Abstract
<b>Background:</b> First Contact Physiotherapy Practitioners (FCPPs) are embedded within general practice, providing
expert assessment, diagnosis and management plans for patients with musculoskeletal disorders (MSKDs),
without the prior need for GP consultation.
<b>Aim:</b> To determine the clinical effectiveness and costs of FCPP-led compared to GP-led models of care.
<b>Design and Setting:</b> Multiple site case study design. UK GP practices.
<b>Method:</b> General Practice sites were recruited representing three models: 1. GP-led care; 2. FCPPs who could
not prescribe/inject (Standard (St)); 3. FCPPs who could prescribe/inject (Additional Qualifications (AQ)). Patient
participants from each site completed clinical outcome data at baseline, 3 and 6 months. The primary outcome
was the SF-36v.2 Physical Component Score (PCS). Healthcare usage was collected for 6 months.
<b>Results:</b> N=426 adults were recruited from 46 practices across the UK. Non-inferiority analysis showed no
significant difference in physical function (SF36-PCS) across all three arms at 6 months (p=0.999). At 3 months a
significant difference in numbers improving was seen between arms: 54.7% GP consultees; 72.4% FCPP-St,
66.4% FCPP-AQ; (p=0.037). No safety issues were identified. Following initial consultation, a greater proportion
of patients received medication (including opioids) in the GP-led arm (44.7%) compared with FCPP-St (17.5%)
and FCPP-AQ (22.8%); (p<0.001). NHS costs (initial consultation and over 6 months follow up) were significantly
higher in the GP-led model (median £105.50) vs FCPP-St (£41) and FCPP-AQ (£44); (p<0.001).
<b>Conclusion:</b> FCPP led models provide safe, clinically effective and cost-beneficial management for patients with
MSKDs in general practice and reduced opioid use in this cohort.