First contact physiotherapists: are they able to reduce the burden on rheumatology services? A critical review of the evidence base

Abstract

First Contact Practitioners have emerged over recent years in response to growing pressures within the National Health Service (NHS) and are now central to primary care musculoskeletal (MSK) services. Within the musculoskeletal field these allied health professionals may be from a range of disciplines including Physiotherapy, Podiatry and Osteopathy. Early referral to rheumatology is key to successful long-term management of many inflammatory musculoskeletal conditions but presents challenges to overburdened services. Evidence supporting the recognition and referral of patients with rheumatological disorders by First Contact Practitioners is lacking, however physiotherapists have been shown to successfully substitute the role of a doctor within the MSK field. This review investigates the value of First Contact Physiotherapists (FCPs) within primary care and their role in early recognition and referral of rheumatological MSK disorders in line with national guidance. FCPs are best placed to fulfil the role of MSK ‘champions’, positively impacting the whole MSK pathway, with the potential to reduce burden on rheumatology services. Planned rapid upscale of FCPs over the next few years will support sustainability of MSK NHS services. First Contact Practitioner (FCP) is a relatively new role within GP practices in the NHS whereby physiotherapists manage patients with musculoskeletal problems such as arthritis. In patients with inflammatory conditions such as rheumatoid arthritis (RA), recognising signs and symptoms as early as possible and referring these patients to rheumatology for treatment is essential, giving the best long-term outcomes. Rheumatology services in the UK are under pressure due to staffing levels not meeting current demands, so it is essential that the right patients are referred. Physiotherapists have been shown to successfully undertake similar roles to a doctor in diagnosing and managing patients with musculoskeletal problems. However, there is no research into the relatively new FCP role in diagnosis and referral of patients with inflammatory musculoskeletal conditions to rheumatology. This review presents the value of FCPs in GP practices and their role in referring the right patients early to rheumatology as advised by national guidelines. FCPs are best placed to first assess patients with arthritis, providing best care and helping to reduce pressure on rheumatology NHS services. Numbers of FCPs are planned to increase over the next few years.