Sue-Hayward Giles is assistant director of practice and development at the Chartered Society of Physiotherapy. Here she outlines how PCNs can use first contact physiotherapists to their full potential
Primary care is under growing strain, and the search for effective, sustainable solutions is more pressing than ever. Among the most impactful innovations to emerge in recent years is the introduction of first contact physiotherapists (FCPs).
With musculoskeletal (MSK) waiting lists at an all-time high, investing in FCPs, designing the MSK pathway and integrating the FCP role is evidenced to be an effective use of resources, alongside building a stronger and more resilient primary care system.
These expert clinicians are reshaping how MSK conditions are handled in general practice - seeing patients directly, providing faster access to the right care, and easing pressure on GPs. They’re already making a measurable difference, with even greater potential on the horizon.
Patients consistently report high satisfaction with the care they receive, valuing both the speed and the specialist expertise FCPs provide. Practices, in turn, are seeing a positive impact on appointment availability and GP capacity.
FCPs also play a critical role in reducing unnecessary prescriptions, investigations and referrals. Their ability to assess, diagnose, and manage MSK conditions independently makes for smarter, more efficient use of NHS resources.
In doing so, they help reduce the strain on secondary care services and create a more responsive, joined-up patient pathway.
But while the case for FCPs is clear and the need urgent, simply recruiting more clinicians into these roles won’t be enough.
The long-term success of FCPs depends not just on what they do, but how the roles are designed and integrated into the MSK pathway and primary care team, and how they are recruited and employed.
Too often, PCNs have brought FCPs in directly, only to find that the right clinical governance, supervision, and peer support structures are difficult to maintain at practice level.
This not only undermines the quality of care but risks burnout, high turnover and service fragmentation, negating many of the benefits the role is meant to deliver.
That’s why the Chartered Society of Physiotherapy (CSP) strongly advises that FCPs should be employed through NHS trusts or established independent MSK providers; organisations that already deliver MSK secondary care services.
These employers are best placed to offer structured clinical oversight, access to peer networks, protected learning time, and clear routes for professional development and progression.
This model supports quality, sustainability and staff wellbeing, it reduces the risk of isolation and poor access to clinical governance and development opportunities, and facilitates the opportunity to embed real, lasting change in a way that’s difficult to replicate at practice level.
With the additional roles reimbursement scheme (ARRS) funding enabling the continued growth of multidisciplinary teams, PCNs have a pivotal opportunity to embed FCPs as a long-term fixture in their services.
But this needs to be done with a strategic, long-term mindset. FCPs are not a quick fix to plug workforce gaps, they are a core part of the primary care team of the future. The decisions made now around commissioning and employment models will shape the success and sustainability of these roles for years to come.
At the CSP, we continue to work closely with PCNs, commissioners and system leaders to support the safe, effective rollout of FCP services.
For PCNs looking to get started or to refine their current approach, we’ve developed a quick-start guide for GPs, available here.