Physiotherapist as an alternative to a GP for musculoskeletal conditions: a 2-year service evaluation of UK primary care data

Abstract

BackgroundPhysiotherapists are currently working in primary care as first contact practitioners (FCP), assessing and managing patients with musculoskeletal conditions instead of GPs. There are no published data on these types of services.AimTo evaluate a new service presenting the first 2 years of data.Design and settingAnalysis of 2 years’ data of patient outcomes and a patient experience questionnaire from two GP practices in Forth Valley NHS, UK. The service was launched in November 2015 in response to GP shortages.MethodData were collected from every patient contact in the first 2 years. This included outcomes of appointments, GP support, capacity of the service, referral rates to physiotherapy and orthopaedics, numbers of steroid injections, and outcomes from orthopaedic referrals. A patient experience questionnaire was also conducted.ResultsA total of 8417 patient contacts were made, with the majority managed within primary care (n = 7348; 87.3%) and 60.4% (n = 5083) requiring self-management alone. Referrals to orthopaedics were substantially reduced in both practices. Practice A from 1.1 to 0.7 per 1000 patients; practice B from 2.4 to 0.8 per 1000 patients. Of referrals to orthopaedics, 86% were considered ‘appropriate’. Extended scope physiotherapists (ESPs) asked for a GP review in 1% of patients.ConclusionThe results suggest that patients with musculoskeletal conditions may be assessed and managed independently and effectively by physiotherapists instead of GPs. This has the potential to significantly reduce workload for GPs as the service requires minimal GP support. The majority of patients were managed within primary care, with low referral rates and highly appropriate referrals to orthopaedics. Patients reported positive views regarding the service.

Implementing patient direct access to musculoskeletal physiotherapy in primary care: views of patients, general practitioners, physiotherapists and clinical commissioners in England

“…Whilst physiotherapists in this study did not have advanced practice there was support for this, not least as a way of making direct access more efficient and reducing GP appointments [30]. The lack of understanding of physiotherapy is further heightened when it comes to advanced practice, and physiotherapists need to proactively educate colleagues and patients to improve understanding of their roles [31].…”

First point of contact physiotherapy; a qualitative study

“…A small body of literature demonstrates efficacy of FPCP in the UK [3][4][5]. This is supported by several pragmatic service evaluations which all demonstrate similar findings [1,6].…”

“…The evidence that is available would point towards the safety, acceptability and efficacy of FPCP [3][4][5]7]. However, as is often the case the success, or otherwise, of innovative interventions can rest on more nuanced issues.…”

“…Most patients were managed utilising a tailored self-management strategy within two appointments [3,4]. In addition, staff and patients described satisfaction with FPCP services [3,5]. The only published economic evaluation was pragmatic but demonstrated considerable potential savings for the health economy [3].…”

Hvordan kan sykepleiere og vernepleiere dele pleieoppgaver?

“…An initiative in Scotland, which is facing a severe shortage of general practitioners, compared the conventional model, where patients with musculoskeletal problems are seen first by doctors, with one in which extended scope physiotherapists managed patients independently, referring for orthopaedic opinions where necessary. Using a range of measures, including patient satisfaction and appropriateness of referrals, itfound that the two models achieved comparable results (143).…”