First contact physiotherapists: are they able to reduce the burden on rheumatology services? A critical review of the evidence base.

First contact practitioners have emerged over recent years in response to growing pressures within the National Health Service (NHS) and are now central to primary care musculoskeletal (MSK) services. Within the MSK field, these allied health professionals can be from a range of disciplines, including physiotherapy, podiatry and osteopathy. Early referral to rheumatology is key to successful long-term management of many inflammatory MSK conditions, but presents challenges to overburdened services. Evidence supporting the recognition and referral of patients with rheumatological disorders by First Contact Practitioners is lacking; however, physiotherapists have been shown successfully to substitute the role of a doctor within the MSK field. This review investigates the value of First Contact Physiotherapists (FCPs) within primary care and their role in early recognition and referral of rheumatological MSK disorders in line with national guidance. FCPs best placed to fulfil the role of MSK champions, positively impacting the whole MSK pathway, with the potential to reduce the burden on rheumatology services. Planned rapid upscaling of FCPs over the next few years will support sustainability of MSK NHS services.