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This section has links to documents looking at the range of AHPs who can work as FCPs and the training needed for each

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This section has links to documents looking at the range of AHPs who can work as FCPs and the training needed for each

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Range of Professions able to work in FCP roles:
Role descriptors and profession specific roadmaps-

FCP/AP Roadmap for Musculoskeletal

Osteopaths as FCP

FCP/ AP Roadmap for Paramedics

FCP/AP Roadmap for Podiatry

FCP/AP Roadmap for Occupational Therapy

FCP/AP Roadmap for Dieticians

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Local examples of ARRS roles support and development opportunities

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Local examples of ARRS roles support and development opportunities

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Expanding the primary care workforce - Sussex Training Hub

Preceptorships (hee.nhs.uk)

New Roles in Primary Care (hee.nhs.uk)

New Roles in Primary Care (ARRS) Join a Preceptorship | News | NHS North East and Yorkshire Leadership Academy (nelacademy.nhs.uk)

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Our mission is to provide excellence in training for current and future generations of General Practitioners, while supporting those who educate them and the wider GP community in the areas covered by Health Education England North East and Cumbria.

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This section contains guidance and information on how to integrate FCP in your system

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This section contains guidance and information on how to integrate FCP in your system

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Kings Fund report 2022- covers the challenges of integration and proposes solutions to these:
Kings fund report on Integrating additional roles into primary care networks

NHSE MSK pathway- examples of how integrated FCP roles can deliver benefits and support and the whole pathway:
Musculoskeletal (MSK) pathway - Musculoskeletal (MSK) digital playbook - NHS Transformation Directorate (nhsx.nhs.uk)

How physiotherapists can support primary care-  Health Education England

Elective care high impact interventions first contact practitioner msk services specification

CSP resources for physiotherapy FCP roles:
Setting up a First Contact Physiotherapy service: lessons learned | The Chartered Society of Physiotherapy (csp.org.uk)

https://www.csp.org.uk/professional-clinical/improvement-innovation/first-contact-physiotherapy/first-contact-physio-3

https://www.csp.org.uk/publications/principles-first-contact-physiotherapy-resource-support-service-evaluation

https://www.csp.org.uk/publications/guide-implementing-physiotherapy-services-general-practice

What MSK First Contact Physiotherapists can offer you | The Chartered Society of Physiotherapy (csp.org.uk)

Developing an FCP peer network | The Chartered Society of Physiotherapy (csp.org.uk)

Using digital to support implementation:
Primary and community triage and consultation - NHSX

Musculoskeletal (MSK) pathway - NHSX

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The King's Fund has a long history of supporting and developing teams working in and across health and care systems, and more recently we have been working with general practices and PCNs as they develop team-based models of care. Drawing on this experience and expertise, we developed this project to explore the factors affecting the successful implementation and integration of ARRS roles within general practice, focusing on the experience of staff working within these roles, to explore what might be done at national and local level to address any challenges.

This work focused on four ARRS-funded roles: social prescribing link workers; first-contact physiotherapists; paramedics and pharmacists. We selected these roles for several reasons: they have been covered under the ARRS for the longest period; they represent a mix of both clinical and non-clinical roles; and they represent a mix of employment models. We carried out focus groups and semi-structured interviews with professionals from each of the four ARRS staff groups and interviewed stakeholders from relevant national bodies and PCN clinical directors and managers.

This work was commissioned by the Department of Health and Social Care and funded by the NIHR Policy Research Programme (grant number NIHR200702) as part of the Partnership for Responsive Policy Analysis and Research (PREPARE), a collaboration between the University of York and The King's Fund for fast-response analysis and review to inform the Department of Health and Social Care's policy development.

We found that PCNs are in their early stages of development and in many cases lack a clear, shared overall purpose and strategy or a clear, shared vision and buy-in for the ARRS roles. Many PCNs do not share a team identity, and this makes deploying network-wide staff in a supported way very complex when there are different strategies, different cultures and different identities to be managed.

The confusion around strategy is also linked to a lack of agreement about whether the roles are primarily intended to deliver the requirements of the PCN contract or to undertake what might be considered the 'core' work of general practice.

The potential contribution of additional roles to general practice is not universally understood, despite large amounts of written guidance, job descriptions and roadmaps, all of which may even have added to the confusion.

There is ambiguity among GPs about what multidisciplinary working would mean for them and their working practices, both clinically and in the way in which their practices are run. While the national direction of travel appears to be that multidisciplinary working in general practice is a key part of the future vision, there has not been enough consideration about how GP roles, or the organisation of general practice itself, might need to change as a result.

The cultural change required by the introduction of additional roles, and new approaches to teamworking, requires extensive organisational development, leadership and service redesign expertise and this has not been adequately available to PCNs, nor is it present in many individual practices. All this has been compounded by the impact of the Covid-19 pandemic on general practice.

This lack of effective and supported implementation means that the core needs of individuals working in ARRS roles - autonomy, belonging and contribution - are not being met in many cases.

A variety of support - including clinical supervision and managerial, HR and peer support - is critical to the effective integration of ARRS roles within general practice and yet there is inadequate additional funding to provide PCNs with the capacity to provide this support well.

Centralised or subcontracted employment models have the potential to provide some of this support more easily but may leave ARRS staff feeling even more distanced from the teams they are working alongside.

A lack of an adequate estate is fast becoming an issue in many areas. The solutions will require expertise in the design and use of space to support multidisciplinary teamworking, and it is not clear how PCNs will access such expertise.

The uncertainty around the funding for the ARRS roles after 2023/24 has started to generate concern. Expectations of the impact that these roles will have are high, but like all new roles, it will take time before they are fully understood. Creating stability and certainty will play an important part in this.

The Covid-19 pandemic has had positive and negative impacts on the deployment of ARRS roles. Learning from that experience and taking proactive steps to address the issues identified need to be a clear part of recovery from the pandemic if the significant investment in ARRS roles is to have the intended impact.

We found examples of good practice and positive stories of implementation, but to ensure successful implementation of the roles we make recommendations including:

a clearer, shared vision for a multidisciplinary model of care

a comprehensive package of support for implementation of the scheme including improved support for clinical and managerial supervision

streamlining and communicating current guidance and roadmaps in different ways that make them more accessible and practical for PCNs, practices and professionals to understand and implement

a focus on future sustainability, including funding, estates strategy and career progression

leadership and management skills development embedded in GP specialist training.

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Integrating additional roles into primary care networks

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How well are staff employed under the new Additional Roles Reimbursement Scheme being embedded within general practice teams? In this report we consider the experience of staff working in these roles and explore what might be done to address any challenges.

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This section contains a range of broader resources related to MSK health, starting with the Best MSK  Health Collaborative pathways and documents 

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This section contains a range of broader resources related to MSK health, starting with the Best MSK  Health Collaborative pathways and documents 

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PIFU Documents:
Patient Initiated Follow Up (PIFU) Patient infographic

Orthopaedic consultant Andrew Dunn talks about PIFU benefits

PIFU in Trauma and Orthopaedics

DRAFT PIFU for Spinal Services

Pathway documents:
MSK pathways toolkit for spinal, shoulder, OA hip and knee

DRAFT Spinal Pathways

Vertebral fragility fractures pathway flowdiagram

DRAFT Axial Spondyloarthritis pathway

DRAFT Rheumatology High Level Connective Tissue Disease (CTD) & Vasculitis Pathway

DRAFT Rheumatology High Level Inflammatory Arthritis (IA) Pathway

Best MSK Spinal Clinician infographic for Spinal MRI

Best MSK Spinal Patient infographic re Spinal MRI
Best MSK Spinal MRI Patient Advice 22-07-22 - BestMSK Health Collaborative - FutureNHS Collaboration Platform

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We are a collaboration platform empowering everyone working in health and social care to safely connect, share and learn across boundaries. Be part of a FutureNHS.

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This Padlet brings together all the information and resources you need to know about to support the development and integration of FCP roles into the wider MSK system. .

It is targeted at service leads, ICS leads and clinicians alike, bringing together the essential resources into one place. The Padlet is divided into sections that cover all aspects of FCP roles, from planning and implementing through to demonstrating effectiveness and impact.

There are also sections looking at broader aspects of the role and  wider policy implications, with links to relevant resources.

In a fast moving field, we know that some of these documents will lose currency over time, so we will update this resource every 3 months.

We welcome your feedback and suggestions for further relevant resources that should be added: please send these to ..........................

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This section has resources relating to health inequalities, looking at what they are, how they impact on people and how they are measured

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This section has resources relating to health inequalities, looking at what they are, how they impact on people and how they are measured

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King’s Fund framework
My role in tackling health inequalities: a framework for allied health professionals | The King's Fund (kingsfund.org.uk)

Kings Fund- what are health inequalities?
What are health inequalities? | The King's Fund (kingsfund.org.uk)

Health inequalities dashboard- fingertips data
Inequality Tools - OHID (phe.org.uk)

Public Health profiles (fingertips)
Public health profiles - OHID (phe.org.uk)

ARMA health inequalities paper
MSK Health inequalities resource page (arma.uk.net)

Royal Society for Public Health AHP page
RSPH | Health Inequalities

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What are health inequalities?

People experience different combinations of these factors, which has implications for the health inequalities that they are likely to experience. This means that people grouped according to one factor, such as disabled people or people from a particular ethnic background, will not be homogenous - there will be variation in health profiles and risks within any given population group. The way these factors combine and interact with each other also influences the health inequalities people experience. This is often referred to as ' intersectionality'. For example, women experiencing homelessness have distinct health risks and needs compared to men experiencing homelessness.

This explainer provides an overview of how health inequalities are shaped and experienced in England's population. We focus on data up to 2019 in most of what follows, and then look at the impact of the Covid-19 pandemic towards the end.

Inequalities in life expectancy

Life expectancy is a key measure of a population's health status. Inequality in life expectancy is therefore one of the foremost measures of health inequality.

Life expectancy is closely related to people's socio-economic circumstances. The most common summary measure of these circumstances across a population is deprivation. The index of multiple deprivation is a way of summarising how deprived people are within an area, based on a set of factors that includes their levels of income, employment, education and local levels of crime.

In England, there is a systematic relationship between deprivation and life expectancy, sometimes known as the social gradient in health. In 2017-19, women living in the least-deprived 10 per cent of areas could, at birth, expect to live to 86.4 years old, whereas women in the most-deprived 10 per cent of areas could expect to live to 78.7 years - a gap in life expectancy of almost 8 years. For men, this gap was even wider, with a difference of 9.4 years between the life expectancy for those in the least-deprived 10 per cent of areas (83.5 years) and the most-deprived 10 per cent of areas (74.1 years). In recent years, inequalities in life expectancy by deprivation have widened.

This social gradient relationship holds true across the whole population - health inequalities are experienced by everyone, not just those at the very bottom and top. Figure 1 shows how, during 2015-19 in England, rising levels of neighbourhood deprivation were linked to falling levels of life expectancy.

There are also geographical inequalities in life expectancy. in 2017-19, the North East of England experienced the lowest life expectancy at birth for both men and women across England's regions, followed by the North West. Life expectancy in the four most southerly English regions was higher than the England average, whereas in all other regions, life expectancy was lower than the England average.

The north of England has a higher concentration of deprived neighbourhoods than the south of England, and therefore a greater proportion of communities where life expectancy is likely to be lower based on their levels of deprivation. But in addition to this, for any given level of deprivation, life expectancy in the north of England is lower than in the south of England.

The maps below illustrate differences in life expectancy at birth in 2017-19 by local authority areas. For women, the gap between the area with the lowest life expectancy (Blackpool, at 79.5 years) and the area with the highest (Westminster, at 87.2 years) is 7.7 years. For men, the gap is 10.5 years, also between Blackpool (74.4 years) and Westminster (84.9 years).
Hover over each local authority to see the average life expectancy at birth.
Some population groups have significantly shorter life expectancy than the general population. For example, based on 2018-19 data, women with a learning disability had a life expectancy at birth of 67 years - 17 years less than females in the general population. Men with a learning disability had a life expectancy at birth of 66 years, which was 14 years younger than men in the general population.

Inequalities in life expectancy exist between ethnic minority and white British groups, as well as between different ethnic minority groups. 1 The picture of health inequalities by ethnicity in general is both complex and limited by a lack of high-quality data. In terms of life expectancy, 'experimental' ONS statistics suggest that in 2011-14, life expectancy at birth among men and women of white and Mixed groups was lower than in all other ethnic groups. This may be due in part to the ' healthy migrant effect', whereby people who migrate tend to be in good health, as well as lower rates of smoking and alcohol consumption in ethnic minority groups compared to white groups.

Inequalities in healthy life expectancy

Another key measure of health inequality is how much time people spend in good health over the course of their lives, given how crucial good health is to quality of life and people's ability to do the things that they value.

A widely-used measure for this is healthy life expectancy. This estimates time spent in 'good' or 'very good' health, based on how people perceive and report on their general health.

The gap in healthy life expectancy at birth by deprivation is stark. In 2017-19, people living in the least deprived areas could expect to live almost two decades longer in good health than those in the most deprived areas. People in the most deprived areas spend around a third of their lives in poor health, twice the proportion spent by those in the least deprived areas. This means that people in more deprived areas spend, on average, a far greater part of their already far shorter lives in poor health.

Again, geographical inequalities exist in this measure. In 2017-19, healthy life expectancy at birth for women in the North East of England was 59.0 years, compared to 65.9 years for women in the South East, a gap of 6.9 years. For men, this gap was 5.9 years.

Inequalities in avoidable mortality

Deaths are considered avoidable if they could have been averted or delayed through timely, effective healthcare (known as 'treatable mortality') or wider public health and preventive interventions (known as 'amenable mortality'). In 2019, almost 140,000 (roughly one in five) deaths in the UK were considered avoidable.

Differences in rates of avoidable mortality between population groups reflect differences in people getting the help that they need to address life-threatening health risks and illnesses. In England, in 2019, women in the most deprived areas were 3.5 times more likely to die from an avoidable cause than those in the least deprived areas. Men in the most deprived areas were 3.6 times more likely to die from an avoidable cause than those in the least deprived areas.

Figure 4 shows avoidable mortality by local authority area between 2017 and 2019. Darker blue areas have higher rates of preventable mortality. Blackpool had the highest rate at 405.1 deaths per 100,000, almost three times higher than the lowest area, which was Hart at 138.0 per 100,000.
Hover over each local authority to see the mortality rate per 100,000 population from avoidable causes.

Inequalities in long-term health conditions

Long-term conditions are a major cause of poor quality of life in England. People in lower socio-economic groups are more likely to have long-term health conditions, and these conditions tend to be more severe than those experienced by people in higher socio-economic groups. Deprivation also increases the likelihood of having more than one long-term condition at the same time, and on average people in the most deprived fifth of the population develop multiple long-term conditions 10 years earlier than those in the least deprived fifth.

People from ethnic minority groups are more likely than white British people to report limiting long-term illness and poor health, with those identifying as white Gypsy and Irish Traveller reporting the poorest health.

Inequalities in the prevalence of mental ill-health

Assessing differences in the prevalence of mental illness between social groups is challenging and complex, because rates of recognition, reporting and diagnosis are likely to vary between groups. Existing evidence is patchy and inconsistent, but data from a range of sources highlights a range of differences in how mental illness and treatment for mental illness is experienced.

First, data suggests that demand for mental health services is higher among more deprived communities. Figures 5 and 6 show that in England in 2018/19, both the rate of attended contacts with community and outpatient mental health services and the rate of inpatient stays in secondary mental health services were higher among more deprived populations. Data also shows that between 2010-17, suicide rates among the most deprived decile were consistently around double the rates among the least deprived decile (although the correlation between deprivation decile and suicide rate is only seen among working-age adults).

Second, existing evidence suggests that inequalities in various types of mental ill-health exist across a range of protected characteristics, including sexual orientation, disability, sex and ethnicity.

The 2014 Adult Psychiatric Morbidity Survey found that women in England were more likely than men to report experiencing a common mental health disorder, with 19 per cent of women reporting symptoms compared to 12 per cent of men.

The Adult Psychiatric Morbidity Survey also showed disparities in mental ill-health by ethnicity in England. For example, rates of psychotic disorder experienced by Black men (3.2 per cent) and Asian men (1.3 per cent) were higher than among white men (0.3 per cent), although for women no significant difference by ethnicity was observed.

Several socially excluded groups have been shown to experience higher rates of mental ill-health than the general population. For example, more than 80 per cent of people experiencing homelessness report having a mental health difficulty, and in 2019 people in this group were 14 times more likely than those in the general population to die by suicide. Asylum seekers and refugees are also at increased risk of experiencing depression, post-traumatic stress disorder and other anxiety disorders.

There is also substantial evidence of ethnic differences in pathways into psychiatric care across England. For example, in 2018/19, rates of detention under the Mental Health Act among the Black or Black British group were more than four times higher than the white group. In addition, access to mental health services through general practice has been found to be less likely for people in the Black group compared to people in the white group. This has been linked in part to higher rates of serious mental illness in this group as well as to racism and discrimination within services.

Equity and endurance: how can we tackle health inequalities this time?

Here we draw out what can be learnt from past attempts to tackle health inequalities and make the case for a long-term approach that endures.

Inequalities in access to and experience of health services

Access to health services refers to the availability of services that are timely, appropriate, easy to get to and use, and sensitive to user choice and need. Inequitable access can result in particular groups receiving less care relative to their needs, or more inappropriate or sub-optimal care, than others, which often leads to poorer experiences, outcomes and health status. Access to the full range of services that can have an impact on health includes access to preventive interventions and social services, as well as primary and secondary health care.

Inequitable access might mean that a group faces particular barriers to getting the services that they need, such as real or anticipated discrimination or challenges around language. It can mean that information is not communicated in an easily understandable or culturally sensitive way. These issues are often reported for asylum seekers and refugees and Gypsy, Roma and Traveller communities in particular.

Access can be measured in terms of service availability and uptake. More deprived areas tend to have fewer GPs per head and lower rates of admission to elective care than less deprived areas, despite having a higher disease prevalence.

Different social groups might also have systematically different experiences within the services that they use, including in terms of the quality of care they receive and whether they are treated with dignity and respect. A recent review commissioned by the NHS Race and Health Observatory, for example, found evidence of women from ethnic minority backgrounds experiencing 'stereotyping, disrespect, discrimination and cultural insensitivity' when using maternal and neonatal healthcare services. To take another example, in a 2018 study by Stonewall, 13 per cent of LGBT respondents reported experiencing unequal treatment from health care staff because they were LGBT, with this number rising to 32 per cent for people who are transgender and 19 per cent for LGBT people from ethnic minority backgrounds. The differences between groups in this latter example demonstrate how using intersectional lenses gives us a more precise picture of health inequalities.

Pathways to health inequalities

The examples above show systematic differences across various measures of health for different population groups in England. This section explores differences inthe likelihood of engaging in healthy or unhealthy behaviours and differences in the wider determinants of health. Both involve differences in the health risks that people are exposed to and in the opportunities they have to lead healthy lives.

Behavioural risk factors

People's behaviour is a major determinant of how healthy they are. Smoking, poor diet, physical inactivity and harmful alcohol consumption are leading risk factors that drive preventable ill health and premature mortality in England. Behavioural risks to health are more common in some parts of the population than in others. The distribution is patterned by measures of deprivation, income, gender and ethnicity, and risks are concentrated in the most disadvantaged groups. For example, in England in 2019, the proportion of adults who were smokers in the lowest income quintile was 27 per cent, compared to 10 per cent in the highest income quintile.

Higher-risk health behaviours also tend to cluster together in certain population groups, with individuals in disadvantaged groups more likely to engage in more than one risky behaviour. The prevalence of multiple higher-risk behaviours varies significantly by deprivation. In 2017, the proportion of adults with three or more behavioural risk factors was 27 per cent in the most deprived fifth, compared with 14 per cent in the least deprived fifth.

Health-related behaviours are shaped by cultural, social and material circumstances. For example, recent analysis suggests that the poorest 10 per cent of UK households would need to spend, after housing costs, 74 per cent of their income on food in order to follow the government's official guidance on a healthy diet - compared to only 6 per cent of income for the richest 10 per cent of households.

Furthermore, evidence suggests that some people's circumstances make it harder for them to move away from unhealthy behaviours, particularly if they are worse off in terms of socio-economic factors such as debt or poverty. This is compounded by differences in the environments in which people live - for example, in 2017 deprived areas in England were likely to have many more fast food outlets per person than less deprived areas. This indicates that interventions aimed at changing behaviours need to be able to adapt to the reality of people's lives, addressing the contexts in which behaviours take place and recognising the challenges of achieving behavioural change under conditions of stress.

The wider determinants of health

The wider determinants of health are the social, economic and environmental conditions in which people live that have an impact on health. They include income, education, access to green space and healthy food, the work people do and the homes they live in. It is widely recognised that, taken together, these factors are the principal drivers of how healthy people are, and that inequalities in these factors are a fundamental cause of health inequalities. Addressing these wider socio-economic inequalities is therefore a crucial part of reducing health inequalities.

Table 1 provides some examples of health impacts relating to a range of wider determinants. The examples focus on individual determinants, but these determinants are often experienced together and cumulatively over time. Particular groups can be disadvantaged across a number of factors, and these disadvantages can be mutually reinforcing. Deprived areas have, for example, on average nine times less access to green space, higher concentrations of fast food outlets and more limited availability of affordable healthy food.
Table 1 Selected impacts of wider determinants on health inequalities

Income
Income determines people's ability to buy health-improving goods, from food to gym memberships. Living on a low income is a source of stress, and emerging neurological evidence suggests that being on a low income affects the way people make choices concerning health-affecting behaviours.

Children from households in the bottom fifth of income distribution are over four times more likely to experience severe mental health problems that those in the highest fifth.

Housing
Poor-quality and overcrowded housing conditions are associated with increased risk of cardiovascular and respiratory diseases, depression and anxiety.

Households from minority ethnic groups are more likely than white households to live in overcrowded homes and to experience fuel poverty.

Environment
Access to good-quality green space is linked to improvements in physical and mental health, and lower levels of obesity. Levels of access to green space are lower on average for people from ethnic minority communities and people living in areas with lower average incomes.

Exposure to air pollutants is estimated to cut short 28,000-36,000 lives a year in the United Kingdom. Differential levels of exposure are associated with both deprivation and ethnicity.

Transport
Those living in the most deprived areas have a 50 per cent greater risk of dying in a road accident compared with those in the least deprived areas. Children and young adults in the most deprived areas are more likely to be killed or injured on the road than those in wealthier areas.

Education
On average among 26 Organisation for Economic Co-operation and Development countries, people with a university degree or an equivalent level of education at age 30 can expect to live over five years longer than people with lower levels of education.

Work
Unemployment is associated with lower life expectancy and poorer physical and mental health, both for unemployed individuals and their households. In 2019/20, employment rates in the least deprived decile were 81.5 per cent, compared to 68.4 per cent in the most deprived decile.

The quality of work, including exposure to hazards and job security, determines the impact that work has on health. People from minority ethnic backgrounds experience higher levels of work stress than those from white groups.

Interactions between the factors driving health inequalities

Our health is shaped by a complex interaction between many factors. These include the accessibility and quality of health and care services, individual behaviours and, most importantly, wider determinants such as housing and income. Health inequalities exist as a result of systematic variations in these factors across a population.

Inequalities in these factors are inter-related. First, disadvantages are concentrated in particular parts of the population. For example, as noted above, lower socio-economic groups tend to have a higher prevalence of higher-risk health behaviours, worse access to care and less opportunity to lead healthy lives than higher socio-economic groups.

Second, these factors can reinforce each other to compound and magnify the health risks and challenges that disadvantaged groups face. Unemployment, for example, as well as being associated with a direct negative impact on health, can harm future earning potential, thereby affecting other determinants of health such as income and poverty - which in turn can impact on health behaviours and decision-making processes.

Policies and interventions undertaken to tackle health inequalities need to reflect the complexity of how these inequalities are created and perpetuated, otherwise they could be ineffective or even counterproductive.

The impact of Covid-19 on health inequalities

Covid-19 has had an unequal impact on different population groups and has exacerbated existing health inequalities in England.

Mortality rates from Covid-19 have been higher in more deprived areas than in less deprived areas. Up to March 2022, the Covid-19 mortality rate was 2.6 times higher for the most deprived decile in England than for the least deprived decile. This contributed to widening inequalities in life expectancy between the most and least deprived areas: between 2019 and 2021, the gap in life expectancy for women grew by 1.0 years and for men grew by 1.1 years, with gaps in 2021 of 8.7 years for women and 10.4 years for men.

The pandemic has also had an unequal impact on different ethnic groups. Up to December 2021, Black and Asian groups experienced Covid-19 mortality rates that were 2.1 times higher than for the white group and, up to March 2022, also experienced the highest cumulative mortality rates for deaths from all causes (which includes deaths involving Covid-19).

Disabled people experienced a greater risk of dying from Covid-19 than non-disabled people. Up to March 2022, the risk of death involving Covid-19 was 1.6 times greater for disabled women who consider their daily life to be 'limited a lot' (based on self-reported disability status in the 2011 census) compared to women without a disability, and was 1.4 times greater for disabled men who consider themselves 'limited a lot' compared to men without a disability.

Covid-19 restrictions and the reprioritisation of health care services to manage demand associated with Covid-19 also affected some groups more than others. Disabled people were more likely than non-disabled people to report both that Covid-19 restrictions had a negative impact on their lives and that their medical treatment was disrupted during the pandemic.

The longer-term impact of the pandemic is likely to widen health inequalities even further unless urgent and significant action is taken. Recent analysis by The King's Fund has shown inequalities in the elective care backlog, with waiting lists in the most deprived fifth of areas growing by 55 per cent, compared to 36 per cent in the least deprived areas. Health inequalities are also likely to be exacerbated by growing disparities in the wider determinants of health linked in part to the pandemic, including around education, unemployment and financial insecurity.

Tackling health inequalities

Based on factors outside of their direct control, people in England experience systematic, unfair and avoidable differences in their health, the care they receive and the opportunities they have to lead healthy lives.

Health inequalities are not inevitable and the gaps are not fixed. Evidence shows that a comprehensive, multifaceted approach to tackling them can make a difference.

Concerted, systematic and sustained action is needed to address the multiple and overlapping web of factors that drive health inequalities - from differences in experiences and quality of healthcare through to the wider determinants of health. This includes, but goes well beyond, the health and care system. It requires working in partnership across services, sectors and communities, at local, regional and national level.

To find out more about current policy and opportunities for action on health inequalities, you can read further content from The King's Fund on:

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What are health inequalities? People experience different combinations of these factors, which has implications for the health inequalities that they are likely to experience. This means that people grouped according to one factor, such as disabled people or people from a particular ethnic background, will not be homogenous - there will be variation in health profiles and risks within any given population group.

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This section looks at what data can be collected to support delivery of FCP roles, and what data would be useful to collect in the future

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This section looks at what data can be collected to support delivery of FCP roles, and what data would be useful to collect in the future

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First contact physiotherapy data and evidence | The Chartered Society of Physiotherapy (csp.org.uk)

Best MSK Health Programme:
Draft-High level recommended metrics for primary and community MSK services

Keele University MSK community services standardised dataset - BestMSK Health Collaborative - FutureNHS Collaboration Platform

Measuring Quality:
Use quadruple aims for overall systematic approach on measuring quality of a workforce role
The Triple Aim or the Quadruple Aim? Four Points to Help Set Your Strategy (ihi.org)

Quality Service Improvement and Redesign Tools
Layout 1 (england.nhs.uk)

IHI resources relating to population health management
Resources for Public Health Quality Improvement | IHI - Institute for Healthcare Improvement

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Working in Partnership with People and Communities Statutory Guidance document from NHS England and DH&SC, July 2022

NHS England » Working in partnership with people and communities: statutory guidance

NHS futures platform co-production/Always Events page

https://future.nhs.uk/AlwaysEvents

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This section covers common questions about what training and supervision is needed for FCP roles

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This section covers common questions about what training and supervision is needed for FCP roles

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Above is a framework developed by Natalie Heighway from Shropshire, Telford and Welkin Primary Care training hub. It pulls together key stages, components, timescales, and evidence, to produce an excel document which shows the time and what’s needed by individuals and supervisors to allow FCP’s to complete the roadmap. This document has acted as a steppingstone to produce business cases to access funding for clinical supervision, provided structure and a way for each FCP and supervisor to document the time taken to complete different parts.

Key stakeholders have found a single A4 document along side this to also be helpful that they can refer to when needed for each stage.

Stage 3 is currently being added to the spreadsheet.

Roadmaps to Practice | Health Education England (hee.nhs.uk)

What training is needed to be an FCP?
HEE landing page for FCP/AP roles

HEE FAQs about the training and supervision for the roadmap

Chartered Society of Physiotherapy FCP resources

CQC guidance on governance of FCP roles

Roadmaps to Practice | Health Education England (hee.nhs.uk)

Stage 2 Roadmap verification process | Health Education England (hee.nhs.uk)

Advanced Practice physiotherapy network videos:
APPN webinar - what is level 7 learning?
Level 7 learning- APPN 2021

Where do I get that training?
HEE landing page for FCP/AP roles
See link above for HEI training courses

First Contact Practitioners (FCP) – Lancashire and South Cumbria Training Hub (lscthub.co.uk)

Single Module First Contact Practice in Primary Care Level 7 (30 credits) | University of Salford

First Contact Practice | AECC University College | Transforming lives through Health Sciences

First Contact Practitioners (FCP) – Lancashire and South Cumbria Training Hub (lscthub.co.uk)

Postgraduate Certificate First Contact Musculoskeletal Practice - First Contact Musculoskeletal Practice Degree | University of Essex

First Contact Practitioners PG Cert | Coventry University

bradford university fcp module - Search (bing.com)

First Contact Practitioner (FCP) in Primary Care Practice Placement (ADV777) - University of Plymouth

How do I ensure my FCPs align with good practice and the national quality requirements for advanced practice?
CQC guidance on governance of FCP roles

HEE Workplace supervision for Advanced clinical practice

New FCP masters programme in Scotland | The Chartered Society of Physiotherapy (csp.org.uk)

CSP MSK service standards 2021

CSP MSK standards audit tool

How do I support multidisciplinary cross system mentorship, supervision and training across an integrated FCP service and MSK pathway?
Roadmap supervision courses | Health Education England (hee.nhs.uk)

How much time does the training take?
See the attachment above  at the top of this section for a detailed review from Shropshire, Telford and Welkin that gives a clear breakdown of the time commitment required for each stage of the training for FCP

Additional training resources:
Personalised Care Institute

Peer Leadership Development Programme for Lived Experience partners

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Deep Dive into road map - Natalie Heighway

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Pathways, guidance documents and helpful infographics

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Pathways, guidance documents and helpful infographics

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Useful resources for Primary Care:
FCP_GP Support pack_Final.pdf (csp.org.uk)

First contact physiotherapy GP resources | The Chartered Society of Physiotherapy (csp.org.uk)

FCP implementation leaflet from CSP

Policy documents:

Driving forward social prescribing: a framework for AHPs:
RSPH | Driving forward social prescribing: A framework for Allied Health Professionals

Fuller Stocktake report:
NHS England » Next steps for integrating primary care: Fuller stocktake report

Integrated care systems: what do they look like? - The Health Foundation

Useful resources for AHPs:
UK AHP Public Health Strategic Framework 2019-2024.pdf (ahpf.org.uk)

Allied health professionals within integrated care systems (england.nhs.uk)

The Allied Health Professions (AHP)for England: 2022 to 2027 AHPs Deliver

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Funding is available from various sources for FCP training.

Local employer funding should be explored, and in addition there are external opportunities that may support training.

For details of HEE funding opportunities, see:
primarycare@hee.nhs.uk
advancedpractice@hee.nhs.uk

For details of CSP Education Awards Panel funding opportunities see:
Academically Accredited Courses (AAC) Award | The Chartered Society of Physiotherapy (csp.org.uk)

For MACP (Musculoskeletal Association of Chartered Physiotherapists) members:
Awards and Bursaries (macpweb.org)

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This fund supports applications for national academically accredited or validated programmes, such as national vocational qualifications, BTEC awards, access and postgraduate courses. The fund does not support member costs towards undertaking part-time or full-time qualifying degrees in physiotherapy.

If you are unsure of a programme's eligibility, please contact the programme provider or the awards administrator.

Applications for funding should normally be made in the year in which the programme is to be undertaken. Applications can be made retrospectively, providing they are submitted by a deadline which falls within the same calendar year in which the programme has been completed.

Award amounts will be based on the amount of credit carried by the course. As a guide successful applicants would receive no more than:

£350 - 20 credits

£500 - 30 credits

£650 - 40 credits

£900 - 60 credits

£1,250 - 120 credits

£1,600 - 180 credits MSc

£2,000 - PhD

The AAC Award is already open to Associate members of the CSP, and the CSP Charitable Trust has now received a generous donation specifically for Associate members under the AAC Award. Eligible members may apply in the usual way following the rest of the criteria and guidance outlined.

How to apply

There are two rounds of funding per year for this award. Applications are now open - the deadline to apply is midday on Wednesday 7 September 2022.

Applications for the AAC Award must be submitted through the CSP Learning Hub.
Access the Learning Hub
Application form and guidance notes

The application form and guidance notes are made available for information only and are not for completion - please log in to view these documents. Applicants should access the Learning Hub when applications are open in order to download the documents applicable to that award round.

Full article content is only available to CSP members. If you are a member you will need to log in.

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Academically Accredited Courses (AAC) Award

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This fund supports applications for national academically accredited or validated programmes, such as national vocational qualifications, BTEC awards, access and postgraduate courses. The fund does not support member costs towards undertaking part-time or full-time qualifying degrees in physiotherapy. If you are unsure of a programme's eligibility, please contact the programme provider or the awards administrator.

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Professional and patient organisations that might be useful

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Professional and patient organisations that might be useful

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Chartered Society of Physiotherapy
https://www.csp.org.uk/

Royal College of General Practitioners
https://www.rcgp.org.uk/

British Orthopaedic Association
https://www.boa.ac.uk/

British Society of Rheumatology
https://www.rheumatology.org.uk/

Royal College of Radiologists
https://www.rcr.ac.uk/

College of Paramedics
https://collegeofparamedics.co.uk/

General Osteopathic Council
https://www.osteopathy.org.uk/

Arthritis and Musculoskeletal Alliance
http://arma.uk.net/

Versus Arthritis
https://www.versusarthritis.org/

Personalised Care Institute
https://www.personalisedcareinstitute.org.uk/

British Pain Society

https://www.britishpainsociety.org/

Physiotherapy Pain Association

https://www.britishpainsociety.org/

Pain Concern

https://painconcern.org.uk/

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The Chartered Society of Physiotherapy (CSP) is the professional, educational and trade union body for the UK's 64,000 chartered physiotherapists, physiotherapy students and support workers.

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Case studies using evidence and data for MSK transformation

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Case studies using evidence and data for MSK transformation

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Ealing JSNA MSK Health project

National Evaluation of First Contact Practitioner (FCP) model of primary care (csp.org.uk)

Implementation of a provider based musculoskeletal first contact physiotherapy service model: Key points to consider
Ingram et al Musculoskeletal Care. 2021 Jun;19(2):232-235. doi: 10.1002/msc.1527. Epub 2020 Nov 2

Sussex system example- see above infographic

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SMSKPE FCP Case Study Single Slide_FINALv2

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Case studies relating to integrating FCP roles

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Case studies relating to integrating FCP roles

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Chartered Society of Physiotherapy case studies:
First Contact Physiotherapy case studies

NHSE/I FCP case studies on Future Platform

FCP Case study video clips

Midlands Partnership case study

SOP for FCPs Herefordshre and Worcestershire.pdf

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Draft MPFT FCP case study V 1.5 26102022

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Case studies related to training and supervision for FCP roles

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Case studies related to training and supervision for FCP roles

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Great case study above

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Implementing a First Contact Practitioner service across an Integrated Care System at pace…our journey so far v1.7

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This section has resources relating to FCP and AP job plans and the job planning process

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This section has resources relating to FCP and AP job plans and the job planning process

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NHSE AHP job planning guidance 2019: helpful advice on writing a job plan.
aps-job-planning-best-practice-guide-2019.pdf (england.nhs.uk)

NHSE guidance: helpful advice on what a job plan is and how to use it in practice.
NHS England » Allied health professionals job planning: a best practice guide

NHSE guidance e-job planning 2020
e-job-planning-guidance.pdf (england.nhs.uk)

Job descriptions NHSE:
NHS England » Example job descriptions for Allied Health Professionals

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Examples of possible job plans above