Providing patients with faster access to the right care

To mark Back Care Awareness Week, a Senior Policy and Implementation manager from the National Elective Care Transformation Programme highlights the initiative to improve MSK pathways through a First Contact Practitioner service:

Back Care Week aims to raise awareness of the problems back pain can cause, as well as successful prevention and treatments.

Low back pain causes more disability, worldwide, than any other condition and four-in-five of us will suffer with back pain at some point in our lifetime.

Back pain is a common cause of short-term sickness absence, accounting for a significant portion of the over 30 million working days lost due to musculoskeletal (MSK) conditions every year in the UK, and which in turn has accounted for 30% of GP consultations.

However, this increasing demand on primary care, and subsequent referrals into secondary care services, can be streamlined using a First Contact Practitioner approach, to benefit the patient, GP practices, secondary care services and the wider multidisciplinary team.

The NHS Long Term Plan includes a commitment to narrow health inequalities, address unwarranted variation in care and build on the work undertaken during 2018-19 to ensure all adults in England with a musculoskeletal condition will have direct access to MSK First Contact Practitioners (FCP) by 2023/24.

A First Contact Practitioner service is provided by a registered health professional who is the first point of contact for patients, providing new expertise and increased capacity to general practice and providing patients with faster access to the right care.

The FCP model brings physiotherapy expertise to the front end of the MSK pathway. Over 70% of patients receive specific self-management advice, with 90-99% patient satisfaction rates reported in pilots. Early access to physiotherapy and advice and – where necessary – treatment, accelerates recovery and improves the long-term health and wellbeing prospects of patients with MSK problems.

By being part of the GP team and using the local referral pathways and services, the FCP enhances the quality of care provided by the primary care workforce, delivering better MSK management and reducing referrals into secondary care.

As part of the Elective Care Transformation Programme High Impact Intervention in MSK, we have worked closely with Chartered Society of Physiotherapy, NHSE/I regional teams, Clinical Commissioning Groups (CCGs) and Sustainability and Transformation Partnerships (STPs) to develop the FCP specifications which sets out the criteria and actions for mobilising, embedding and implementing the service through good, evidence-based practice.

In Lincolnshire a First Contact Practitioner MSK service was piloted to reduce GP caseload by segmenting the patient demand and redirecting MSK problems to a physiotherapist. Patients with MSK conditions who contacted the surgery to make an appointment were identified by the GP reception staff and referred directly.

This resulted in fast advice and treatment for patients, with a 39% shift of MSK patients to physio, increasing GP capacity. Feedback from patients was 100% positive.

Similar levels of patient and GP satisfaction were reported in West Cheshire, which piloted a GP physiotherapy service across 36 practices and expanded to offer evening appointments.

They found quick access provides rapid return function and less need for further treatment; more than 60% of self-referred patients were discharged after the first appointment. In addition, fewer than 3% of self-referred patients needed to see the GP.

Kalu Nwaka is a Senior Policy and Implementation manager in the National Elective Care Transformation Programme, High Impact Intervention team, where he is the FCP workstream lead.

Kalu has worked in a range of roles across different NHS organisations.

He worked as a Programme Manager in a pathology service consolidation across two of the biggest NHS Trusts, realising significant cost savings from streamlined processes and reducing waste in the system.