agreed between NHS England and the BMA General Practitioners Committee (GPC) published in January 2019. The scheme is intended to create an estimated 20,000+ additional posts in five reimbursable primary care roles by 2023/24.
Through ARRS, NHS England will reimburse employment oncosts, and 100% of the ongoing salary costs. By 2024, an average PCN will have access to sufficient funding to employ three FCPs, in addition to five clinical pharmacists, three link workers, two physicians associates and one community paramedic. However, the framework grants flexibility to PCNs to determine the staff mix of the extended team employed through the Scheme. (Please note: NHS England’s GP Contract Framework only names First Contact Physiotherapists as reimbursable under ARRS.)
Where FCPs are employed by an NHS trust or other non-PCN body, the proportion of time that the FCPs spend on PCN-related activity (WTE) will be used to calculate the actual salary costs eligible for reimbursement though the ARRS.
The investment sum will increase from £110 million in 2019/20 to £891 million in 2023/24. For the average size PCN (with 50,000 patients) this is equal to £92,000 in 2019/20 and £726,000 in 2023/24. It is estimated that there will be over 20,000 reimbursable additional posts to increase the general practice workforce.
Why Pro Point Physio
Craig started the FCP pilot in Dorset and has been working within the role for the last 18 months. He has experienced the best and the worst of the service. This gives us the experience we need to make the service more efficient and effective to achieve maximum benefit. He is also a senior clinician for the DMSK service and is currently training future FCP’s.
Hayley is currently a senior member of the DMSK service and experienced physiotherapist and is also training future FCP’s /MSK clinicians within the service.