In response to the rapidly increasing demand for GP consultations, the National Institute for Health Research (NIHR) awarded a grant of around £900,000 to examine the impact of First Contact Physiotherapy (FCP) in alleviating the pressure on appointments with GPs. This was driven by the fact that approximately one third of GP consultations are related to musculoskeletal disorders, and treating such patients directly via experienced physiotherapists can save valuable GP appointment time. However doubts have always existed at a clinical level (i.e. at the patient health level) regarding this approach. The award was won by the University of the West of England’s Allied Health Professions group, in conjunction with the Departments of Mathematics and Clinical & Experimental Medicine at the University of Surrey, with the latter departments contributing statistical and health economics input respectively. The Chief Investigator is Professor Nicola Walsh, Professor of Knowledge Mobilsation and Musculoskeletal Health at the University of the West of England and academic lead for the Impact Accelerator Unit, which facilitates and expedites the use of evidence in NHS healthcare decision making.
The study commenced in August 2018. However the dramatic effect of the pandemic from 2020-2021 caused severe delays in completing the recruitment of patients with musculoskeletal disorders. And the number of practices involved needed to be expanded substantially in order to obtain sufficiently sized samples undergoing treatment in the three service models: practices with an advanced physiotherapist on site, practices with a standard trained physiotherapist, and practices providing usual care (i.e. GP only). With patients being followed up for 6 months, data collection was finally completed at the end of 2022. Data cleaning, data analysis and report writing were carried out in 2023, culminating in the submission of numerous papers to medical journals.
During the period 2019 to 2024, FCP has been advocated in the NHS as an important move forward in reducing patient waiting times.Professor Walsh recently commented:- “The Scheme (link here) was originally launched in 2019 as part of the NHS Long Term Plan (link here) with recruitment really starting in 2020, but for obvious reasons was scuppered for a couple of years, although did continue to roll out to a degree, although without any strong evidence for it, but I guess more as a way of managing the Primary Care workforce crisis (in addition to the Right Person, Right Time mantra). It didn’t however reach its goal of everyone in England having access to FCPP within their practice. It has been further supported though through the new GP contract (link here). We are expecting the new Workforce Plan to be released in the Spring, so will get a better idea then of the further roll-out – we may even see our paper cited which would be great.”A paper involving Peter Williams has recently been voted #2 in the top ten papers published in the British Journal of General Practice in 2024 (announcement here). The paper is “First contact physiotherapy: an evaluation of clinical effectiveness and costs“. It is available open access (see blog link above). The paper has an interdisciplinary team of 14 authors from 5 institutions (the University of the West of England, Surrey, Queen’s University Belfast, Canterbury Christ Church University and CARES in Canada) with author Peter from Surrey providing the statistical analysis in the paper. The paper provides conclusive evidence from this non-inferiority trial demonstrating that FCP has no detrimental effect on patient welfare, and its roll-out should be continued in haste, for the benefit of all NHS patients.So the impact of this work should hopefully be to expedite the introduction of FCP into as many practices as possible in the United Kingdom. As Professor Walsh says, without any strong evidence for it, FCP has previously just been rolled out on a gradual basis.
