S. Stynes1,2, K.P. Jordan1, J.C. Hill1, G. Wynne-Jones1, E. Cottrell1, N.E. Foster1, R. Goodwin3, A. Bishop1
1Keele University, School of Primary, Community and Social Care, Keele, United Kingdom, 2Midlands Partnership Foundation NHS Trust, Haywood Hospital Spinal Interface Service, Stoke on Trent, United Kingdom, 3University of Nottingham, Division of Rehabilitation, Ageing and Wellbeing, Faculty of Medicine & Health Sciences, Nottingham, United Kingdom
Background: First Contact Physiotherapy (FCP) is a rapidly evolving model of primary care in the United Kingdom (UK). Expert musculoskeletal (MSK) physiotherapists undertake the first patient consultation, to enhance and expedite MSK-patient care and free-up General Practitioner (GP) capacity for other patients.
Purpose: A three-phased evaluation of NHS England’s (NHSE) pilot of the FCP model has been undertaken (2018/2020). Here, we report the quantitative findings from Phase 3, which aimed to evaluate the FCP model of care against six pre-specified success criteria.
Methods: Phase 3 comprised a mixed-methods 24-month service evaluation involving 40 FCP sites across England. Using a single online platform, outcomes were collected immediately following the FCP consultation and at 1, 2 and 3-months follow-up. These included the Keele STarT MSK Tool, pain intensity (0-10 NRS scale), overall MSK health (Musculoskeletal Health Questionnaire (MSK-HQ) range 0-56), and patient experience measures (Friends-and-Family Test). A two-stage qualitative evaluation (focus groups, interviews and observation diaries) of six FCP services explored views and experiences of FCPs, GPs, patients and practice staff (reported elsewhere).
Results: 2825 patients over 13 months were eligible to participate in the evaluation; all were invited by email and 24% (n=680) participated (mean age 56.2 (14.9 SD), 61% female, ethnicity 97% white, mean pain intensity 6.1 (2.13 SD), and mean MSK-HQ score 33.8 (9.5 SD)). 47% had an acute/subacute MSK problem (≤3 months), with 25% having pain in more than one body region and 49% reporting at least one co-morbidity. The Keele STarT MSK tool classified 29% at low-risk of persistent disabling pain, 58% at medium-risk, and 13% at high-risk. Follow-up rates at 1, 2 and 3 months were 63% (n=430), 62% (n=419) and 54% (n=370). At 3-months, a mean reduction in pain intensity of 2.8 (CI 2.5,3.1) from baseline was observed, a mean improvement in MSK-HQ of 7.1 (6.0, 8.2) and 64% reported being much better/better.
Five of the six success criteria were met: 20% of patients saw the GP for the same MSK problem in the 3-months following their baseline visit (target ≤25%); 95% of patients received sufficient information on self-care (target ≥70%); 94% would recommend the FCP service (target ≥80%); 54% of patients achieved at least a 6 point minimal important change on the MSK-HQ at 3 months follow-up (target ≥51%); 54% of patients reported less impact of their MSK condition on work performance (as measured by the Stanford Presenteeism Scale) at 3 months (target ≥51%). One criterion was not met: only 29% of those in employment (n=388) reported receiving specific work advice from the FCP (target ≥75%).
Five of the six success criteria were met: 20% of patients saw the GP for the same MSK problem in the 3-months following their baseline visit (target ≤25%); 95% of patients received sufficient information on self-care (target ≥70%); 94% would recommend the FCP service (target ≥80%); 54% of patients achieved at least a 6 point minimal important change on the MSK-HQ at 3 months follow-up (target ≥51%); 54% of patients reported less impact of their MSK condition on work performance (as measured by the Stanford Presenteeism Scale) at 3 months (target ≥51%). One criterion was not met: only 29% of those in employment (n=388) reported receiving specific work advice from the FCP (target ≥75%).
Conclusion(s): Ahead of the planned scale-up of the FCP model of primary care across the UK, this evaluation provides useful data on the patients who are accessing this service, their short-term clinical outcomes and whether key success criteria are being met. Future robust evaluation of FCP services is needed.
Implications: These results evidence the benefits and challenges of FCP services for MSK pain in primary care. Specific support for the delivery of work advice by FCPs may be needed.
Funding, acknowledgements: The NHS England FCP Evaluation is funded by the Chartered Society of Physiotherapy and the Joint Work and Health Unit
Keywords: musculoskeletal pain, first contact physiotherapist, primary care
Topic: Musculoskeletal
Did this work require ethics approval? No
Institution: N/A
Committee: N/A
Reason: This is not a research study but a service evaluation. Data collection meets regulatory requirements for GDPR & NHS Information Governance
All authors, affiliations and abstracts have been published as submitted.
