The new GP contract for England contains some significant developments for first contact physiotherapy and, potentially, the wider profession. The contract was negotiated between NHS England and the BMA and covers 2020/21 to 2023/24.
First, the good news. Full funding for all FCP posts – up from 70 per cent. This is very welcome. It removes what had emerged as a barrier to implementation in some areas.
The extra money is also accompanied by an expansion in the number of posts in the wider primary care team.
The target is now to have 26,000 non-GP staff by 2023/24. This is up from the previous goal of 20,000. It's a substantial commitment to ensuring patients can see the right professional at the right time.
This expansion will come in part by including more professionals from the Additional Roles Reimbursement Scheme. Primary care networks (PCNs) will be able to recruit a wide range of clinicians, including dieticians, podiatrists and occupational therapists. Alongside the original professionals in the scheme: FCPs, community paramedics, clinical pharmacists, social prescribing link workers and physician associates.
The new additions will not work in diagnostic first contact practitioner roles. They will be providing treatment to patients.
Other positive inclusions in the contract are monthly workforce reporting requirements and retention of the power of CCGs to provide these services where GP led PCNs fail to do so.
A very contentious part of negotiations concerned GP care home visits. These could now be done by other clinicians, at least for some residents. There is potential here for the highly effective work done by physiotherapists in care homes to be expanded. This does not feature in workforce planning figures for FCP, however, so there needs to be further clarification of this.
The role of the primary care team in community services around frailty and rehabilitation is another area which remains less well defined. There is a push for PCN teams to take on more of this. How this fits with enhanced multi-condition, multi-professional community rehab and rapid interventions services is not yet clear.
We also need more clarity on some of the wider issues inherent in having local autonomy over the make-up of teams. It’s important, of course, to ensure the team meets local population needs but there is the risk that in doing so, unwarranted variations in care open up.
We need more information on how national obligations under the long term plan, in addition to the development of patient pathways across sectors, can co-exist with decisions taken locally.
We remain concerned, too, about how some FCPs are employed. The advice from ourselves, the BMA and the RCGP is clear: contract with the main local MSK provider, rather than directly employing the FCP. This ensures cover, clinical supervision and links to the wider pathway, while creating less administrative work for the GPs. The new contract more clearly supports this, even if there continues to be an assumption that PCNs would prefer to directly employ clinicians. We encourage MSK services to work together locally and to proactively pitch an FCP service offer to their local PCNs.
So overall, the main elements of the new GP contract in England are positive. But as ever in healthcare there is potential “devil in the detail”.
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