Purpose
This study evaluates the First Contact MSK Physiotherapy (FCP) role within Primary Care in Taunton, Somerset.
Approach
Patient contact data was collected at French Weir Health Centre (FWHC) between September 2015 and December 2017 and Warwick House Medical Centre (WHMC) between September 2016 and December 2017. Each practice offered eight 20 minute appointments per session. The physiotherapist was able to request investigations (X-Ray, MRI, USS, NCS), provide injection therapy and independently prescribe. The number of FCP sessions per site per week differed (FWHC 5 sessions, 0.5WTE; WHMC 2 sessions, 0.2WTE) but ratio of population per session was similar (FWHC 3226; WHMC 3525).
Outcomes
A total of 3287 consultations were provided by the FCP. 40% of the total contacts were seen first by the FCP, 34% were referred by a GP or nurse practitioner and 22% were follow-up consultations. Symptoms affecting the shoulder (24%), lower back (19.4%) and knee (16.6%) were the most common presentations. Across both GP practices 52.4% of patients were seen within 7 days, this improved to 86.8% with 5 sessions per week at FWHC with 14.3% seen on the same day. 75.6% of patients were managed independently by the FCP with 14.7% and 6.1% referred to physiotherapy and intermediate/secondary care services respectively. A formal GP review was required for 1.4% of patients. Data demonstrates a reduction in the number of patients seen in Orthopaedic intermediate care services from both GP practices. For a 0.2 WTE this equated to 13.6% at WHMC and a 44.2% reduction for the 0.5 WTE at FWHC. Excellent patient satisfaction was reported as patients felt listened to and found the consultation helpful with average scores of 4.9 and 4.7 respectively (0 = strongly disagree and 5 = strongly agree). The majority of patients were happy with the outcome of their consultation (4.6).
Cost and savings
This service evaluation has demonstrated that the FCP role is clinically effective in independently triaging and managing MSK conditions in a prompt manner with excellent patient satisfaction. The role reduces demand on GP´s but the benefits have been shown to extend beyond primary care by reducing referrals to intermediate and secondary care services. Having clinicians with expert knowledge of patient pathways and advanced skills at the start of the pathway would seem integral to the success of these roles. Data suggests improved waiting times and a reduction in intermediate/secondary care referrals with a 0.5 WTE compared to a 0.2 WTE. Furthermore, the FCP role may accelerate the patient pathway, help prevent long-term conditions and improve the skill mix in primary care.
Implications
This study supports the further development of the FCP role within the MSK pathway in Somerset. Resource modelling locally could aid further implementation within the current pathway and identify the optimal level of provision per head of population. Further data collection will establish the impact of the FCP role on the local health economy such as referral-to-treatment times, referrals to MSK physiotherapy services and Emergency Department attendances.
Top three learning points
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Funding acknowledgements
The roles were funded by service level agreements between the GP practices and Taunton and Somerset NHS Foundation Trust.
Additional notes
Presented at Physiotherapy UK 2018.
For further information about this work, contact Simon Ingram.