Evaluation of the First Contact Physiotherapy (FCP) model of primary care

Problem

First Contact Physiotherapy (FCP) is a rapidly evolving primary care model where expert musculoskeletal (MSK) physiotherapists undertake the first patient consultation, to enhance and expedite care and free-up GP capacity. A three-phased evaluation of NHS England’s pilot of the FCP model has been undertaken (2018/2020). We report Phase 3, which evaluates the FCP model against five predefined service aims and twelve success criteria.

Approach

Phase 3 comprises a mixed-methods 24-month service evaluation involving 40 FCP sites across England. Using an online platform, patient reported experience and outcomes were collected immediately following the FCP consultation and at 1, 2 and 3-months. These included the Keele STarT MSK Tool, pain intensity (0-10 NRS scale), overall MSK health (Musculoskeletal Health Questionnaire (MSK-HQ)), and patient experience measures (Friends-and-Family Test). A two-stage qualitative evaluation (focus groups, interviews and observation diaries) involved case studies of eight FCP services to explore views and experiences of FCPs, GPs, patients and practice staff.

Findings

Over 13 months, 2825 patients were registered as eligible and 24% (n=680) completed their initial questionnaire. Their mean age was 56.2 (14.9 SD), 61% were female, ethnicity was 97% white, mean pain intensity was 6.1 (2.13 SD) and mean MSK-HQ score was 33.8 (9.5 SD). Duration of MSK problem (≤3 months) was 47%, with 25% having pain >1 body region and 49% reporting ≥1 co-morbidity. The STarT MSK tool classified 29% low-risk, 58% medium-risk, and 13% at high-risk of persistent disabling pain. On data to date, two success criteria are met: 95% of patients receiving sufficient information on self-care, 94% recommending the FCP to friends-and-family. One success criteria is not met: 29% of those in employment (n=388) receiving work advice (target 75%). Currently follow-up rates at 1, 2 and 3 months are 62%, 62% and 57%. Interim analysis of 295 patients at 3-month follow-up shows a 2.8 (CI 2.5,3.1) mean reduction in pain intensity from baseline, a mean 6.9 (5.7, 8.2) score improvement in MSK-HQ and 63% reporting overall improvement (much better/better) since seeing the FCP. Five themes are identified as important in the success of the FCP model from the qualitative evaluation: Communication (identifying important communicative strategies and considerations); Patient understanding of FCP (lack of awareness/understanding of FCP as a barrier to access); Embeddedness of the FCP service (factors which promote cultural adaptation); Contribution of FCP (patient and staff satisfaction, recognition of MSK expertise); Reconceptualising physiotherapy (extended skills and new models of care).Data collection is ongoing with full results available at the conference.

Consequences

Ahead of the UK wide FCP model scale-up, this evaluation shows who accesses this service, their short-term clinical outcomes and which success criteria are being met to add to the body of evidence to optimise FCP service design and delivery.