Patients with joint pain are now seen by a specialist in the community instead of being referred to hospital, cutting waiting times and improving access to care.  

Patients in Barnet and Enfield with hip, knee, shoulder or spinal pain are now being seen by a physiotherapist known as a First Contact Practitioner (FCP) at their local GP surgery. 

The FCPs, working closely with orthopaedic consultants, assess patients to understand whether their care can be managed in the community or whether they require hospital-based treatment, including surgery.

Crucially for patients, wating times have been dramatically reduced since the scheme launched, with the vast majority being seen within the community.

Emma Brooks, the FCP lead, said: “We work closely with spinal, hip, knee and shoulder consultants to understand whether a patient requires surgery and if so, they are referred to hospital. However, for those patients who don’t need it, they can continue to be cared for in the community, it might be providing self-care advice or seeing a community physiotherapist. If we do refer to a consultant there is a very high conversion rate to surgical intervention.

“From the patient’s first session we are trying to work out a diagnosis and what other factors are impacting on their life and we also include lots of mental health assessment. This enables us to help the patient navigate the system better. This aspect has had really positive outcomes because patients tell us they feel heard.”

The team say they are still dealing with some of the backlog of musculoskeletal issues post COVID-19 but think the integrated model of care is effective and could potentially be replicated by other specialities, such as pelvic health.

They acknowledge there are challenges to the new approach as each practice has its own way of working but envisage FCPs becoming part of standard care in the future.

Emma added: “We feel very strongly that putting a specialist at the beginning of the pathway is the right approach. We have a very stringent competency programme for physiotherapists taking on this FCP role. That’s because there is a lot of responsibility on your shoulders to get it right as the FCP as potentially the person identifying more serious conditions. Everyone trained as an FCP must train as an advanced practice physiotherapist, due to the level of expertise they need. They have close links to multidisciplinary teams within hospitals so they can discuss with colleagues if a surgical decision is required.”

Leonard Tyson, 66, from Enfield, has benefitted from the service. He said: “I had a fall and damaged both my knees. I followed the advice on the NHS website to start with and rested, iced, elevated, compressed and elevated my knees as much as possible but I still felt I needed an expert opinion. My GP surgery got me an appointment with the FCP who referred me for an X-ray at Chase Farm Hospital a couple of days later. Two weeks later I saw the FCP again at my surgery to go through the results. It was very reassuring as they were able to give me both a short term and long term prognosis and we agreed an action plan for me to follow. Overall it was a really positive experience.”

The Royal Free London’s FCP service is currently in six practices across four primary care networks (PCNs) in Enfield and anyone within the postcodes of those PCNs can access any of those clinics. In Barnet the team is currently in one PCN and has clinics in five practices, and this is expanding as new staff are recruited.