First Contact Physiotherapists: Are they able to reduce the burden on rheumatology services? A critical review of the evidence base.

First Contact Practitioners have emerged over recent years in response to growing pressures within the National Health Service (NHS) and are now central to primary care musculoskeletal (MSK) services. Within the musculoskeletal field these allied health professionals may be from a range of disciplines including Physiotherapy, Podiatry and Osteopathy. Early referral to rheumatology is key to successful long-term management of many inflammatory musculoskeletal conditions but presents challenges to overburdened services. Evidence supporting the recognition and referral of patients with rheumatological disorders by First Contact Practitioners is lacking, however physiotherapists have been shown to successfully substitute the role of a doctor within the MSK field. This review investigates the value of First Contact Physiotherapists (FCPs) within primary care and their role in early recognition and referral of rheumatological MSK disorders in line with national guidance. FCPs are best placed to fulfil the role of MSK ‘champions’, positively impacting the whole MSK pathway, with the potential to reduce burden on rheumatology services. Planned rapid upscale of FCPs over the next few years will support sustainability of MSK NHS services.