In a Q&A primary care pioneer Amanda Hensman-Crook explains how you can follow her lead
What is an MSK first contact practitioner/advanced practitioner in primary care?
A first contact practitioner (FCP) is a diagnostic clinician working in primary care at the top of their clinical scope of practice. This allows the FCP to be able to assess and manage undifferentiated and undiagnosed musculoskeletal (MSK) presentations. It is the minimum threshold for working as a first point of contact in primary care.
The clinician must have at least three years’ postgraduate experience in their professional specialty area of practice before starting primary care training to become an FCP. These practitioners refer patients to GPs for the medical management of their conditions and pharmacology outside their agreed scope of practice.
Why is it a good career choice for an ambitious physio?
It’s a great opportunity to pursue a clinical career along a clear pathway to advanced practice. Although MSK care is the focus, this is a diverse role as a diagnostic clinician which requires the clinician to have a broad base of knowledge. You will be dealing with frailty, long-term conditions, complex co-morbidity, public health and safeguarding.
This is a challenging but very rewarding healthcare sector to work in, as you’re responsible for looking after patients with undifferentiated and undiagnosed conditions and managing uncertainty. It’s fast-moving and every day is different.
Working as part of the community and in a tight-knit, multi-professional team for the same common goal of gold standard patient care – what can be more rewarding than that?
What steps would an aspiring physio need to take to get there?
The Roadmap to first contact and advanced practice in primary care was launched in October. This sets out the training supervision and governance requirements for this role.
A diagram to illustrate the career pathway from being an undergraduate into a primary care role can be found on page 9 of the roadmap (see link below).
Once clinicians have been registered post-HEI [higher educational institute] training, as novice practitioners they are encouraged to work across all specialities (such as neurology, medicine, respiratory, paediatrics, orthopaedics, rheumatology) and across all healthcare settings for two years. This is to build a broad base of knowledge in practice within and outside MSK and to learn multi-system care pathways across all settings.
Following this, and now in MSK, they continue to develop across the MSK spectrum and move from novice to experienced clinician over at least three years before starting primary care training.
This time is spent broadening their learning across MSK specialties and consolidating their understanding of how other conditions and pathologies can be drawn into one clinical consultation to manage the presenting condition effectively.
It’s essential for clinicians to have this firm foundation. The additional primary care training typically includes radiography, MSK bloods, injection therapy and prescribing, as well as developing the ability to work with complexity and medical uncertainty.
I find working in primary care really rewarding ... it’s a great place for innovation, allowing you to develop the best care pathways for out-patients starting from the grassroots and extending across the whole healthcare system. I love it!
How many of these physios will be needed in primary care in England by 2030?
The goal is to have 100 per cent primary care network coverage by then.
How will the roadmap help to make this plan a reality?
It provides a sustainable pathway to deliver a pipeline of clinicians at the right level of capability, moving through their careers into primary care.
There are options of either a taught route or a portfolio route to make the role accessible to all clinicians who wish to become FCPs. The taught route is delivered as a Masters module at an HEI with suitable accreditation. The portfolio route is a supportive pathway with bespoke supervision. We want everyone to have the chance to pursue this career choice.
The publication talks about the ‘four pillars’ of advanced practice – what are these?
The four pillars are:
They shouldn’t be viewed as distinct entities, but rather as overlapping ones.
An advanced practitioner is somebody who has been verified to Masters level across all four pillars of practice. In comparison, an FCP has been verified to Masters level in the clinical pillar and has gained a portfolio of evidence/knowledge in the other three, but hasn’t quite reach Masters level in those yet.
There is an explicit ‘top up’ a clinician can do on completing FCP training enabling them to go on to work as a verified advance practitioner.
How did you get into the field and has it been rewarding?
I developed first contact practice with Neil Langridge in 2014. We could see how putting the right person with the right capabilities at the front of the care pathway could solve inefficiencies across the whole care pathway and provide the patient with a streamlined journey and gold standard care. It started with a couple of local audits which showed that this premise worked as a reality.
The whole FCP journey from then to now can be seen here: http://arma.uk.net/wp-content/uploads/2020/05/FCP-MSK-review-with-authors_v3.pdf
I find working in primary care really rewarding. You're very much part of the community and work in a great multi-professional team, with patients truly at the heart of everything that you do.
It’s also a great place for innovation, allowing you to develop the best care pathways for out-patients starting from the grassroots and extending across the whole healthcare system. I love it!
Amanda Hensman-Crook is a national AHP clinical fellow for education and quality at Health Education England
To see the Roadmap to first contact and advanced practice in primary care, visit: https://www.hee.nhs.uk/our-work/primary-care/first-contact-practitioners-advanced-practitioners-primary-care-musculoskeletal
Author: Ian A McMillan