Multimodal management of low back pain with sciatica in primary care

Advanced physiotherapy practitioners (APPs) are increasingly being employed as first contact physiotherapy practitioners (FCPPs) in primary care to provide rapid and direct access to expert assessment and advice for any musculoskeletal (MSK) health complaints.

FCPPs who also hold an independent prescribing qualification can further enhance the patient's journey to treatment. They are equipped with specialist assessment and diagnostic skills developed over many years of clinical practice and, in addition, can offer a considered and evidence-based approach to medicines management in keeping with the pathology being treated. Noblet et al (2020) predict that independent prescribing will be a core skill used by FCPPs, given they have been shown to be both safe and cost-effective in managing MSK disorders in primary care without service users needing to first consult with a GP (Stanhope et al, 2012).

Findings from a recent study of 6800 FCPP appointments in England showed that patients attending MSK FCPP clinics as an alternative to seeing a GP experienced significant benefits. They were more likely to be offered expert advice and guidance, with around 70% receiving advice on self-care or exercise. They were also less likely to be referred to consultant-led services, with up to 21% fewer referrals to hospital orthopaedic services (Stynes et al, 2021).