Primary objectives

First contact physiotherapists in general practice are providing a solution to some fundamental problems in primary care. The problems include GP capacity, demands facing secondary and community services, and limited support for self-care on offer. 

 

Implementing anything new is complex and challenging and members are grappling with issues around employment, skills, banding and funding. 

 

Many first contact physiotherapists are employed by their NHS provider or health board to work part of their week with the GP and part in secondary or community care.  The benefits of this are continuity of members’ conditions of employment, a more integrated service and broader professional experience. 

 

To be effective, the roles require advanced practice skills. But does this mean they all have to be advanced practice roles?  

 

The service configuration will depend on local population needs. Advanced practice physiotherapy brings high levels of decision making, streamlined pathways, and less reliance on secondary care. These are key to improving patient care in general practice.

 

There should also be opportunities for more junior grades to develop skills, knowledge and experience in primary care.

 

New roles will need to go through a process of job evaluation. How they are banded depends on variables relating to the local demands of the role and the supporting structures. Most roles are being banded as either 7 or 8. 

 

Funding for these posts is not always straightforward and decision makers may be tempted to keep costs down by limiting the posts to band 6 roles. While there are some great examples of band 6 physiotherapists providing effective first contact GP roles they are normally part of a team that has access to daily supervision and a strong framework of training and development. 

 

Advanced practice roles offer a broader set of skills and knowledge and, in the long term, may provide additional value to patients and the system, and are worth serious consideration locally. 

 

Across the UK, planning and funding activities must become more aligned and integrated. In the short-term joint funding agreements between groups of GPs (federations or clusters, depending where you live) and NHS providers and budget holders, are likely to be needed. 

 

All these challenges require the CSP staff and members to step up, work together, network and share information. 

 

We must learn in real time from experience and pool evidence of what works to strengthen our collective ability to influence others.

 

 

See our Frontline feature looking at primary care initiatives in north Wales