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First point of contact care for patients with musculoskeletal related conditions

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Musculoskeletal (MSK) related health complaints provide a large, growing population of patients. And they’re predicted to grow further.

It's estimated that patients with MSK related health complaints make up 30 per cent of a GP caseload.

Nottingham CityCare ran a pilot of a ‘1st line’ physiotherapy service. This CIC social enterprise evaluated the pilot after a year. The project provided first point of contact physiotherapy in two GP practices. Patients with a MSK related health complaint could see a physiotherapist instead of a GP.

The project ran from April 2014 to March 2015. Two MSK physiotherapists (band 7) were introduced as first contact MSK practitioners. They provided two half-day sessions per week in the inner city and university GP practices in Nottingham. They assessed patients and offered advice, exercise prescription or referral onwards, as appropriate.


Overall, the service achieved the following:

  • over 70% of patients managed by the first point of contact service alone
  • over 95% of patients managed by physiotherapy alone
  • physiotherapists reduced the number of patients referred for investigations and secondary care - delivering a cost saving
  • improvements found in patients’ clinical recovery - over 70% reported continued improvement at 6 months
  • patients reported satisfaction and confidence with the service provided by the physiotherapists - satisfaction in information provided and confidence in the practitioner

The physiotherapy service was considerably more cost effective than usual GP care. On average costs were £56.51 and £84.26 per patient at the inner city and university sites. This compares with GP costs of £366.44 and £647.16 at the same practices.

Last updated:
26 June 2019