Advanced practice in primary care

With the advent of first contact MSK physiotherapy roles in primary care, the development of a career pathway with an educational training roadmap supported by specific supervision has evolved.  

It’s created an exciting opportunity to work at the front of the MSK care pathway as a diagnostic clinician. For the first time, physiotherapy undergraduates will be able to see primary care as a career choice, as a developmental journey from the day that they register with the HCPC.  

Health Education England (HEE) has set out a national route into MSK primary care roles. All clinicians completing the required training via a portfolio or a taught route will be recognised and held on a directory of practitioners at the HEE Centre for Advancing Practice. 

From April 2022, all clinicians will need to have completed the required training prospectively and retrospectively prior to entry into primary care. This is a great opportunity for structured CPD and to have recognition of meeting the new standard of practice in primary care. 

To work in primary care, although MSK knowledge and clinical expertise to level 7 (masters level) is essential, unlike other areas of MSK specialty, it is a diagnostic role working with undifferentiated and undiagnosed conditions as the first point of contact. You will you work with complexity, uncertainty, co-morbidity, polypharmacy, frailty, public health, mental health, long-term conditions and safeguarding.  

All of which need to be integrated to inform an MSK assessment and form a diagnosis and management plan for the patient.  
Working in this way means that as well as developing an MSK specialty, it is as equally important to nurture development of: broad non MSK knowledge (eg respiratory, neurology, surgical, and elderly care), recognition of red flags, serious pathology and visceral masqueraders, the ability to work and integrate multi professionally, and to develop cross system knowledge and across care pathways.  

This skill set is essential for any clinician wishing to travel along the advancing practice pathway. If built upon from graduation, it becomes a natural progression as you move through your career.

More information

• First Contact Practitioners and Advanced Practitioners in Primary Care: (Musculoskeletal)
• The educational training pathway to Advanced Practice in Primary care

Amanda Hensman-Crook is Health Education England allied health professions national clinical fellow and a consultant MSK physiotherapist