We have had two MSK practitioners at our practice for the last twelve months and the feedback from both staff and patients has been positive. They work within their wide scope of practice and cope well with uncertainty but seek advice when appropriate.
We decided we needed to diversify our workforce due to reducing numbers of GPs nationally. We have a varied population in York and were aware a huge number of urgent and routine GP contacts were for musculoskeletal problems – despite patients having been able to self-refer to secondary care MSK services for a number of years. We are also employing urgent care practitioners (paramedics) and pharmacists, as well as the MSK practitioners, offering competitive pay to bring these clinicians in to primary care.
How they work
Our two MSK team members run routine clinics across the week at our different sites but also have capacity allowed for urgent same-day triage phone calls which assists the acute care team. The timings of their sessions vary and there are different appointment slots available – routine, clinician book only and urgent same-day appointments as well as telephone slots for our MSK practitioners to book their own follow up (for example, to discuss an MRI result).
The main benefit is that the workload burden on GPs has reduced, as most patients with a musculoskeletal problem are now signposted to book an appointment with an MSK practitioner. In the first year of employing physios, we found that around 8,000 MSK appointments were completed by the two MSK practitioners (for a practice with >55,000 patient list size). Patients also undergo a more thorough assessment and our practitioners are very much tuned in to red flags symptoms. The MSK practitioners are a valuable information resource as they keep up to date with guidelines and are happy to be approached for advice. For example, our MSK practitioners recently put on an education session for all our clinical staff on the updated NICE guidelines on Cauda Equina Syndrome. Patient feedback has generally been very positive, with many patients booking in again directly with the MSK practitioners when they develop further/different musculoskeletal problems.
We have seen only benefits in the past year having MSK practitioners on board, but it can take time for a physiotherapist to get used to the pace of primary care – for example, having only 15-minute appointments. The main potential drawback we have noticed is the de-skilling of GPs in practical tasks such as intra-articular injections and the Epley Manoeuvre. The GPs do continue to offer these but are doing far fewer than previously.
The NHS long-term plan, new GP contract and introduction of primary care networks will only encourage further diversification of the workforce. We see it as necessary to continue to embrace this and use the opportunity for highly skilled and experienced GPs to work in a ‘consultant’ role mentoring and supervising our allied health professionals.
Dr Abbie Brooks is a GP partner in York
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