Implementing a First Contact Practitioner service - Local challenges and deep dive into local data beyond the national evaluation

Purpose

First Contact Practitioners (FCPs) have shown a positive impact to the musculoskeletal (MSK) pathway by delivering MSK expertise in primary care. The national evaluation has given a high level summary of this but only focused on a small range of outcomes i.e imaging and secondary care referral rates and didn’t analyse the underlying differences between FCP and GP clinical decision making. The aim of this project was to evaluate the differences between how a GP and an FCP manage patients. In addition we explored a richer layer of how patients were managed.

9% of FCP's
Provided exercises FCP's gave exercises
compared to 2%
of General Practitioners

Approach

An EMIS template was used for every FCP contact and data was fed into the national pilot run by NHS England. Additional information was collected and evaluated to analyse differences and trends between FCP’s and GP’s. This included: The advice and information patients were given; If exercises were given; How many patients required a follow up; the reason for follow up and; outcome of the follow up. A random sample of 100 patients was taken and clinical notes were analysed at 6 months post initial appointment. This was performed for FCP’s and GP’s proportionally according to how many patients were seen on average by FCP vs GP.

Outcomes

Results: Data was evaluated over a 6 month period. Differences between FCP's and GP's were observed, including FCP's notated advice and education and more - GP 18% FCP 25%. FCP's gave exercises more - GP 2% FCP 9%. FCP’s were much less likely to follow up patients. GP’s followed up patients on average 3 times more than FCP’s. This was mainly due to their pain worsening. In addition to the above, the data collected as part of the national evaluation showed some similarities to national data but some that contrasted with national trends: Similarities: Reduced referrals into secondary care GP 15% FCP 4% Prescribed less medication GP 29% compared to FCP 0% Referred for imaging less GP 13% compared to FCP 7% Differences: Refer more to physiotherapy – GP 16% compared to FCP 56%

Conclusion(s): Our results would suggest that FCP‘s help patients to self-manage better. This is shown by the significant difference in follow up rates between FCP’s and GP’s (1:3) This is likely due to the fact that FCP’s are more likely to offer advice and education, give exercises and are less likely to prescribe medications (that often require follow up if the medications aren’t working). Other trends shown in the national evaluation were seen but to a lesser extent i.e reduction in imaging and secondary care referrals and some trends i.e physiotherapy referral showed the opposite trend - FCP’s were much more likely to refer to physiotherapy.

Cost and savings

This was part of the national pilot and as such was funded by NHS England. The cost of the pilot was £50k

Implications

Our evaluation and results give local context to FCP implementation. This has helped commissioners and service providers in making decisions about FCP models of care. It also provides a richer source of information than the national pilot regarding FCP versus GP clinical decision processes and their impact on patients.

Top three learning points

No further data. 

Funding acknowledgements

The FCP pilot was funded by NHS England.