In a recent article in Pulse Today there was a report that training applications to become GPs are down 15%. It is expected to create a GP recruitment crisis despite an uplift in earnings in recent years. The role as a GPs has become less attractive with poor morale, high levels of stress and potentially longer working hours in general practice being cited frequently in the HSJ. The governments’ most likely response to this will be to increase training numbers, incentivise medics and recruit from overseas. This will be a set back in terms of reducing health spending. Thankfully there is a cost effective solution that can help reduce the work burden placed on GPs…..
It is thought that 25-30% of GP referrals are musculoskeletal conditions. In my opinion GPs are not the best health professionals to be the first point of contact in primary care…physiotherapists are. They are highly skilled specialists who are trained and trusted to diagnose, assess and manage MSK conditions. Physiotherapists would reduce the number of inappropriate orthopaedic referrals. The hard work in making this possible has been achieved….self referral to physiotherapy is common practice and now prescribing medication is within their scope of practice.
If there is a genuine push for the patient to see the right person at the right place at the right time then immediate access to physiotherapists at GP surgeries is somewhat of a no brainer. I would anticipate that Dr Bishop and Nadine Foster’s current pilot studies will provide the research evidence that shows physios are best placed to be the gatekeepers for MSK problems. (See:http://www.csp.org.uk/frontline/article/making-physios-gatekeepers-msk-problems-branded-%E2%80%98dangerous-idea%E2%80%99.)
With the clinical debate won then all that is left is to win the land slide argument about the economic benefits of employing a physiotherapist at a GP surgery on a 1:3 ratio. There is a need to make savings in health yet improve services. This can be achieved by employing physio’s who continue to be the most undervalued clinicians in the health sector.
So what can prevent physiotherapists from heading off a GP recruitment crisis and providing better MSK services for patients?
Well, there is an unfortunate hierarchy in health and physiotherapists continue to be the poor relations. GPs are unlikely to accept their physiotherapy colleagues as equivalents in this field. The next barrier to advancement of physiotherapy is the physiotherapists themselves. Too often they assume a subservient role when placed around a table with Orthopaedic Consultants and GPs. In short there is a confidence issue. In Karen Middleton, the new chief executive of the CSP there is a chance. She has strong conviction to this cause and in a recent Frontline article urges the profession to be bold. If clinicians can provide a compelling case for a role at a local level and the CSP lobby at the higher echelons of government there is great potential for physiotherapists to reduce the strain on GPs and gain the profile they deserve.