Employing a physiotherapist

Physiotherapists, also termed MSK practitioners, can be a huge asset to the multi-disciplinary team working in primary care.

They are highly trained clinicians who have completed a degree level qualification in physiotherapy, and registration with the Health and Care Professions Council.

To work in general practice, a physiotherapist needs to be an experienced, confident, independent practitioner, with several years of experience working within the NHS or private sector.

Job role

Physiotherapists, or MSK practitioners, perform key clinical roles in general practice:

• MSK practitioners can be employed as first-contact clinicians, meaning patients can book an appointment directly with them.
• They are independent practitioners who offer a complete assessment – from history to examination, investigation and treatment plan, or referral if appropriate.
• They can offer telephone triage in urgent and routine care, as well as several face to face contacts per session.
• They can request radiology tests including X-Ray, ultrasound and MRI scanning, and also arrange blood tests to rule out inflammatory or potentially malignant causes of musculoskeletal presentations.
• Many advanced physiotherapists are also independent prescribers.
• According to BMA advice on employing first-contact physiotherapists via primary care networks, physiotherapists should ‘soon’ be able to issue fit notes.¹

Many physiotherapists have previously worked in the hospital or private setting, so primary care offers a different approach and requires some of these clinicians to work outside of their comfort zone. That said, there are great opportunities for MSK practitioners in primary care, with the ability to design and develop the role and go on to forge links or referral pathways with our secondary care colleagues.

Employing a physiotherapist

The role of the MSK practitioner or physio in general practice is fairly new, so finding the right employee can be a challenge. The right person would have to be confident in their own knowledge and ability, comfortable with a degree of uncertainty and aware of their own boundaries.

Although independent, they do require a degree of support and the practice should allow an opportunity for the clinician to debrief with an experienced GP as appropriate. It is important they have a named GP mentor and regular reviews to allow for two-way feedback and ongoing development of the role.

To recruit an MSK practitioner, advertise on various platforms including your practice website and NHS Jobs. To help attract good candidates, you can highlight that working in primary care offers practitioners independence, flexibility and an opportunity for development. General practice allows the opportunity for part-time or portfolio careers for MSK clinicians, as well as GPs.

It is important to consider how you will find the ‘right fit’ for your practice when recruiting someone – including personality and available hours.

Salaries

Physiotherapists sit on band 7 or 8a of the Agenda for Change pay scale – so salaries currently range from £37,570 to £50,819.

Practices may in future be able to access physiotherapists via their local primary care network, under the ‘Additional Roles Reimbursement Scheme’ in the new GP contract. This promises to at least partially fund over 22,000 new allied health staff members across primary care including MSK practitioners (as well as pharmacists, paramedics, physician associates and social prescribers). They will be employed as part of Networks and 70% funding should be available for first-contact MSK practitioners (physiotherapists) from April 2020 (at Band 7-8a salary).

Potential benefits

Having the option of an MSK practitioner in the practice means there is a reduced burden on GP appointments and workload.

Patients potentially get a more thorough assessment with a guided treatment plan based on specialist expertise.

There is potential for reduced prescription costs as the patient is getting advice regarding self-care and activity, which may negate the need for prescribed analgesia.

Another advantage is that physiotherapists are a valuable information resource – as independent clinicians, 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.

Potential drawbacks

It can take time for a physiotherapist to get used to the pace of primary care – for example, having only 15-minute appointments.

Physiotherapists have a different model of undergraduate training so may not be so familiar with the ‘medical model’ – it is important to ensure robust mentoring to allow for debrief of complex presentations.

The main potential drawback to adding MSK practitioners to the GP team is the de-skilling of GPs in practical tasks such as intra-articular injections and the Epley Manoeuvre.

Summary

• Physiotherapists / MSK practitioners are highly skilled independent clinicians
• They offer complete assessments and can refer for imaging/blood tests directly
• Free up GP appointments and allow more thorough MSK assessments
• Need some supervision and debriefing
• Potentially result in deskilling of GPs in some procedures

Dr Abbie Brooks is a GP partner in York

Reference

1. BMA. Support services for practices – Primary Care Networks Handbook