Advanced Practice Physiotherapists in GP practices: a how-to guide for implementation

The number of APPs working in primary care in Scotland, as the first point of contact, has grown significantly.  Initiated as part of the 2018 General Medical Services Contract, expanding these roles is supported by the Scottish Government. 

This document summarizes the key benefits and challenges of implementing these new, broad based, highly skilled physiotherapy roles in primary care.


Early access to MSK expertise for patients - Advanced Practice Physiotherapists (APPs) working in primary care have extensive expertise in the clinical assessment, diagnosis and management of musculoskeletal (MSK) conditions.  Patients are therefore able to see the most appropriately skilled healthcare professional, in a primary care setting as their first point of contact.

Reduced number of investigations for patients - Positioning MSK APPs in primary care reduces the need for imaging and blood tests and result in less prescriptions.  There are also fewer onward referrals to physiotherapy or orthopaedics and a lower conversion rate to surgery.

More high skill level roles in the profession -  the skills and responsibility required by APPs in primary care are advanced and generally indicate a minimum of Band 7. In many cases, the scope of the role means it will be graded as a Band 8a.  


Implementation must complement and support the MSK pathway - The introduction of APPs in primary care must involve all stakeholders and should consider the entire MSK patient pathway. It must not be achieved at the expense of other services within this pathway.

Job planning must allow for the range and responsibility of the role - APPs by definition work across all 4 pillars of practice; clinical practice, leadership, research and development and facilitation of learning. Job planning must therefore be realistic.  It must ensure time is built into the posts to reflect their range of the role and responsibilities. It is not possible to work at an advanced practice level only offering clinical interventions.