Advanced Physiotherapy Practitioners (APP) in PRIMARY CARE Primary aims: To release GPs time to manage more complex presentations To provide early assessment, diagnosis, advice and management of Musculoskeletal (MSK) conditions, help prevent chronicity and dependence on healthcare systems. To improve longer term outcomes and patient experience To reduce referrals to secondary care MSK services eg Orthopaedics; Rheumatology; Pain

Advanced Physiotherapy Practitioners (APP) in PRIMARY CARE Funding In Wrexham and Flintshire resources have been secured via pacesetter monies/ cluster groups and the Health board to fund 3 wte APP’s in primary care for the next 2 years. Further funds have been identified to support an additional 2 wte in 2017/18 if the role is successful. The Scheme It is well documented that up to 30% of the GP caseload relates to MSK (musculoskeletal) conditions This service is designed to allow patients with MSK conditions to be seen by an APP as first point of contact as an alternative to their GP. Reception staff will be responsible, after training, to navigate the patient to the APP schedule. This will create more capacity for GPs to see the more complex medical cases.

Advanced Physiotherapy Practitioners (APP) in PRIMARY CARE APP – skills and qualifications Advanced MSK assessment and diagnostic skills. Independent prescriber. Non – medical referral rights – allowing them to refer to radiology for X-rays / US scans and nerve conduction studies. Request and interpret blood / fluid tests Soft tissue and joint injection skills Ability to refer into secondary care MSK services via WCCG. BUT They will not do routine physiotherapy treatment – if patients require a course of physiotherapy they will be signposted to the nearest physiotherapy department. Some APPs are still currently training in the above skills and will require mentorship / support from the GPs in the practice to fully develop

Advanced Physiotherapy Practitioners (APP) in PRIMARY CARE Requirements from the practices Support and mentorship for the APP in primary care. Space for the APP – a medical room, with plinth / access to emis web/ vision/ sink. Ability to house the APP for two sessions per week. Future thoughts: Practices unable to meet the requirements above may still be able to refer their patients in a neighbouring practice for assessment/ advice and appropriate intervention; working on a cluster basis. Following successful evaluation the aim is to extend the service into more practices in subsequent years; so more opportunities later. If you are able to meet the requirements above and wish to have an APP in your practice then please contact your cluster lead

Example of possible appointment template Appt time Duration 20 mins Appt Type 8am standard slots booked anytime 8.20. 8.40. 13 slots 9.00 am 9.20. 9.40. 10am 10.20. 10.40. 11am urgent Slots opened day before. 11.20. 11.40. 12pm 12.20. ADMIN   admin LUNCH 13.00. Travelling time if needed. 7 slots 13.20. 13.40. 14.00. 14.20. 14.40. 15.00. 15.20. 15.40. 16.00. FINISH Example of possible appointment template

Advanced Physiotherapy Practitioners (APP) in PRIMARY CARE Contacts If practices wish to discuss the role of the APP please contact – Cathy Wynne CMATS/ MSK primary care lead cathy.wynne@wales.nhs.uk Anna Doran – Advanced Practitioner in primary care anna.doran@wales.nhs.uk References BCUHB Health Board,. (2015). Developing Our 3 Year Plan: Healthy Communities, Sustainable Services 2015 to 2018. Bishop, A., Foster, N., & Croft, P. (2013). SAPC hot topic: is it a dangerous idea to make physiotherapists the gatekeepers of frontline primary care for all patients with musculoskeletal problems?. Prim Health Care Res Dev, 14(04), 413-415. http://dx.doi.org/10.1017/s1463423613000364 British Medical Association,. (2014). General Practice - A Prescription for a healthy future. British Medical Association. Kumar, P., & Clarke, M. (2012). Clinical Medicine. 8th eds. Oxford: Saunders Elsevier. Ludvigsson, M., & Enthoven, P. (2012). Evaluation of physiotherapists as primary assessors of patients with musculoskeletal disorders seeking primary health care. Physiotherapy, 98(2), 131-137. http://dx.doi.org/10.1016/j.physio.2011.04.354 National Leadership and Innovation Agency for Health Care,. (2010). Framework for Advanced Nursing, Midwifery and Allied Heath Professional Practice in Wales.. tinyuri.com/NLIAH-framework. Royal College of General Practitioners,. (2013). The 2022 GP. A Vision for General Practice. London: Royal College of General Practitioners. Welsh Government,. (2015). Our plan for a primary care service for Wales up to March 2018. Welsh Government. Welsh Government,. (2015). A £10m investment in primary care will develop and improve access to local health services - Health Minister. Retrieved from http://gov.wales/newsroom/healthandsocialcare/2015/investment/?lang=en CW V1