Advanced practice physiotherapist working as an FCP

A specialist fitness for work service: Advanced practice physiotherapist working as an FCP  


A specialist fitness for work service [Photo Brian Duckett]

The Innovations in Physiotherapy database is an online platform of quality assured examples that showcase innovation. Dr Laran Chetty, advanced practice occupational health physiotherapist at Royal Free London NHS Foundation Trust, shares his highlights from a pilot project to introduce a fitness for work service delivered by a first contact practitioner (FCP) 


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. 

Waiting times reduced from 5 months to 5 days


The service is staffed by a [Band 7] advanced practice physiotherapist who manages the whole clinical pathway including triage, assessment, treatment, fitness-for-work assessments, and case management. This service allows clients to self-refer directly into the service, and accepts management referrals. Traditionally, GPs, OHPs/OHAs and managers were the gate keepers and would refer employees for physiotherapy or secondary care for further investigations. 

The innovative aspects of this new service included self-referral to a first contact APP thereby avoiding GP or OHP/OHA consultations or management referral, and links to secondary care for direct listing of clients that required further investigations. 

Cost and savings 

Net cost benefit generated by the fitness for work service is £3,140 per client, representing a 1:15 return on investment. 


This pragmatic evaluation of the specialist fitness for work service indicated that is likely to be feasible in terms of service usage and cost-effectiveness, and could be rolled out nationally to reduce sickness absence, improve productivity and reduce the

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financial strain on the NHS. 

Top three learning points 

  1. Robust data collection is required to benchmark current data to previous and new pathways. 
  2. There is increasing evidence that specialist fitness-for-work services are cost-effective. 
  3. Early physiotherapy contact for musculoskeletal disorders can improve health and work outcomes.  

Author’s reflections 

This pilot demonstrated the feasibility of an advanced practice physio working as a first contact practitioner in a specialist fitness for work service. Clients attending the service felt reassured about their return to work and came away with lots of helpful advice and tips to stay healthy at work.  

Publication on the database has provided an additional platform to share it within the profession. Physiotherapists have unlimited access to the information. This work aligns with ACPOHE’s strategy to ensure robust data collection to develop new pathways for advanced practice practitioners. 

Notes and funding 

  • This work was unfunded.  
  • This work was presented at Physiotherapy UK 2019.

For more information, including author contact details, please visit Dr Chetty’s database entry.

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