FRONTIER: First Contact Physiotherapy in Primary Care: A Realist Evaluation of effectiveness and costs


National Institute for Health (NIHR) Health Service & Delivery Research (HS&DR) Ref. 16/116/03

What is the research question?

To evaluate ‘First Contact Physiotherapy’ in general practice for patients with musculoskeletal disorders (MSKDs), and provide evidence for the adoption of appropriate service delivery models.

What is the problem?

Millions of people in the UK experience pain and reduced quality of life as a result of conditions or injuries that affect the bones, spine, joints and muscles – these are known as musculoskeletal disorders (MSKD), and about one third of all GP appointments are taken up by patients consulting with these problems. This is costing the NHS a lot of money and making it more difficult for all patients to get an appointment with their GP.

One approach that is gaining popularity is First Contact Physiotherapy (FCP), whereby a highly skilled physiotherapist who is expert in managing MSKD works within the GP practice, and sees patients with MSKD without them having to consult a GP first. The physiotherapist is able to assess the patient’s condition and provide immediate advice, and in some cases prescribe drugs, order x-rays and blood tests, or inject joints. Early information on this new model collected by the applicants suggests that it may free up GP time to see other patients, reduce unnecessary requests for further tests or consultant opinion, improve patient satisfaction and save the NHS money.

What is the aim of the research?

There are different ways in which FCP can be provided, but we know little about what works in which circumstances. For example, in some practices physiotherapists can only assess and provide limited treatment and advice, whereas in others they can also prescribe drugs, inject joints and order other investigations and tests. These factors are likely to have a significant effect on: costs; the amount of GP time saved; satisfaction levels; and the overall quality of the service patients are offered. We will investigate use of FCP in a variety of GP practices across the UK, to find out what works best in different situations, and why.

How will this be achieved?

First we will conduct a UK-wide survey to establish the extent of FCP practice, and use this information to select a sample of GP practices to study in further detail.

We will then review previous work on FCP to identify the factors that may affect the way the service works, and consult with stakeholders to ensure we fully understand the important issues. We will then use this information to guide how we investigate GP practices that are implementing FCP.

We will focus on 8 different practices nationwide that use FCP, and investigate how these models work in practice. We will also include 4 GP practices that do not have FCP, for further comparison.

We will interview healthcare staff, patients, receptionists, practice managers and commissioners to gain a better insight into what works, how and for whom. We will monitor some patients within each.

GP surgery to track how their pain and function changes over six months, and collect information about waiting times and satisfaction with the service they received. We will compare the type and amount of healthcare resources they use, and how quickly they are able to return to work or their usual activities.

Who is leading the research?

Prof Nicola Walsh, Professor of Knowledge Mobilisation & Musculoskeletal Health, Faculty of Health and Applied Sciences, University of the West of England.

Further information:

Visit the FRONTIER study website

For more information or to get involved in this project, please contact

The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.