Physiotherapists in Generel Practice

Physiotherapists as first contact practitioners in a general practitioner’s clinic – Is it a realistic option?
Abstract
Background
In Denmark and globally there is a lacking workforce of general practitioners (GPs) (1,2). Due to reduction in workforce, 3 out of 4 clinics in Denmark has reached the limits of how many patients they can manage and as a result they have closed patient access. This is unsatisfying for patients’ not having a GP within reasonable distance of where they live, long waiting lists and affects their experience in the healthcare system having to see different GPs. From a GPs perspective it is unsatisfying not having enough time and resources to provide optimal person-centered care (1). The prevalence of musculoskeletal complaints in private practice is 20-25% (3, 4). A report from WHO estimates it to be increasing (5). It is deemed necessary to look for future solutions on how to relieve the GPs and provide optimal person-centered care from both the individual and society perspective. In Denmark nurses have been part of the staff in GP clinics providing care in certain domain of the caseload. It is interesting to assume physiotherapist with a special interest in musculoskeletal care could relieve the GPs in a similar way.
Purpose:
Reasons for exploring this area of musculoskeletal care was to gain insight into future areas for musculoskeletal practices and solutions for optimizing the health care system. Could it be possible to integrate a musculoskeletal physiotherapist as a first contact practitioner into a GP clinic. Secondly would it be a resource of any value for patients and other staff-members at a GP clinic.
Methods:
A pragmatic clinical example of a physiotherapist who over 14 months has been integrated as a first contact practitioner at a GP clinic. The approach is best described as action research. The GP clinic has 3800 patients in a larger Danish city. The clinic has 2 GPs, a resident GP, a nurse and 2 secretaries. A formal contract according to national laws and ethics was signed between the GP and the physiotherapist. An initial and unformal 1 hours meeting with all staff-members was conducted prior to seeing the first patients. This included a summary of the criteria that the staff could apply when booking patients with musculoskeletal presentation for the physiotherapist. The physiotherapist is at the clinic 1 day a week. He is seeing musculoskeletal patients which should evaluated, triaged and advised according to best evidence-based practice. Including follow up visits according to guidelines and appropriate referrals to further investigations such as x-ray, magnetic resonance imaging, specialist doctors or physiotherapist in out-patients’ clinics if needed. The secretaries evaluated all patients who called for an appointment and offered those appropriate an appointment with the physiotherapist. GPs including the GP resident referred patients to the physiotherapist for second opinions if in doubt regarding musculoskeletal or non-musculoskeletal conditions. Or to discuss and evaluate if further specialist evaluations or rehabilitation processes with physiotherapist, pain centers etc. was of relevance.
Results:
Not applicable.
Conclusion(s):
Not applicable.
Implications:
Could physiotherapist in GP clinics potentially relieve pressure on GPs, improve patientcare and create new areas of practice?
Additional information to be provided:
Keywords:
General practice staff, first contact practitioner
Funding acknowledgements:
No funding
Ethics approval:
Ethics approval was not required.
Information concerning any presentations or publications of the work made prior to congress None