A Roadmap To Practice - Health Education England

First Contact Practitionersand Advanced Practitioners inPrimary Care: (Musculoskeletal)A Roadmap to Practice

First Contact Practitioners and Advanced Practitioners in Primary Care: (Musculoskeletal)A Roadmap to PracticeAcknowledgementsThis Primary Care Educational Roadmap was developed by Health Education England,with support from and in collaboration with multi-organisational, multi-professional, andpatient group stakeholders. It builds upon work previously undertaken by the nationalprogramme delivered by the Arthritis and Musculoskeletal Alliance (ARMA) and its memberorganisations, as well as the subsequent work that delivered the Musculoskeletal corecapabilities framework for first point of contact work.IFOMPT has granted permission for the IFOMPT Educational Standards 2016 to be usedwithin this document ‘First Contact Practitioners and Advanced Practitioners in PrimaryCare: (Musculoskeletal) A Roadmap to Practice’ and other accompanying documents,this includes both words and illustrations. The Educational Standards 2016 remains theintellectual property of IFOMPT, and any changes and or modifications to this documentrequires the consent of IFOMPT. IFOMPT supports the use of a single set of clinical andeducational standards for musculoskeletal physiotherapists within the UK.Development of the Roadmap to First Contact practice and Advanced practice in PrimaryCare was project managed by Amanda Hensman-Crook (Health Education England). TheRoadmap was led by Dr Neil Langridge (Southern Health NHS Foundation Trust). Thedevelopment of the clinical and governance frameworks and the Knowledge Skills andAttributes was led by Dr Tim Noblet (St Georges University Hospitals NHS FoundationTrust) with Jodie Smith (Somerset NHS Foundation Trust). Supervision content was ledJulia Taylor (Lister House Surgery and Health Education England). Matthew Low (RoyalBournemouth and Christchurch NHS Foundation Trust) provided expertise and supportthroughout the roadmap’s development.We are extremely grateful to the many stakeholders who have been instrumental inshaping this piece of work, in particular to our patient representatives who sit in the heartof the roadmap. We would also like to thank:Dr Richard Collier (Centre for Advancing Practice, Health Education England), PrimaryCare Deans, NHSE and NHSE/I, CQC, ARMA, HCPC, RCGP, Chartered Society ofPhysiotherapy, Royal Collage of Occupational Therapy, College of Podiatry, College ofParamedics, Institute of Osteopathy, MSK Partnership group, Musculoskeletal Associationof Chartered Physiotherapists, Society of Musculoskeletal Medicine, IFOMPT, AdvancedPractice Physiotherapy Association, The British Dietetic Association, National First Contactworking group, Primary Care Network representatives, Nursing and Midwifery Council,Public Health England, Primary Care Rheumatology and Musculoskeletal MedicineSociety, Skills for Health, Connect Health, MSK Reform, Higher Education Institutions, andall the multi-professional clinicians who have taken time to contribute.2

First Contact Practitioners and Advanced Practitioners in Primary Care: (Musculoskeletal)A Roadmap to PracticeTable of ContentsGlossary 6Introduction 8i Purpose 8ii Historical background and context 8iii The Centre for Advancing Practice 101.0 Declarations 121.1 What is a First Contact Practitioner? 121.2 What is an Advanced Practitioner? 131.3 Agenda for Change (AfC) Band 7 and Band 8a – How do they differ? 141.4 What is Quality Assurance Agency (QAA) Level 7? 162.0 Primary Care Educational Pathways 17Diagram to illustrate pathways to FCP and AP in Primary Care173.0 National standards and frameworks for MSK practitioners183.1 MSK Core Capabilities Framework (MSK CCF) 183.1.1 Multi-Professional Framework for AdvancedClinical Practice Framework in England (MPFACP) 193.1.2 IFOMPT 193.1.3 Linking the Frameworks 203.2 Building the evidence 224.0 The Roadmap to FCP 245.0 Stage 1: Knowledge, Skills & Attributes (KSA) 265.1 E-learning 265.2 Next steps 265.3 KSA document 273

First Contact Practitioners and Advanced Practitioners in Primary Care: (Musculoskeletal)A Roadmap to Practice6.0 Stage 2: Moving into Primary Care 287.0 Building the portfolio 308.0 Recognition and supervision process 328.1 Recognition process 329.0 Supervision 349.1 Continuing Professional Development (CPD) supervision349.2 Clinical supervision 349.3 Supervision requirements 359.4 Checklist of recognition processes: Stage 1 and Stage 23610.0 Stage 3: Roadmap to AP 3810.1 Linking to Advanced Practice in Primary Care portfolio (MSK)3911.0 Useful resources 4011.1 Online learning 4011.2 Leadership development 4011.3 Charity & sector resources 4211.4 Primary Care 4212.0 APPENDICES 4312.1 Supervision flow chart 4412.2 Case-Based Discussion FCP 4812.3 Clinical Examination Procedural Skills (CEP) Assessment FCP5412.4 Clinical Supervisor’s Report 5612.5 Consultation Observation Tool: marking/notes sheet – FCP5912.6 Multi-Source Feedback (MSF) 6612.7 Personal Development Plan (PDP) 6912.8 Person Satisfaction Questionnaire (PSQ) for an FCP472

First Contact Practitioners and Advanced Practitioners in Primary Care: (Musculoskeletal)A Roadmap to Practice12.9 Tutorial record 7512.10 Tutorial evaluation 7612.11 Multi-professional Supervision in Primary Carefor First Contact & Advanced Practitioners - course overview7712.12 Knowledge, Skills and Attributes document 79Domain A: personalised approaches 79Domain B: Assessment, investigation and diagnosis82Domain C: Condition management, interventions and prevention87Domain D: Service and professional development 94Personal attributes 9612.13 Linking to Advanced Practice Portfolio (MSK) document 9813.0 References 1125

First Contact Practitioners and Advanced Practitioners in Primary Care: (Musculoskeletal)A Roadmap to PracticeGlossaryABBREVIATIONFULL TEXTAPAdvanced PracticeAdvanced PractitionerFCPFirst Contact PractitionerGPGeneral PractitionerCSPChartered Society of PhysiotherapyNHSENHS EnglandHEEHealth Education EnglandKSAKnowledge Skills and AttributesThe CentreCentre for Advancing PracticeQAAQuality Assurance AgencyICSIntegrated Care SystemCCGClinical Commissioning GroupPCNPrimary Care NetworkCPDContinuing Professional DevelopmentMSKMusculoskeletalPDPPersonal Development PlanSMARTSpecific, Measurable, Attainable, Relevant, TimeboundBand 7Band 8aAgenda for Change pay bands7 FCP 8a Advanced PractitionerRCGPRoyal College of General PractitionersWPBAWorkplace-Based AssessmentCOTConsultation Observation ToolCBECase Based ExaminationFTEFull time EquivalentCEPClinical Examination ProcedurePSQPatient Satisfaction QuestionnaireMSFMulti-Source FeedbackMScMaster of ScienceCCFCore Capability Framework6

First Contact Practitioners and Advanced Practitioners in Primary Care: (Musculoskeletal)A Roadmap to PracticeABBREVIATIONFULL TEXTMPFACPMulti-Professional Framework for Advanced Clinical Practice inEnglandARMAArthritis and Musculoskeletal AllianceIFOMPTInternational Federation of Orthopedic ManipulativePhysiotherapistsHEIHigher Education InstitutionQIPQuality Improvement ProgrammeLevel 7Level 8Academic level of practice.7 Master’s 8 DoctorateMOMember Organisation7

First Contact Practitioners and Advanced Practitioners in Primary Care: (Musculoskeletal)A Roadmap to PracticeIntroductioni PurposeThis document provides a roadmap of education for practice when moving into FirstContact Practitioner (FCP) roles, and onward to Advanced Practice (AP) roles in PrimaryCare. It sets out: The definition of First Contact roles, their respective training processes andeducational pathways. The definition of Advanced Practice roles, their respective training processes andeducational pathways. How to build a portfolio of evidence for both FCP and AP roles. How to support training with relevant supervision and governance, and the link toHealth Education England’s Centre for Advancing Practice.This is the MSK version of the educational pathway to FCP and AP in Primary Careand is relevant to all professionals specialising in MSK. The framework presented isapplicable across adults and children dependent on the scope of practice, appropriateknowledge and skills that may apply to specific patient groups, and the job descriptionthat the FCP is working under.ii Historical background and context FCP roles began with the development of the FCP Physiotherapist in 2014, inresponse to the shortage of General Practitioners (GPs) in Primary Care. FCP rolesare designed to support GPs as part of an integrated care team and to optimise thepatient care pathway by seeing the right person in the right place at the right timehttps://gettingitrightfirsttime.co.uk/. As the FCP role evolved (see historical perspective MSK-review-with-authors v3.pdf), it created a template forother professions to use and develop FCP roles in Primary Care. This created anassurance that there was a standardisation of quality provided across multipleprofessions at this level of practice. This standardisation assures governance andultimately patient safety, ensuring capability to see and manage undifferentiated andundiagnosed MSK presentations within an agreed scope of practice.8

First Contact Practitioners and Advanced Practitioners in Primary Care: (Musculoskeletal)A Roadmap to Practice To create sustainability for multi-professional FCP roles, there is a need to build aclear national Primary Care training pathway for clinicians moving into FCP rolesonto AP, which ultimately will provide a pipeline of professionals at the right level ofpractice, and will help to recruit and retain them in Primary Care. HEE Primary Care training begins at a minimum of three years post-registrationexperience (see diagram below) in a clinician’s professional role in the area wherethey will be practicing in Primary Care.Pre-registrationdegreePostgraduatelearning inpracticePrimary caretraining forFirst ContactRoles, Portolioroutes andtaught HEImodelsEntry toPrimary CareMinimum of 4-6 monthsvia portfolio routes; theory(stage 1) verified PRIORto entry into PC.Stage 2 completed in PCPre registrationexposure to practicebased learningMINIMUM OF 3YEARS - considerrotational postsand shadowingopprtunitiesContinuationto AdvancePractice(stage 3)Taught FCP HEIlevel 7 module:10 monthsDiagram to illustrate career progression of Primary Care roles. Clinicians will need to be supported by a verified FCP AP supervisor outside PrimaryCare to complete required Primary Care recognition prior to entry into an FCP role(see sections 8 and 9).9

First Contact Practitioners and Advanced Practitioners in Primary Care: (Musculoskeletal)A Roadmap to PracticeTo provide further background to FCP roles in Primary Care, please refer to the followingdocuments from The Chartered Society of Physiotherapy (CSP), Health EducationEngland (HEE) and NHS England (NHSE).1. https://www.csp.org.uk/system/files/001404 fcp guidance england 2018.pdf2. df3. march-2020-v2.pdf4. irst-contact-physiotherapists/iii The Centre for Advancing PracticeThe Health Education England Centre for Advancing Practice (The Centre) has beenestablished, working extensively and collaboratively with professional bodies and otherstakeholders to support education and training for Advanced Practitioners in England.It is now agreed that FCP roles will also be supported by The Centre in the followingways; An FCP Directory will be held for verified FCPs. There will be portfolio routes and taught routes to recognition as an FCP in the FCPdirectory. A retrospective route for existing FCPs will be available via the portfolio route to gainrecognition. This route will only be available for existing FCPs that meet the criteria andhave undertaken the mapping required to achieve recognition. This route will only be available for a limited period of time - 12 monthsmaximum (this is based on the minimum employment model of one session aweek): the start date TBC.10