Read our top 10 questions asked by members about this increasingly widespread physio role.
Physio Amanda Hensman-Crook (left) is an MSK practitioner at Windermere Health Centre
Physiotherapists have a strong role to play in primary care, not least broadening the GP team and providing more services outside of hospital.
The value of using physiotherapists with advanced practice skills means that patients can access physiotherapy expertise without the need to see a GP: assessment, diagnosis and management advice is all physio-led.
Pilots show this can reduce both the burden on GPs and inappropriate referrals into secondary care, as well as improve population health and patient care.
Q1: How will the workforce be developed to take up these roles?
The CSP is calling for governments across the UK to invest in the physiotherapy workforce to support professional development and create a career structure in primary care. There are current initiatives that the CSP is supporting to increase healthcare students’ access to practice-based learning opportunities in primary care settings.
Many universities offer postgraduate courses that support members in developing advanced practice knowledge and skills, while various local initiatives are specially addressing workforce development needs in primary care. In the longer term, employer investment in advanced clinical practice apprenticeships should support ongoing workforce development.
Q2: How will roles be professionally supported?
There needs to be clear arrangements for physiotherapists’ professional development, clinical supervision/review and mentorship, as well enabling access to broader opportunities for professional networking. This is essential to ensure sustainable capacity, robust clinical governance, and prevent professional isolation.
The most successful models build this in, with first contact physiotherapists working within the GP practice team and also being part of a larger physiotherapy service in a secondary care or community setting.
Q3: Where will the workforce come from?
More graduates will be coming through the system, as more physiotherapy student places are being provided by universities from 2017/18.
First contact physiotherapy roles in general practice are also being developed from within the existing workforce, with physiotherapists from triage or interface services, and hospital outpatients transferring to primary care and GP practices – either in full or part-time roles.
Q4: Won’t this increase waiting times for hospital based physiotherapy services?
No. Evaluation of first contact physiotherapy pilots in general practice show a reduction in onward referrals for physiotherapy treatment, by responding quickly to the majority of MSK patients who need advice and signposting to self-management resources.
Q5: Do the roles require advanced practice skills?
Yes. First contact physiotherapy roles require a high degree of independence to manage uncertainty and risk; advanced skills in assessment and clinical-reasoning; the ability to undertake complex case management; make onward referrals; order and interpret investigations; and usually inject and prescribe.
Q6: What are the steps to follow in developing the role?
The CSP advocates the following five steps in developing the roles, including the use of the Agenda for Change (AfC) Job Evaluation Scheme.
Establishing the role title comes at the end of the process and does not denote grade. The first contact physiotherapy roles are new and still developing. So far a number of other titles have also been used, including General Practice Physiotherapist and Senior MSK practitioner. It is important that patients understand and can consent to the professional expertise they are accessing, so including ‘physiotherapist’ in the title is essential.
Q7: How should the roles be banded?
NHS and non-NHS employers should use the AfC Job Evaluation Scheme and the scheme’s band profiles. The Band 8a Principal, Band 7 Advanced Physiotherapist and Band 6 Specialist Job Evaluation Profiles should be used to decide the level and grade of a first contact physiotherapy role. The capabilities and experience this requires strongly suggests that job evaluation in most cases would result in a band 7 or 8a grading.
Many CSP members are also looking at how a mixed-banded team approach across a number of GP practices can be progressed. This has the potential to create capacity, a sustainable model for developing the workforce and provide opportunities for physiotherapists to develop advanced practice knowledge and skills in primary care settings.
Q8: What should the employment arrangements be?
Experience so far is that when CCGs and GP practices, federations or clusters enter into contracts with existing providers of NHS services, it results in the most successful arrangement. This approach is recommended by the CSP, BMA and the RCGP.
Q9: Why does this development need to happen?
The physiotherapy profession has always moved with the times to meet and respond to current challenges. Shifting more services outside hospital enables the profession to offer solutions to some of the problems in primary care. Being proactive strengthens the professions ability to influence and safeguard patient access to quality services, quality employment and professional practice opportunities for CSP members.
Q10: Are there other new physiotherapy roles in primary care?
There will be more opportunities for physiotherapists and support workers – for example, in multi-disciplinary hubs around GP services, to improve management of long-term conditions. While the physiotherapy roles in general practice have so far focused on MSK, increasingly important will be other areas of expertise – such as management for the frail elderly and building confidence among people with long-term conditions to be more physically active.