MSK Practitioner Service

Musculoskeletal (MSK) First Contact Practitioner

What are FCPs?

A first contact practitioner is usually an experienced practice physiotherapist or osteopath who has the advanced skills necessary to assess, diagnose and manage musculoskeletal (MSK) problems – such as lower back pain, ankle sprains or frozen shoulder, for example.

An FCP service allows patients who would normally present to their GP with an MSK issue, to self-refer to a professional with expertise in that field. This ‘cuts out the middle man’ and helps to ensure the correct advice/exercises are prescribed from day one, allowing patients to take control of their recovery from day one.

What the NHS say…

NHS England reports that patients with MSK issues make up to 30% of GP consultations and 10% of all GP referrals. The FCP service has the following benefits:

  • Quicker access to treatment
  • Reduced workload on the GP’s and associated costs – reducing GP waiting times
  • Reduced costs – on prescriptions and secondary referrals
  • Increased emphasis on self-management and reduction in inappropriate referrals

What you might expect from an FCP appointment…

A brief history of the problem will be taken before several clinical tests will be performed. The aim of the FCP is to assess the problem in order to decide what the patient requires to maximise their recovery.

A majority of patients with MSK problems will be discharged with advice and exercises using RehabMyPatient software; providing a clear, concise programme to manage recovery. If symptoms did persist despite this, the patient has the ability to book back in to see the FCP where further treatment options can be discussed.

Assuming the appropriate ‘MSK patients’ have been booked in, very little require GP input, but if it is, then this can easily be organised between the FCP and the GP’s. The FCP also has the ability to refer patients on for further care if deemed appropriate; this may include referral for imaging (x-rays or scans), joint injections or to the local orthopaedic team.

This may simply be further guidance and support on exercises, but often it is where treatment is indicated; e.g. manual therapy, acupuncture or shockwave.

We also use an excellent physiotherapy software tool: Rehab My Patient which allows us to send over 2500 HD videos and exercises, and over 470 advice sheets to our patients.

Physiotherapists/Osteopaths in General Practice Surgeries. What do we offer?

  • We will run a Musculoskeletal Assessment Service for your surgery, at the agreed number of hours, seeing your patients with musculoskeletal issues.
  • These patients will be managed in session, or referred on via your normal referral routes. Our set up will fully integrate with your current ways of working.
  • Osteopaths and Physiotherapists are highly skilled and highly trained with many years of experience.
  • All governance is managed in line with GP practices current guidelines.
  • Full auditing of service.

The length of consultation is 20 minutes with a 20 minute admin break in a session (4 hours).

If this sounds like something you would be interested in or something that would suit your surgery then please do get in contact. NHS England Mandate want this in place in every GP surgery in the next year so get in touch and see if we can help you set it up now.

And Why are we doing this?

The Changing Face of Primary Care

Demands on GP practices are at their highest, without growth in resources (Health Committee Select – Primary Care, 2016), which has in fact been reduced by about 25% over the past few years (Briggs, 2015). GP training places are going unfulfilled (12% – National Audit Office, 2015) and numbers in 2015 show that 11% of patients seeking a GP appointment failed to get one due to demand exceeding capacity (RCGP, 2015). The National Audit Office estimates that 27% of appointments were avoidable contacts. Of note is that it is estimated 40% of a GPs working week is spent on tasks such as prescriptions, referrals and form filling.

So why is this news?

The British Orthopaedic Association estimate that 1 in 3 GP consultations are musculoskeletal. The Chartered Society of Physiotherapy suggests that 15-30% of the GPs caseload is Musculoskeletal. Which means MSK practitioner could see these patients.


Osteopaths and Physiotherapists are skilled practitioners in musculoskeletal medicine. They are trained to a high level to assess patients with musculoskeletal pain, rule out anything serious and advise on future treatment and management.


  • Cost saving. A GP costs £130.71 per hour (CSP Policy Briefing, 2016). The way we are able to model such a service means we can offer an Osteopath or Physiotherapist to a GP practice at £45 per hour.
  • More time for GPs. A pilot in North Wales in six months had MSK practitioner see 1525 patients of which only 23 needed any input from a GP, and a pilot in Suffolk in six weeks saw 164 patients with only one needing any input from a GP. GP’s will also not have to do any referral paperwork.
  • Improved Patient Pathway. Right care. Right time. Right place. Reduced referrals to secondary care (12% in North Wales) and reduced prescription costs/medication use. A pilot in Nottingham found statistically significant improvements in clinical recovery from going straight to the MSK specialist. A pilot in Suffolk had a 99% Friends and Family score, with 96% of patients ‘strongly agreed or agreed’ that they were seen quickly and the service was easily accessible and 88% ‘strongly agreed or agreed’ that the service offered was ‘perfect’.


  • Red Flags
    • Osteopaths are the expert group concerning MSK issues
    • Highly skilled to spot and act upon red flags
    • Osteopaths have same high safety record as GPs, second only to Orthopaedic Consultants in Musculoskeletal Knowledge (BMC, 2005)
    • CSP’s Primary Care Health Monitor 2016 that 8/10 GPs are already confident in the service