Under the microscope – healthcare leaders hotly debate challenges and value of First Contact Physiotherapy

A virtual thinktank scrutinizing the roll-out of FCPs in primary care networks sparked heated debate among around 200 healthcare leaders and clinicians.

29 September 2020


Hosted by Connect Health Change, the session honed in on the topic of First Contact Practitioners (FCP) delivering front-end access to Musculoskeletal (MSK) expertise across the UK, in a bid to free up GP time amid estimates that up to 20% of GP referrals are for MSK issues.

Identified by Larry Koyama, Head of FCP Implementation at the Chartered Society of Physiotherapy as ‘a significant strategic priority’, the promise of FCPs proved a hot topic, with the expert panel fielding a deluge of 90 questions in little over an hour.

Findings from successful pilots of the scheme were presented, with Dr Jon Tose, GP and formerly Clinical Director, NHS South Tyneside CCG, reporting that 1 in 5 GP appointment requests were successfully diverted to a First Contact Physiotherapist.

Catherine Thompson, Programme Director, Improving Planned Care at the West Yorkshire and Harrogate Health and Care Partnership also shared positive feedback, after redesigning the MSK pathway across the entire region.  FCPs were at the forefront of this, with Bradford University commissioned to deliver a course for 20 practitioners in FCP posts or potential role holders. A second cohort of a further 15 postgraduate physiotherapists with ambitions to work in primary care has been agreed. Over 50% of the region’s primary care networks now have FCPs in post and they hope to reach 75% coverage when all vacant posts are filled, which is the 2021 NHS England target.

Points of debate included:

  • Could the introduction of FCPs in primary care networks destabilise the MSK pathway?
  • Why system leadership and an integrated approach is needed to ensure DES funding is adequate to cover associated costs and resource requirements for the posts, estimated at 10% per year per WTE role. This often requires understanding the potential positive impact on these roles to the whole MSK system / pathway and creating a space for the local system to see the benefits of collaboration. The Yorkshire and Harrogate example demonstrated this.
  • The impact on band 5 and 6 physiotherapists, who do not fall within the funded roles and may be without clinical expertise to guide their early-career development

Danielle Chulan, Deputy Director NHS Services at Connect Health, led the discussion on DES funding implications. She said:

There are resource, time and management costs and overheads that aren’t met by the DES funding, and the question is who should cover these? It’s easy to be blinded by the offer of a ‘freebie’, but it has already been identified that there is a significant initial training need and requirement for ongoing robust governance.

“If we get FCP implementation right we can ensure our clinicians feel supported and they can provide safe and effective care. If we get this wrong, at best, we create a retention issue, and at worst we’ll create unsafe and ineffective care to the patients, and further fragment the MSK pathway.”

While discussions were lively on how best to achieve successful implementation of FCPs, the panel were united on the importance of collaboration and above all, putting the patient at the very heart of the system.

Larry Koyama explained:

The evidence and principles that support successful implementation are consistent and supported by evidence, and the webinar recognised the challenges particularly around DES, training and governance.


Other key points highlighted by the speakers during the webinar included the need for:

  • FCPs to be part of the primary care team
  • Integration to wider MSK pathway
  • Governance and leadership beyond individual services
  • The ability to see and understand the whole system
  • Local decisions – directly employed and use of existing MSK providers can be successful with the right leadership.

Catherine Thompson concluded:

The webinar demonstrated that there were examples of a particular approach having strengths in a particular place, but successful implementation was as a result of good system involvement and a determination to integrate. The examples where things hadn’t worked too well weren’t necessarily that the model was wrong, but that good practice in change management hadn’t been followed.

Chaired by Andrew Cuff, Consultant Physiotherapist and Clinical Lead at Connect Health, the panelists were:

  • Amanda Hensman-Crook, Consultant MSK physiotherapist, National Health Education England AHP clinical fellow,
  • Larry Koyama, Head of FCP Implementation, Chartered Society of Physiotherapy
  • Dr Jon Tose, GP, formerly Clinical Director, NHS South Tyneside CCG
  • Catherine Thompson, Programme Director Improving Planned Care, West Yorkshire and Harrogate Health and Care Partnership
  • Danielle Chulan, Deputy Director NHS Services, Connect Health

The talk was the latest in a series from Connect Health Change, debating how NHS services can transform in the wake of the COVID pandemic. The next session is focused on pain management and contemporary pain science on 21 October – more info here.

Watch the recording and a transcript of the Q&A session here:


Read more about First Contact Physiotherapy at Connect Health:


Read more about transformation at Connect Health: