Read our most frequently asked questions about first contact physiotherapy in primary care.
About First Contact Physiotherapy services
What is a musculoskeletal First Contact Physiotherapist?
- First Contact Physiotherapists (FCPs) are advanced practitioners working within primary care with extensive expertise in the clinical assessment, diagnosis and management of musculoskeletal (MSK) conditions.
- FCPs see patients with (suspected or diagnosed) MSK conditions as the first point of contact, instead of a GP, and can be accessed directly by contacting the practice’s reception.
What do FCPs do during appointments?
- A typical FCP appointment involves assessment, diagnosis and first-line treatment. FCPs can also refer patients for a course of physiotherapy treatment, order investigations or make referrals into secondary care services using the same pathways as GPs. Some FCPs are also able to independently prescribe and provide injection therapy.
- As a person-centred service, most appointments include self-management advice, social prescribing, and discussions about physical activity and fitness for work.
How long are FCP appointments?
- Most services find 20 minute appointments allow for safe and effective consultation. FCPs also require additional time for administrative activities.
What is the difference between FCP and self-referral?
- Typically, self-referral services are accessed by patients who know they need to see a physiotherapist. As most FCP appointments are booked through the general practice’s reception, FCPs see many patients who had not considered seeing a physiotherapist in the first instance. Also, unlike self-referral or direct access, FCP is not (early access to) a course of physiotherapy. Should the patient require further treatment, then the FCP can make a referral.
Will FCP roles affect triage services?
- We would expect FCP to impact other physiotherapy services. What this impact looks like will vary due to factors such as local population, workforce and commissioning models. In some areas the need for these services will continue, although the demand may reduce as more patients access expertise earlier in the pathway.
Can private practitioners provide FCP services within GP practices?
- Private practitioners may well have the skills and experience necessary to work as the first point of contact in primary care settings. However, there must be robust clinical governance arrangements in place to ensure safety and prevent professional isolation. This includes access to appropriate referral pathways and diagnostic rights across local MSK pathways and the correct level of clinical supervision/review and mentoring. Without evidence of this, private physiotherapists may struggle to gain local rights of direct secondary care referral and diagnostics.
I would like to develop FCP services in my area. Where should I start?
- The CSP has produced a suite of resources, including the CSP’s implementation guidance for FCPs in Primary Care (developed with the BMA and RCGP). Members are also encouraged to join the First Contact Physiotherapy iCSP forum to access the latest FCP news, resources, events and discussion. In addition, members may benefit from contacting FCP services in their local area to learn from their experiences.
How can I measure the impact of my FCP service?
- The CSP recommends using a standardised data collection template on general practice data systems to capture coded outcome data from FCP appointments. This enables FCPs to report on their performance and their impact on other services. (Download the CSP's guidance and templates for data collection.)
Is FCP only for MSK conditions?
Though First Contact Physiotherapy roles have so far focused on MSK, a small number of services are using the FCP model for other priority areas, including frailty. The CSP will share examples of these services as more are developed.
About First Contact Physiotherapist roles
Who employs FCPs?
Though the CSP, BMA and RCGP recognise that different models have their own benefits, on balance, they recommend that existing providers of NHS services employ FCPs. This option embeds and integrates FCPs across the MSK pathway (where they can access training and peer support). It also enables the provider to ensure service consistency and staff continuity.
As a physiotherapist, what skills do I need to work as a musculoskeletal FCP?
- FCP roles require advanced skills across many areas based upon the principles of shared decision-making and person-centered care. In England, the Musculoskeletal Core Capabilities Framework for First Point of Contact Practitioners, produced by Health Education England (HEE), sets out clear expectations for the role and can be used to inform training needs analysis and recruitment.
How should FCP roles be banded?
- FCP roles require advanced level skills to manage uncertainty and risk with a high degree of independence and autonomy. The capabilities and experience this requires strongly suggests that roles are at Band 7 Advanced Physiotherapist or Band 8a Principal. NHS and non-NHS employers should follow the Agenda for Change Job Evaluation Scheme and band profiles.
- Some services are employing a mixed-banded team approach which provides opportunities for physiotherapists to develop advanced practice knowledge and skills in primary care settings. For this to be a safe and successful model, robust governance and (Band 8a) supervision arrangements must be in place. (View an example FCP job description.)
Are there enough FCPs to meet demand?
- The CSP estimates that approximately 10,000 registered physiotherapists currently work at the recommended Bands (7-8a) and so are likely to have the advanced physiotherapy skills required for FCP. In addition, there are a number of potential MSK FCPs who could undertake further training to upskill as part of a phased rollout. FCP services are also expected to reduce referrals into triage and secondary care physiotherapy services, enabling staff to move into First Contact roles. Physiotherapy as a profession is growing across the UK with a 35% increase in Higher Education Institute pre-registration intakes since 2015. This expansion can provide backfill for mainstream MSK physiotherapy roles in order to allow clinicians with more advanced skills to adopt FCP roles.
What title should FCPs use with patients?
The CSP recommends always using ‘Physiotherapist’ as part of the job title (e.g. First Contact Physiotherapist). This ensures that patients are fully informed about who they are seeing. As a protected title, the use of ‘physiotherapist’ requires individuals to be registered and regulated by the HCPC. This safeguards patients’ interests and safety, and upholds public protection.
Does an FCP have to be able to independently prescribe or inject?
Whilst most FCPs have undertaken the required post-registration training in medicines management (including prescribing and injection therapy), these tasks are not a prerequisite for First Contact roles. However, FCP job specifications can vary due to local staffing, funding and capabilities.