Musculoskeletal First Contact Practitioners. Frimley Health NHS Foundation Trust

Musculoskeletal First Contact Practitioners. Frimley Health NHS Foundation Trust



the demand for musculoskeletal problems is growing and now the same movement down to the left we know that it's somewhere in the region of 20 to 30 percent of a-gps caseloads but what we're finding is that with the first contact role because we're seeing them so early in their pathway they're often being able to be managed without needing to be referred into a traditional physiotherapy department the onward refers in secondary care particularly into orthopedics have reduced by about a third it's had benefits for the patient's themselves seeing the person most able to help them at the first appointment capacity for general practice has increased both for the media and routine appointments and then press I think we've learned a lot from the GPS I think the GPS have learned a lot from us very good certainly I feel as a clinician that I'm maximizing my skills and experience so based on your assist we're not trying to replace GP what we're trying to do is add extra value to a patient's consultation the first contact practitioner is somebody that is based usually within a GP practice a patient will ring the GP practice and instead of going to see a GP they would come in and be booked directly in see one of my team they would be assessed and given the appropriate advice and guidance about how to manage their problems so that they're getting knowledge about how to self-manage right from day one the surgery was very keen to be involved in getting this work started in trying to see how patients could be served better the way we have everything set up is that the practitioners are indeed the first point of contact when I graduated from my master's degree the development of extended scope practice was beginning and I think first contact is a natural development and so that the patients are seeing the right person at the right time we have easy access of the practitioners to hide the patient's own GP or another GP if the practitioner sees somebody who they don't actually feel has a musculoskeletal condition then it's very easy for the patient to be passed on to the right person to be able to see them how does that feel we've worked with them to help them become prescribers which has allowed the patients to be given medication where appropriate which of course in the long run has helped us we have demonstrated that our onward referral rate to orthopaedics has been reduced from 28 to 9% so there is a huge financial implication for what we do managing patients more effectively and efficiently from a physiotherapist point of view if we can manage those patients correctly from the start hopefully we are preventing a lot of ongoing persistent and chronic problems it very quickly became evident that this was a very successful service and then we had to try and grow or recruit more advanced practice physiotherapists so we created this accelerated learning program for some of our and sixes and sevens the idea was always to train them up to an eight a capability to begin with you're paired up with in it with an experienced advanced practitioner who'd already done some work with in primary care already our clinics normally run side by side of the run very very close to each other and that enables me to dash out and ask them if there's any problems or likewise if my clinics actually ended at that time point then I know that they're going to be there for me to discuss the patients through we have quite a stringent appraisal policy at the trustor so I'd be meeting with my appraiser or normally on a weekly basis but certainly touching base with the first contact practitioner that's experienced in the role at least once per clinical say what we've found is the things they've learnt in the first contact role they've been able to bring back to the benefit of all in the department and so that cross learning and understanding how somebody presents maybe first thing in their journey and versus coming in to the physiotherapy departments really helped me I don't think first contact roles are going to disappear I think the demand for them is going to increase and I think having trained staff that are ready to go has to be the way forward

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