As pressures mount on the UK’s primary care system, driven by an ageing population, rising multi-morbidity and chronic workforce shortages, the deployment of first contact practitioner (FCPs) podiatrists under the Additional Roles Reimbursement Scheme (ARRS) has become an essential tool for PCNs. 

These advanced-level clinicians bring specialised lower-limb knowledge into general practice settings, offering a timely, patient-centred solution that improves outcomes and reduces demand on GP appointments.

Podiatrists: a clinical asset in general practice

Podiatrists are degree-qualified healthcare professionals, registered with the Health and Care Professions Council and trained in the diagnosis, treatment and prevention of foot and lower limb pathologies. Their scope of practice encompasses dermatological, musculoskeletal, neurological, vascular and all other systemic disease manifestations affecting the foot and lower limb across the life course.

Crucially, podiatrists are increasingly trained in advanced skills such as independent prescribing, minor surgical procedures under local anaesthetic and interpretation of diagnostic imaging and blood tests. An FCP podiatrist’s skill set spans advanced consultation skills, multi-sectoral and multi-disciplinary care coordination, shared decision-making and risk management. 

The first contact practitioner role

The FCP model, championed by NHS England and initially detailed in the Health Education England (HEE) roadmap, positions podiatrists as the first point of clinical contact for people presenting with foot and ankle issues in primary care. This model enables people to directly access specialist assessment, diagnosis, treatment and complex care coordination. 

Faster access to expertise leads to improved health and wellbeing outcomes, reduced healthcare use, reduced treatment burden and reduced costs. This model also enhances the patient journey. Delays between GP referral and specialist input are minimised. FCP podiatrists refer directly into secondary or community services when necessary – coordinating care and streamlining referrals.

FCP podiatrists undergo postgraduate training (at Masters level 7), including clinical competencies in advanced assessment and diagnostics. This includes interpreting imaging, ordering and interpreting blood tests and initiating pharmacological treatment. These capabilities enable FCP podiatrists to work at the top of their licence, resolving issues quickly and independently within general practice.

Alleviating GP workload, improving access and tackling complex care

Typically, an FCP podiatrist could provide consultations for approximately 10% of a standard GP list. One of the most significant contributions of podiatrists in general practice lies in their ability to manage complexity. Patients living with multi co-morbidities often present with intersecting needs: wound care, mobility challenges, chronic pain or the early signs of systemic disease. Podiatrists are uniquely placed to recognise these complexities early and intervene holistically.

For example, identifying secondary causes of symptoms such as digital ulceration or persistent cold extremities – including connective tissue disease, vascular pathology, or drug-induced vasospasm – requires a level of diagnostic acumen and interdisciplinary coordination that FCP podiatrists can deliver. 

They can play a crucial role in preventing deterioration and avoiding unnecessary referrals or admissions. An FCP podiatrist supports mobility and enables people, especially those with higher BMI, to stay physically active and maintain a healthy lifestyle. By alleviating pain, improving balance, and preventing falls, podiatrists help reduce barriers to exercise, thereby supporting weight management and reducing the risk of inactivity-related health issues.

Integrated care and continuity

FCP podiatrists are key contributors to integrated neighbourhood teams, working alongside GPs, community nursing and other allied health professionals to deliver proactive, place-based care. Their expertise in lower limb health supports admission avoidance by identifying and managing issues earl – particularly in patients with long-term conditions such as diabetes, frailty, or peripheral arterial disease. 

Through their role in ambulatory care and frailty pathways, they help reduce unnecessary hospital attendances and contribute to coordinated, multidisciplinary care planning. Their ability to navigate across primary, community, and secondary care settings ensures timely referrals and joined-up management with services such as vascular surgery, rheumatology, and rehabilitation.

Importantly, this integration supports continuity of care and safety-netting with risk management for people who choose not to access some traditional services. Rather than fragmenting management between multiple services, FCP podiatrists can offer ongoing monitoring, patient education, and preventative interventions, reducing the risk of complications or admissions.

Clinical governance and safety

As the FCP podiatry role evolves, robust clinical governance remains essential. Advanced training, clinical supervision, and audit are central to ensuring safety and quality. Non-medical prescribing, for example, requires podiatrists to monitor blood pressure, review side effects, and provide appropriate safety-netting advice to patients – a responsibility they are increasingly equipped to manage with confidence and accountability. FCP podiatrists integrate with and work alongside practice teams and governance structures. Formalised and touch-point clinical supervision are essential for safe working. Escalation and risk management are critical for roles that include safety-netting.

Sustainable solutions

General practice continues to face sustained pressure, but sustainable solutions exist within the broader primary care workforce. FCP podiatrists offer targeted, expert management of foot and lower limb conditions, reducing GP workload and enhancing patient access to timely, specialist care. Their integration into primary care aligns with key health policy aims- reducing unplanned admissions, preventing escalation of co-morbidities that lead to life-changing and high-cost interventions, such as amputation, and supporting medicines optimisation, including pain and antimicrobial stewardship.

By improving mobility, promoting physical activity and enabling earlier diagnosis and treatment of avoidable or treatable conditions such as diabetes, cancer, inflammatory arthritis, gout and peripheral arterial disease, FCP podiatrists play a vital role in shifting care upstream. They also help reduce ineffective, frequent healthcare use while improving access for underserved populations. They support early intervention and development to encourage lifelong physical activity and wellbeing.

The inclusion of podiatrists in multidisciplinary primary care teams reflects a necessary evolution toward more integrated, responsive, and preventative care models. Their contribution is central to a more equitable, efficient, and sustainable future for the NHS.

Professor Jane McAdam is chair of the Royal College of Podiatry and interim deputy dean for the School of Health and Society at the University of Salford.