Implementation of a first contact physiotherapy service within GP practices in North East Wales. A four year evaluation

Purpose

The first contact physiotherapy service (FCP) in North East Wales was established in 2015. Since it’s inception it has been through periods of rapid growth and retraction and now maintains a consistent service across 33 GP practices. Many lessons have been learned which may be of use to new FCP services becoming established.
The aims of the evaluation was to review the impact of the service on the population, Primary and Secondary care services. To assess if working methods, recruitment and workforce are fit for purpose to enable establishment of a first contact service. To provide advice for newly established FCP services.

11 referrals per month or 1.4% of patients
required an orthopaedic referral into secondary care by the FCP service

Approach

A retrospective analysis of quantitative and qualitative data collected, including patient reported experience measures.

Outcomes

Results: The first contact physio team comprises of  1WTE B8a Lead,  and 4.12WTE B7 .  The BCUHB (Betsi Cadwalader University health Board) East FCP team cover a population of 287,300 in Wrexham and Flintshire localities. Appointment duration is 20 mins with an admin slot of 20 mins per 7 patients. All team members are IRMER trained and registered non medical referrers for medical imaging, have access to ordering haematology investigations. Three out of nine practitioners are independent non medical prescribers. A total of 34807 patients were seen by the BCUHB East FCP team within a four year period averaging 791 patients per month.  The average 1st point of contact per month (seen by an FCP clinician without prior medical contact) was 44% with an initial data point at 40.4% August 2016 now increased to 65.7% October 2019, a percentage point change of 25.3%. Physiotherapy rehab referrals made by FCP service averaged 97 per month 12.2% of total patients seen within one month. Orthopaedic referrals into secondary care made by FCP service averaged 11 referrals per month making up 1.4% of patients seen within one month. There is a small overall reduction in referrals into secondary care orthopaedic services since the start of the FCP service.
Patient reported experience measures indicate that over 95% of respondents would recommend our service to friends and family.

Conclusion(s): Our experience of scaling up of an FCP service has led to the following observations;
1. A robust telephone/reception triage needs to be implemented within each GP practice.
2. There needs to be sufficient FCP coverage within each GP practice to allow for maintenance of a high 1st POC percentage. 
3. To impact upon total referrals into orthopaedics within secondary care there needs to be an integration of the orthopaedic triage service and FCP to minimise the 'scattergunning and doubling up' of referrals.
4. There is a lack of sufficiently skilled and experienced MSK (musculoskeletal) practitioners to fulfil current and future demand, retention and recruitment is problematic due to the nature of 12 month rolling temporary contracts.
5.Equitability of an FCP service is dependant upon funding source, i.e cluster funding requires an FCP presence within each GP practice diluting the effect of FCP.

Cost and savings

No further information is available. 

Implications

Results can be implemented into physiotherapy practice and further research into first contact physiotherapy.

Top three learning points

No further information is available. 

Funding acknowledgements

Work not funded.