First Contact Physiotherapist

MSK Pathway Redesign

First Contact Physiotherapist (FCP) Specialist MSK Physiotherapy service:

This is an assessment and advice service for those people registered with a GP surgery in Dacorum region, who have a musculoskeletal problem such as:

• Back or neck pain- radiating arm and leg pain in absence of recent change in bowel, bladder and sexual function (Cauda Equina Syndrome).
• Sprains or strains- ankle and shoulder sprain, wrist sprain etc
• Sports injuries- hamstring, quadriceps, Achilles tendon or knee ligament injury
• Joint or muscle pain- shoulder, knee, hip, ankle, elbow, wrist

What is a musculoskeletal first contact physiotherapist? A typical FCP or MSK appointment involves assessment, diagnosis and first-line management. MSK Specialists 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 MSK Specialists 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.

MSK Specialists First Contact Practitioner Physiotherapist (FCP) role:

The role of the MSK Specialists FCP in primary care is to assess patients with soft tissue, muscle and joint pain and to decide on the most appropriate management pathway. This is to promote early access and right person at the right time at right place.

In most cases, you do not need to see your GP with these kinds of problems, so book an appointment in the with MSK Specialists FCP instead of with your doctor. The service will provide you with a thorough assessment and advice about the best path of care for you.

How MSK Specialist FCP differs from other services

MSK Specialists FCP and direct access / self-referral to MSK services: Unlike FCP, direct access / self-referral services are accessed by patients who know they need to see a clinician MSK expertise. The latter usually consists of a course of treatment, whereas MSK Specialists FCP consultations primarily provide assessment, diagnosis and management advice. Because most people with an MSK issue still go to their GP first, even when they can self-refer, these services do not significantly reduce demand on GPs.

MSK triage services: Clinical MSK triage services provide specialist clinical assessment of patients often carried out by advanced MSK physiotherapists or GPs with Special Interest. Whilst some specialist assessment and investigations may be delivered by FCPs (advanced MSK physiotherapists), a proportion of patients will still require specialist assessment (Rheumatology, pain management) and investigation (MRI/US).

Where are the MSK Specialists FCP clinics?

The clinics are offered from a wide range of sites across the Dacorum area and usually in your or nearby GP surgery. Your doctor’s surgery will arrange appointment for you in the FCP clinic at preferred location.

Lincoln House Surgery has MSK Specialists FCP working on site several days a week.

How do I access the service?

By completing an online consultation on the GP surgery website. (or over the phone if you do  not have access to the internet) You should ask for the MSK Specialists FCP appointment, and in many cases, these will take place in your own practice. In some instances, you may be offered an appointment in a nearby clinic, but this will not affect the care you will receive.

As the appointments at Lincoln House Surgery are triaged and signposted appropriately, even if you do not ask for one, you may be offered an appointment with this service if we believe it is the best option for your case.

What if I think I need surgery or to see a hospital Consultant?

The MSK Specialist FCP work very closely with MSK service (Connect Health). This means that if clinically indicated, you will be referred to Connect health who will triage and refer on directly to Orthopaedics or Rheumatology is needed. Your FCP will discuss your options with you and help you reach the decision of what is best for you.

Benefits to service user

• Quick access to expert MSK assessment, diagnosis, treatment & advice.
• Prevention of short-term problems becoming long-term conditions.
• Improved patient experience.
• A shorter pathway, so patients have fewer appointments to attend.
• Simple logistics, so patients are less likely to miss appointments, or to suffer administrative errors.
• Opportunity to gain lifestyle/physical activity advice.
• Longer appointment times, meaning patients feel listened to, cared for and reassured.

MSK Pathway redesign:

The introduction of MSK Specialists First Contact Physiotherapist (FCPs) is redesign of the MSK pathway. It should not add further steps in the pathway, but rather reduce the steps and speed up the time it takes for a patient to receive the services they require.

The diagram below presents an example of the timescales with an FCP as part of the pathway, compared to a traditional MSK pathway. It is based on case studies of FCP early pilots.