SWL MSK First Contact Practitioner Guidance Draft

1. SWL MSK First Contact Practitioner GuidanceDraft Nick Sullivan SWL Strategic Clinical Lead - MSK Capability Framework July 2019

2. SWL MSK Capability Framework Project First Contact Practitioners (FCPs)

3. First Contact Practitioners – what are they and what do they do?

4. Despite a decrease in the rate of GP Secondary Care referrals from 2017/18, there is a rising waiting list and declining performance in elective care against the Referral to Treatment (RTT) standard. The number of GP referrals to hospitals varies greatly, even after accounting for factors such as deprivation. The NHS Long Term Plan includes a commitment to narrow health inequalities, address unwarranted variation in care and build on the pilot work undertaken during 2018/19 to ensure patients will have direct access to MSK First Contact Practitioners (FCP). In SW London, Trauma & Orthopaedics and Rheumatology are amongst the specialities with the highest spend by CCGs. SWLEOC report conversion rates from GP referral to surgery as low as 15% First Contact Practitioners – what are the benefits? Evidence from national FCP pilot data:

5. New patient pathway in primary care: Effective implementation of MSK assessment, diagnosis, management planning and triage, which delivers on the national pilot study projections, requires FCPs to be embedded within relevant local pathways. These should include: • Framework for requesting diagnostic investigations, receiving results and agreed processes for timely review and management of urgent reports (including red flags and multidisciplinary oversight) • Pathways for direct referral to community, secondary and tertiary care services, including engagement and collaboration with relevant stakeholders to ensure appropriate work-up is undertaken early in the pathway and reduce avoidable outpatient referrals • Robust training, appraisal and professional development procedures to ensure staff meet, as a minimum, the standards set by NHSE/HEE’s MSK Capability Framework (2018) and Multi-Professional Framework for Advanced Clinical Practice (2018). Compliance with upcoming HEE Academy of Advanced Clinical Practice guidelines also strongly recommended to ensure staff meet future regulatory expectations (publication est. 2020) Embedding First Contact Practitioners

6. Key themes and lessons learned from national pilot evaluation: Embedding First Contact Practitioners

7. Operational considerations for FCP implementation:

8. Potential models for FCP implementation: Embedding First Contact Practitioners TBC Costings TBC Costings TBC Costings

9. Potential models for FCP implementation: Embedding First Contact Practitioners TBC Costings TBC Costings