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Introducing physiotherapy posts to general practice

The Chartered Society of Physiotherapy (CSP), RCGP and BMA have published guidance for implementing and evaluating physiotherapy posts in general practice. Separate guidance is available for England and Wales.

The guidance looks at how physiotherapy can work as a ‘first point of contact’ service, so that patients presenting with a musculoskeletal problem for a GP appointment are offered a consultation with a physiotherapist instead.

It is estimated that musculoskeletal consultations account for up to 30% of GP consultations. The CSP has produced a cost calculator to estimate how much GP time practices can free up through reallocating GP appointments for patients with musculoskeletal problems to physiotherapists. You can access this here.

Benefits of general practice physiotherapy

  • Patients have quick access to expert musculoskeletal assessment, diagnosis, treatment and advice, which can help prevent short-term problems becoming long-term conditions.
  • There is a shorter treatment pathway, making it more convenient for patients.
  • Releases GP time through re-allocating appointments for patients.
  • Reduces the number of musculoskeletal referrals to secondary care, reducing waiting times for orthopaedics, pain services, rheumatology, community physiotherapy and clinical musculoskeletal assessment and treatments services.
  • Provides opportunities for physiotherapists to develop their scope of practice and skills.

Funding physiotherapy posts in general practice

There are several ways that physiotherapy posts can be funded in general practice:

  • The role can be GP funded on a contractor basis, so the practice would pay for a physiotherapist to come in and work on a sessional basis as a freelancer/locum. Under this model the physiotherapist remains self-employed.
  • Physiotherapists can be employed by the practice.
  • The physiotherapist could be employed on a contract through the CCG or Health Board.
  • A physiotherapy service could be developed across a GP federation with the physiotherapist either employed by the federation or employed on a sessional basis as above.

Implementation considerations

The highlights factors that need to be considered when making practical arrangements for a physiotherapist service.

Starting out
Practices, or employing CCGs or federations, will need to understand the local patient population, public health resources and local development/commissioning plans when deciding how to set up the service.

Supervision
An appropriate governance structure and access to supervision are key to the successful implementation of physiotherapy posts, the guidance says. Physiotherapists are autonomous practitioners, however they need to have a strong awareness of their own scope of practice and understand the importance of working within their competence. They also need access to support and advice on how to best manage the needs of individual patients and have access to opportunities for professional development.

Types of role
Early adopters of physiotherapy posts have used ‘advanced practice roles’, which means these physiotherapists are able to work independently and are able to manage high levels of complexity, uncertainty and risk. The guidance says that as these roles become established and in greater number there will be more opportunities to develop a wider skill mix, so that more junior physiotherapists and physiotherapy support workers can contribute to general practice under the supervision of the more established physiotherapists.

Indemnity
Physiotherapists carry their own professional indemnity. If a practice employs a physiotherapist the practice should ensure its medical defence organisation knows about this role as the partners may require additional insurance to cover any vicarious liabilities as employers. If the physiotherapist is contracted from another employer, such as the CCG or health board, the insurance cover should be provided by that organisation. If the physiotherapist is self-employed and acting as a sole trader they should have their own indemnity. Practices should check this as they would with any GP locum they employ.

Patient access
Physiotherapists should provide reception and practice staff with training and advice to enable them to identify patients who can most appropriately see a physiotherapist. The guidance says it can be useful to develop a script with receptionists so that there is consistency in how questions are asked and the responses given. Receptionists have a key role in marketing the service effectively and offering patients appointments.

Defining the role

The guidance provides a list of key characteristics of the general practice physiotherapy role under the following headings:

  • Provides a service for musculoskeletal patients
  • Provides an expert advisory service to general practice colleagues
  • Contributes to service evaluation and collaboration

There is also advice on the the capabilities a physiotherapist would need to fulfill the role. Physiotherapists that are able to fulfil a high level role in primary care will have typically completed post-registration professional development. This would usually include masters-level learning related to musculoskeletal conditions, competence in injection therapy and the independent prescribing qualification.

These sections in the guidance should help employing organisations formulate a person specification and a job description for their physiotherapy role.

Under Agenda for Change physiotherapy posts are graded from band 5 (newly-qualified) through to band 9. However, the greatest value and impact of physiotherapy roles in general practice will be from those requiring a high level of independence, the ability to order further examinations and refer onto specialist services. As such the role is likely to fall within the band 8 range.

Download the guidance

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