In England, there have been First Contact Physiotherapists (FCPs) working in primary care for a number of years.
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Thanks to a programme of pilot projects, some GP surgeries have had FCPs embedded in their teams since 2017 – or even before this in certain regions. These pilots have contributed to a national standardised dataset that champions the gathering of evidence from each pilot site.
This data contributed to the CSP's influencing and lobbying in collaboration with organisations such as the British Medical Association and the Arthritis and Musculoskeletal Alliance.
The Direct Enhanced Service (DES) contract was later announced including FCP as part of the General Medical Services (GMS) contract. Furthermore, NHS England announced a programme of financial support known as the Additional Role Reimbursement Scheme (ARRS), which allocated funding from central government to primary care networks and NHS trusts to employ FCPs in primary care.
This was later updated to increase the funding available for 2020-21, and the Network Contract DES provided further clarity on the money available, including new reimbursement roles (such as advanced practitioner physiotherapy roles), and inner and outer London weighing.
In May 2021, the NHS Confederation published its 10 key priorities for restoring primary care. This includes a continued commitment to multidisciplinary teams and services within primary care. The DES and the ARRS continue to be reviewed, and you should read the most recent information on these aspects of primary care to understand more.
Health Education England (HEE) has developed the 'First Contact Practitioners and Advanced Practitioners in Primary Care: (Musculoskeletal) A Roadmap to Practice', which was launched in 2020. This framework outlines the Knowledge, Skills and Attributes (KSA) required to meet the minimum standard to be an FCP and/or work at an advanced practice level in primary care. This will be referred to as the roadmap below.
The HEE is also in the process of setting up the multi-professional Centre for Advancing Practice. This body will provide a framework to recognise individuals from all professions working at advanced practice level. Once established, it will also play a role in verifying FCP/advanced practice supervisors and clinicians practicing at advanced practice level. For the latest on this please see the advanced practice pages on the HEE website.
The KSA of the roadmap have been developed using the musculoskeletal (MSK) core capabilities framework, the multi-professional advanced practice framework and the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) standards, which are agreed national MSK partnership standards.
The roadmap sets out up to three stages for clinicians to develop along towards FCP and advanced practice in primary care.
These stages set out how to develop your career prior to working in primary care (stage 1), how to evidence an FCP role in primary care (stage 2) and how to evidence an advanced level of practice within primary care (stage 3).
Stage 1 must be completed prior to employment in primary care, whereas stage 2 must be completed and verified once you are working in primary care.
There are two routes to ‘sign-off’ as an FCP and/or advanced practitioner
- The portfolio route.
- The taught route via a higher education institute (HEI).
FCPs will need to demonstrate and evidence that they are working at master's level (academic level 7) in the clinical pillar. They will be 'signed off' within primary care by their supervisor. Although FCPs are likely to also have evidence of emerging capabilities across all four pillars of advanced practice: clinical, leadership and management, education and research.
Once signed off by their supervisors, FCPs can be listed on the HEE FCP registry.
Primary Care Training Hubs will take responsibility for any auditing procedures to monitor portfolios and FCPs on the register. This will be different in different areas, and FCP services should contact their local training hub to understand the process in more detail.
Advanced practitioners will need to demonstrate and evidence that they are working at master's level across all four pillars of advanced practice: clinical, leadership and management, education and research. Clinicians who are aiming for stage 3 sign-off as advanced practitioners will verify their portfolio locally and then submit this to the Centre for Advancing Practice.
See the HEE roadmaps to practice page for full details and updates.
There are a number of possible exceptions from the stage 1 portfolio requirement of the roadmap if you are a current FCP aiming for retrospective recognition:
- Master's recognised by the MACP – If you hold an MSc which is currently recognised by the Musculoskeletal Association of Chartered Physiotherapists, HEE has acknowledged that this is equivalent to stage 1 of the roadmap KSA portfolio.
- SOMM diploma – If you hold a previous Society of Orthopaedic Musculoskeletal Medicine diploma and do a one-day top-up course, HEE has acknowledged that this is equivalent to stage 1 of the roadmap KSA portfolio.
- Recent SOMM diploma – If you have recently completed a SOMM diploma (since the release of the roadmap), your diploma may have been fully mapped to the roadmap. Please check with course leaders whether the top-up day is required for you.
If you are exempt for one of the reasons above, you will not need to have a stage 1 portfolio signed off, but you will need to complete the primary care and personalised care e-learning modules. You will also still need to complete a stage 2 portfolio – ie, the KSAs as demonstrated in primary care practice.
The roadmap sets out an approximate timeline and progression for clinicians to become recognised FCPs.
Pre-registration students should be exposed to practice in primary care settings.
Just starting out
Once you are registered as a physiotherapist, a minimum of three years postgraduate learning and experience is required in your professional speciality area of practice (for example MSK). However, a broad range of experience is considered ideal for FCP role development.
At stage 1, it would normally take you a minimum of four-six months to develop through the portfolio route prior to entry to primary care. (The membership criteria for some membership organisations has been successfully mapped to stage 1 of the roadmap.)
Based on a full-time equivalent role, best practice is that you would complete stage 2 within six months of commencing work in primary care or a completion date as negotiated with your local employer.
The suggested length of time required to complete an FCP MSc module through the taught higher education institute (HEI) route is 10 months.
In England, there are a number of workforce models in practice.
Host provider model
FCPs are employed by the NHS Trust or 'provider' and 'hosted' by the primary care network (PCN). In this model, governance and training is often shared between the provider organisation and the PCN with the amount of governance and training provided by the PCN dictated by the Service Level Agreement (SLA) between the organisations. FCPs are often employed on a split role between primary care FCP and another provider organisation service such as core physiotherapy or interface/Musculoskeletal Clinical Assessment and Treatment (MCAT) service. Supervision for FCPs is the responsibility of the employer organisation. This may mean provider organisations provide all supervision for their FCPs or that supervision is negotiated and agreed by the provider organisation and the PCN.
Directly employed model
FCPs are employed by the PCN or GP surgery directly with no other NHS provider organisation involved. In this model, governance and training is provided by the PCN or GP surgery. Primary Care Training Hubs and Integrated Care Systems are key to ensuring FCPs are involved in system-wide approaches to primary care development and have access to system-wide support. See HEE information on Primary Care Training Hubs and King's Fund information on Integrated Care Services to understand more. In this model, the employing PCN or GP surgery is responsible for proving supervision for the FCP.
Independent practice physiotherapy
Independent practitioner FCPs are either working as sole traders or employed by an independent physiotherapy business. In this model, the FCP is responsible for their own training, supervision and governance.
In England, Health Education England (HEE)has many resources for FCPs to understand more about educational opportunities and training needs. It also has resources and information to help you understand the role of supervision for FCPs.
Many universities have or are developing FCP modules and/or programmes. It is advisable to check with the university that their programme is being mapped to stages 1 and 2 of the roadmap if you are interested in studying at an HEI. Please check the HEE roadmaps to practice page for further information on higher education programmes.
There are also universities offering advanced clinical practitioner master's programmes. These are full master's degrees. They are often multidisciplinary and focus on general knowledge and skills across many systems, but they often include optional specialist modules.
There are other university modules that FCPs may be interested in undertaking such as in independent non-medical prescribing or injection therapy. Funding may be available, so speak to your line manager or contact your trust educational coordinator, Primary care network educational lead or Primary Care Training Hub to explore the options.