1. 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

2. 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.

3. 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

4. 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

5. 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

6. 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
Anna Doran – Advanced Practitioner in primary care
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),
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),
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 Welsh Government.
Welsh Government,. (2015). A £10m investment in primary care will develop and improve access to local health services - Health Minister. Retrieved from
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