PhysioUpdate 14th December 2021

Scottish Government draft pain framework highlights value of first contact physiotherapy initiative

Physiotherapists and their representatives have until the end of February 2022 to respond to a Scottish Government framework on how services should be delivered to people with chronic pain.

The framework, which was released in draft form earlier this week (6 December), includes 11 case studies – one of which is titled ‘New models of support for people with chronic pain’. This highlights the dramatic impact that first contact physiotherapists (FCPs) are having in primary care settings in Scotland.

FCPs give patients 'timely access to diagnosis, early management and onward referral' (stock image)

'Expertise and autonomy'

Noting that FCPs display ‘expertise and autonomy’ – by taking responsibility for investigations and referrals, for example – the framework says the initiative offers patients ‘timely access to diagnosis, early management and onward referral’, and saves resources as a result.

Fewer that two patients in 100 (2 per cent) who are assessed by an FCP are referred on to a GP, while orthopaedic and imaging referral rates have fallen by almost a third (30 per cent), according to national data.

Meanwhile, the referrals that are made are more ‘appropriate’, while most patients (60-70 per cent) ‘do not require further intervention and are empowered and more confident to engage with self-management’.

The case study also notes that having a FCP results in fewer MSK patients being sent from primary care settings to mainstream NHS physiotherapy services (a 60 per cent fall). As a result, more capacity is available to manage those cases requiring ‘more specialist support’.

More than 200 advanced MSK practitioners promised

A further case study looks at the role of physiotherapists and other allied healthcare professionals (AHPs) in managing chronic pain. The study refers to various Scottish Government strategies that support the training and development of the AHP workforce in the chronic pain field, including early interventions that help to prevent and manage MSK conditions. See:

For example, 225 more advanced MSK practitioners will eventually work in primary care settings, while the number of training places for the physiotherapy workforce is increasing, the study notes. ‘Work to review AHP education and training is planned and we will identify opportunities to enhance support for people with chronic pain through its recommendations.’

East Lothian in the spotlight

Another case study in the draft framework focuses on East Lothian’s multidisciplinary pain management service, which takes GP referrals for people needing specialist support. The services provide patients with various options: telephone support, NHS NearMe, digital group work, face-to-face sessions and online resources are all available.

Staff collaborate with other pain management services through the Lothian Physiotherapy Pain Network, ‘which supports shared learning and service development to improve patient care’. In time, the service will include psychological therapies, occupational therapy and pharmacy support, the case study adds.

Pain Navigator Tool

Another case study looks the Pain Navigator Tool, which was developed with funding from the Scottish Government. The tool helps people with chronic pain to identify what they want from their treatment, as well deciding what questions they will ask their healthcare professional during a consultation. For more information, visit:

Other case studies include digital access to mental health support for people with chronic pain, and local opportunities to become physically active.

This consultation on the draft framework comes at a crucial time, given the continued impact of the Covid-19 pandemic on both people with chronic pain and the services they use [Maree Todd, public health minister]

In the publication’s foreword, Maree Todd, minister for public health, women's health and sport, thanks healthcare practitioners and others who contributed to the framework. The input from the National Advisory Committee for Chronic Pain, whose members include Paul Cameron, a physiotherapist by background, receive a special mention. Dr Cameron is the chief medical officer’s speciality adviser for chronic pain and the clinical lead NHS Fife Pain Management Service.

Ms Todd added: ‘This consultation on the draft Framework comes at a crucial time, given the continued impact of the Covid-19 pandemic on both people with chronic pain and the services they use.

‘The framework intends to support pain management services to achieve these goals by empowering its workforce, enhancing the use of data, and ensuring research and best-practice is implemented to improve care.’

To download a copy of Chronic pain service delivery - draft framework: consultation, visit:

The deadline for responding to the consultation is 28 February 2022. Responses can be made through the Scottish Government's consultation hub, Citizen Space. To respond online, visit:

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