FCP PCN

Summary

A request was made for details on the First Contact Practitioner (FCP) service specification, funding, agreements, and staff salaries within Manx Care. The authority provided a pilot overview, job description, and operational model but withheld specific salary breakdowns and certain reimbursement agreements.

Key Facts

• The FCP service is a pilot program designed to provide MSK assessments and treatment to reduce GP workload.
• The prototype operates at Ballasalla and Kensington with 9 daily appointments over 4 days.
• FCP sessions are 30 minutes long and include assessment, diagnosis, and management advice.
• The service aims to provide quicker access to MSK care and improve patient self-care experiences.
• Certain information regarding salary breakdowns and specific reimbursement agreements was withheld.

Data Disclosed

• 2025-05-19
• 2025-06-02
• 9.00 – 18.00
• 9.00 – 12.00
• 13.00- 17.30
• 30 minutes
• 9 daily appointments
• 4 days
• 32 appointments
• 6-8 weeks
• Grade 8a
• 21 pages
• 3 documents

Original Request

Please provide: 1. Details of First Contact Practitioner Service specification & service deliveries information within Manx Care & to island wide GP surgeries / PCN (Primary Care Network) 2. Details establishment of First Contact Practitioner (FCP) service & source of funding. 3. Details of service level of agreement of FCP with island wide GP surgeries / PCN, approved date 4. Specifically, please provide any agreement/ approval/ protocol of procedure/ reimbursement of additional roles for FCP to undertake joint/ MSK injections at : a. Ballasalla Medical Centre b. Laxey and Village Walk GP Health Centres c. Kensington Group Practice. 5. Breakdown of salary of each FCP member of staffs by year since inception of FCP role. 6. FCP Job Description & Scope of Practice document. 7. Any existing information in relation to reimbursement arrangements & agreement with GP (Primary Care Network) for provision of steroid/ joint injections procedure to each patients registered at their practice.

Data Tables (3)

Full Response Text

First Contact Practitioner pilot overview

• Patient contacts clinic, receptionist staff conduct screening questions to identify MSK issue. If patient is eligible to see the FCP, they are booked for an upcoming appointment, bookings are made up to 1 week in advance. • Service runs 9.00 – 18.00 [Clinical operating hours will be 9.00 – 12.00 & 13.00- 17.30 with 30 minutes sessions. • Total number of appointments in final model to be calculated by assessing demand during pilot • FCP conducts assessment, gathering a detailed patient history.

• The session will include: o A detailed MSK assessment on patients with an undifferentiated and undiagnosed apparent MSK presentations. o Screening for previous pathology and red flags. o MSK diagnosis will be formulated. o Initial treatment will be provided as per EBP/NICE guidelines. o Safety netting.

• Pathway 1: Patient education and advice (conducted during FCP session) • Pathway 2: Onward referral for block of 1:1 MSK Physio sessions
• Pathway 3: Referral to secondary care • Pathway 4: Patient booked in with a GP/ANP/Practice Nurse if not an MSK problem or requires medication. Model overview
First Contact Practitioner MSK Prototype details: • Operating hours will be 9.00 – 15.00 [Clinical operating hours will be 9.00 – 12.00 & 13.00 – 14.30]. • There will be 9 daily appointments on 4 days totalling 32 appointments provided at Ballasalla and Kensington. • Clinic sessions will be 30 minutes. The session will include a detailed assessment, diagnosis and management advice (see model below).
• The prototype will run for 6-8 weeks. • Important Note: The FCP model provides additional capacity for both core GP services (replacing a GP appointment through the FCP assessment in the first part of the session) and physio services (through the delivery of the treatment in the second part of the session. This is the reason for longer sessions than a GP appointment. The funding of these sessions is new money into Primary Care in addition to the Network funding. First Contact Practitioner pilot overview

• Waiting times
• Number of FCP appointments
• DNA rate
• Referrals for further investigation (e.g. MRI) • Prescription (e.g. exercises)
• GP / practice nurse referrals • Diagnosis
• Referrals to other services
To be developed: • Percentage of GP appointments related to MSK pre and post FCP (NOT ON EMIS currently – requires standardised coding)

• Most patients are managed with self-care advice only (at first contact) with no onward referrals or investigations.
For Patients: • Quicker access to MSK assessment, diagnosis and first- line treatment. • Improved patient self-care experience. • Improved speed of return to work. • Quicker recovery. • Shorter pathway to Imaging and onward referral to secondary care if indicated. For Primary Care Teams: • Increased staff satisfaction and wellbeing. • Improved GP capacity. • Improved level of MSK expertise within Primary Care team. • Increased clinical leadership and service development capacity within the Primary Care team. For local healthcare system: • Reduced prescribing rates and costs. • Reduced secondary care levels. • Improved conversion routes to surgery. • Reduced referral for further investigation (MRIs/X-rays). • Reduced referral for the same condition. • Improved use of 3rd Sector/ Community Programmes • Improved timing of imaging referrals. • More appropriate referrals to secondary care services. Potential interventions: • Give information on self-care, enable and support behaviour change. • Exercise preparation. • Discuss fitness for work. • Undertake social prescribing and provide information on 3rd Sector. • Discuss physical activity, general health and lifestyle advice (e.g. smoking cessation, weight management and pacing). • If indicated, refer to Physiotherapy for a course of evidenced based treatment. • Refer to Orthopaedic/Rheumatology/Pai n Services. • Request investigations. • Medicines optimisation and prescribing (when qualified). • Administer joint/soft tissue injections (when qualified). • Manual therapy – if indicated as per NICE guidelines for specific conditions. *Removed at PCN request – loss of income to GPPs. KPIs
Proposed i t ti Expected outcomes

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Manx Care

Job Description

Job Title:
First Contact Physiotherapist Grade:
8a Division: Integrated Therapy Department Job Evaluation Reference Number: 1112v2/JE/20 Responsible to:
FCP Clinical Lead Responsible for: No direct management responsibility

Overview

First Contact Practitioners will work as part of the highly specialist area Out-Patient Physiotherapy Service. First Contact Practitioners will work within GP practices and within the physiotherapy out-patient department (based on 3 sites on island), offering a musculoskeletal physiotherapy service. CARE

In Manx Care we pride ourselves on being committed, appreciative, respectful and excellent. CARE represents what we are about, what we stand for and what we value. All our recruitment, performance management and development is based on our CARE ethos.

Job Purpose

To act as a first-contact physiotherapist practitioner in Primary Care providing highly specialist clinical expertise, diagnostics and decision making to manage Musculoskeletal patients older than 16years of age. This will involve seeing patients without prior contact with their GP.
To integrate a broad range of interventions into practice, including injection therapy and independent prescribing, while also promoting non-pharmacological solutions to patient care. Through patient assessment and working in partnership with patients and their carers, they will make decisions about the best pathway of care, informed by the urgency and severity of patient need, patient acuity and dependency, and establish the most appropriate deployment of resources. This may involve onward referrals for further investigations and assessment in the secondary care setting. To promote a model of self-management, facilitating: behavioural change in line with public health; mobility and physical activity; personal goal achievement and minimising the need for pharmacological intervention.
To take a leading role in the supervision and teaching of all physiotherapists, support staff and students within the speciality. The post holder will be expected to supervise and lead on professional development of physiotherapists working within this area. To initiate and lead service development and quality assurance activities within the specialist area. They will lead and undertake evidence based projects, research and audit within the Out-Patient Physiotherapy Service.

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To work flexibly across the local MSK Service pathway including: Primary Care; Orthopaedic Triage; MSK OP; Chronic Pain and Rheumatology as required, with the ability to order appropriate radiological investigations as required.

Duties and Responsibilities

Takes professional responsibility as a first-contact physiotherapist, with high-level decision-making and clinical-reasoning skills to assess, diagnose and triage patients
Acts as the expert clinician in this area managing a complex caseload of patients, ensuring timely access to care and appropriate use of clinical pathways. To provide a source of highly specialist advice to other healthcare professionals and external agencies involved in patient care. To ensure a well-co-ordinated and comprehensive service delivery by communicating effectively with and other relevant healthcare providers. Works with MDT to develop more effective and streamlined clinical pathways and services Ensures care is proactive, preventive in focus and population based, with an emphasis on early intervention
Provides care which is tailored to the individual needs. This would include, appraising the impact of individuals' clinical status on their general health, well-being, employment status (including in relation to function, physical activity, mobility and independence
Supports patients to set their own goals and be confident in their approach to self-management Communicates effectively and appropriately with patients and carers complex and sensitive information regarding diagnosis, pathology and prognosis. Uses a range of clinical skills which may include non-medical independent prescribing b. joint / soft tissue injections Exercises professional judgement, making, justifying and taking responsibility for decisions in unpredictable situations, including in the context of incomplete/contradictory information
Manages interactions in complex situations, including with individuals with particular psychosocial and mental health needs and with colleagues across the primary care team, sectors and settings To have an excellent understanding of orthopaedic pathways and maintain a good working relationship will orthopaedic consultants within the acute setting. Fully document all patient interventions to meet professional and legal requirements. Leads, manages and contributes to service delivery.
To work with line manager in identifying service needs and formulating strategies to improve and develop the service which would include the compilation of Manx Care policies, protocols and procedures. Provides learning opportunities for the whole multi professional team within primary care. Accountable for decisions and actions via HCPC registration, supported by a professional culture of peer networking/review and engagement in evidence-based practice.

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Organisational Structure A copy of the organisational structure and its relevance to this role is shown below.

Communication and Relationship Skills The communication and relationship skill requirements of this role are:

To promote and maintain effective FCP service communications with GP Practices, as well as other specialties and disciplines, promoting/developing good working relationships to provide patient- centred care.
To meet regularly with the Out-Patient Team Lead, Acute Therapy Manager and GP practice leads to gather, disseminate and impart relevant information relating to service delivery and actively attend/participate in Manx Care staff and peer group meetings.
To develop a close collaborative liaison with primary and secondary services working with MDT colleagues across Manx Care sectors as required to ensure the delivery of co-ordinated care and a seamless services for patients.
To independently and frequently communicate highly complex and sensitive information to patients, parents, carers and other staff effectively, including communicating diagnosis, gaining consent to and understanding of treatment advised, as well as imparting unwelcome news. In addition there may be barriers to understanding, for example, there may be a learning or physical disability, including visual and hearing impairments, which will be managed in order to promote best care/self-management.
To identify clear benefits, goals and processes for developing knowledge, ideas and working practices and to communicate these effectively to others across the Primary care teams and within the MSK Service Specialism to provide peer support across professional boundaries.
To clearly convey complex knowledge of biomechanics, anatomy and physiology to patients, carers and staff, where evidence underpinning practice may be conflicting, ensuring sensitivity to the audience’s level of understanding and prior knowledge.
Therapies and Podiatry Therapy Manager First Contact Practitioner - This post FCP Clinical Lead

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To motivate, persuade and explain information to others (including staff and patients) through advanced verbal & non-verbal communication skills, utilising a variety of communication means such as written, oral, and electronic. To facilitate attitudinal change to promote optimal treatment outcomes and service delivery conveying evidence based practice.
To articulate effectively the specialist physiotherapeutic prospective relating to a patients’ condition with medical colleagues and members of the MDT and negotiate/advocate where various patient options are available.
To independently diffuse potentially hostile and antagonistic situations with staff, patients and relatives, using highly developed negotiation and interpersonal skills.
To represent the FCP MSK Physiotherapy Service developments within GP Practices, Manx Care and to external agencies as required.
To autonomously resolve written and verbal complaints, keeping the GP Practice Lead/Manager, Principal Physiotherapist/Deputy/ Team Leads informed in complex situations and to adhere to the Manx Care complaints procedure.
To independently communicate effectively and advise other disciplines both internally and externally to ensure efficient care verbally and by providing clinic letters/discharge reports, especially when patients are referred onwards.
To independently ensure appropriate onward referral for continuing patient care as required, providing a seamless service and ensuring good communication with healthcare colleagues and providers.
To be independently responsible for maintaining own accurate record keeping in line with local GP Practice Systems and CSP/HCPC standards.
To initiate and maintain contacts with local and national clinical interest groups appropriate to the clinical specialty and to share and disseminate knowledge with colleagues working within the GP Practice, the Physiotherapy Services and other relevant bodies.
To make use of digital technology as this develops. To learn, promote and utilise where appropriate.

Knowledge, training and experience required to do the job The essential knowledge, training and experience requirements of this role are:

Must have or be working / willing to work towards a Master’s Degree in Physiotherapy in a relevant clinical speciality, or equivalent professional experience.
Hold current registration with the Health Care Professionals Council (HCPC).
Have a minimum of 3 yrs experience at Band 7 working within Out-Patient musculoskeletal physiotherapy. May hold or be willing to work towards a prescribing qualification May hold or be willing to work towards injection therapy. Expected to undertake appropriate training as identified in the Knowledge and skills framework for this post. Required to attend mandatory training and updates as identified by the organisation. Evidence of CPD including specialism specific post graduate courses, reflective practice, in-service training and experiential

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