Guide for FCPS
This page provides recommendations to prepare and support continuity of care during public health emergencies by enabling the rapid adaptation of healthcare service delivery. These recommendations are tailored to physiotherapy services for musculoskeletal conditions within primary care and emergency department settings, commonly referred to as First Contact Physiotherapy Services (FCPS). The recommendations are organised into five implementation phases, structured around three key stages: before, during, and after public health emergency with clearly defined agents responsible for implementation.
FCPS IN PRIMARY CARE
STAGE 1: Prior to public health emergency
Phase 1: Preparation and planning
Recommendations included in this phase focuses on the preparation and planning for public health emergencies.
Responsible agents: Policy makers and service providers
| 1. Be pragmatic, adapt and tailor to context | Need to embed contingency plans into FCPS by developing and incorporating rapid adaptation strategies that are pragmatic, tailored to address local capabilities, specific challenges, and MSK healthcare needs. |
| 2. Designate a leader | Prior to crises, appoint a public health response lead at organisational level to oversee the rapid implementation of emergency response strategies in FCPS. This role would facilitate top-down collaboration, resource allocation, supply/equipment sourcing and dissemination, also enhancing communication across the system. This has been found to promote uniformity and ensure a coordinated approach to public health emergencies. |
| 3. Set a time frame | In a case of public health emergency events, evidence suggests that adaptation is considered rapid when it occurs within three months, especially for a large-scale crisis. Based on this, a three-month timeframe is proposed for implementing contingency plans and strategies. It is important to note that the implementation of contingency plans and strategies can begin as soon as a crisis emerges if plans are already in place and there is succession planning to ensure business continuity. |
| 4. Train staff and managers | Provide staff/managers training on public health emergency response coordination, risk assessment (i.e., when to act (adapt) or not), mitigation and rapid adaptation skills, to enhance clinical and service delivery decision making. |
| 5. Fund public health emergency | Ensure FCPS is accounted for in public health emergency budget. |
| 6. Assess the need for personnels | Prior to public health emergency, identify the service demand for FCPS physiotherapy role and develop strategies (i.e. training, recruitment of additional physiotherapists specialising in MSK first point-of-contact care for effective response when need arises). |
| 7. Expand FCPS | To support ongoing MSK care, more FCPS should be implemented within each Primary Care Network, embedded directly within GP surgeries to foster strong interprofessional relationships and integrated care. |
| 8. Review and adopt available evidence-based recommendations | Promote the adoption of evidence based rapid adaptation recommendations to support FCPS decision-making and continuity of care. |
| 9. Prepare MSK patients for contingencies | Promote the dissemination of information to guide MSK patients’ safe care-seeking behaviour and to ready them for potential changes in service delivery platforms during crises. This could be a national level campaign, through leaflets, newsletters and social media. |
Phase 2: Assessing Needs and Engaging
Recommendations included in this phase focus on developing priorities and strategies that support equitable care.
Responsible agents: Service providers and implementers
| 10. Prioritise care and platform | Consider developing a priority plan. Triage MSK patients based on risk. Identify suitable treatment platforms and tailored self-management interventions for MSK management to address these needs. Address equity, acceptability challenges and the unique needs of vulnerable and marginalised populations (i.e. older adults, ethic minority groups). |
| 11. Strengthen communication strategies | Establish a clear communication pathway among FCPS healthcare providers, leadership, team members, and patients. |
STAGE 2: During public health emergency
Phase 3: Executing
Recommendations included in this phase focus on actionable interventions for rapid adaptation during public health emergencies.
Responsible agents: Service providers and implementers
| 12. Rapidly conduct risk assessment/analysis | Quickly perform a risk assessment to evaluate the threats public health emergency posed on FCPS, staff and patients, guiding decisions on when to act/adapt or not. |
| 13. Promptly request funding allocation | Evaluate the funding required for FCPS continuity and submit timely requests to support its rapid adaptation. |
| 14. Adapt to changing context | Adapt to evolving contextual needs by implementing comprehensive risk mitigation measures such as PPE use, hand hygiene, restructuring (e.g., demarcations, removing waiting areas) and vaccination programs. |
| 15. Optimise workforce | Identify the demand for FCPS in PC during public health emergency, provide resources and develop business strategies to boost employee and service efficiency and improve performance. For instance, part-time physiotherapists may expand their hours. |
| 16. Optimise service delivery settings and platforms | Maintain the provision of self-management advice and consider redirection of service delivery such as signposting and specific referrals to community and specialist services for continued care. |
| 17. Use digital technology | Establish or utilise existing digital platforms at the health facility to enable MSK care delivery, strengthen communication strategies and initiate rapid in-service training. Hybrid mode of MSK care (virtual and in-person) may be considered where applicable. Follow established guidance telehealth regulation, considering accessibility, liability, safety and privacy. |
| 18. Prioritise staff wellbeing | Provide accessible, ongoing and timely occupational health assessments and staff safety measures including mental health care, psychosocial support and promote self-care strategies to cope and recover from burn out during the time of crisis. It is important for management to receive training focused on supporting staff wellbeing. |
Phase 4: Reflecting and Evaluating
The recommendation included in this phase focus on the rapid assessment and evaluation of adapted strategies.
Responsible agents: Service providers and implementers
| 19. Incorporate rapid assessment and evaluation | Monitor FCPS by facilitating continuous learning through rapid evaluations of adapted strategies. Utilise routine data and collect feedback from users and providers to drive ongoing and successive improvements. |
STAGE 3: Commence during and beyond public health emergency
Phase 5: Evolution and Maintenance
Recommendations in this phase emphasis the potential for sustaining implemented strategies.
Responsible agents: Service providers and implementers
| 20. Identify the short, medium or long-term use of adapted strategies | Document effective, sustainable strategies for integration into routine FCPS practice while distinguishing temporary contingency measures for future crisis use. Continue to adapt sustained strategies to context through continuous improvement. |
| 21. Create a roadmap for restoring FCPS | Establish a clear plan for recovery gradually restoring modifications made to FCPS where necessary as public health pressure ease. |
| Note that some modifications may be carried into the future following assessment and with continuous improvement. |
FCPS IN EMERGENCY DEPARTMENTS
STAGE 1: Prior to public health emergency
Phase 1: Preparation and planning
Recommendations included in this phase focuses on the preparation and planning for public health emergencies.
Responsible agents: Policy makers and service providers
| 1. Be pragmatic, adapt and tailor to context | Need to embed contingency plans into FCPS by developing and incorporating rapid adaptation strategies that are pragmatic, tailored to address local capabilities, specific challenges, and MSK healthcare needs. |
| 2. Designate a leader | Prior to crises, appoint a public health response lead at organisational level to oversee the rapid implementation of emergency response strategies in FCPS. This role would facilitate top-down collaboration, resource allocation, supply/equipment sourcing and dissemination, also enhancing communication across the system. This has been found to promote uniformity and ensure a coordinated approach to public health emergencies. |
| 3. Set a time frame | In a case of public health emergency events, evidence suggests that adaptation is considered rapid when it occurs within three months, especially for a large-scale crisis. Based on this, a three-month timeframe is proposed for implementing contingency plans and strategies. It is important to note that the implementation of contingency plans and strategies can begin as soon as a crisis emerges if plans are already in place and there is succession planning to ensure business continuity. |
| 4. Train staff and managers | Provide staff/managers training on public health emergency response coordination, risk assessment (i.e., when to act (adapt) or not), mitigation and rapid adaptation skills, to enhance clinical and service delivery decision making. |
| 5. Fund public health emergency | Ensure FCPS is accounted for in public health emergency budget. |
| 6. Assess the need for personnels | Prior to public health emergency, identify the service demand for FCPS physiotherapy role and develop strategies (i.e. training, recruitment of additional physiotherapists specialising in MSK first point-of-contact care for effective response when need arises). |
| 7. Expand FCPS | Consider extending FCPS to PC settings, particularly in regions where these services are not yet well established in PC, to enable patients with MSK conditions receive care without the heightened risk of infection associated with emergency department visits. It is also recommended to pilot FCPS in PC settings before a pandemic response to evaluate their effectiveness and potential risks in real-world conditions. This should include exploring flexible PC funding models that can be rapidly adapted during emergencies. |
| 8. Review and adopt available evidence-based recommendations | Promote the adoption of evidence based rapid adaptation recommendations to support FCPS decision-making and continuity of care. |
| 9. Prepare MSK patients for contingencies | Promote the dissemination of information to guide MSK patients’ safe care-seeking behaviour and to ready them for potential changes in service delivery platforms during crises. This could be a national level campaign, through leaflets, newsletters and social media. |
Phase 2: Assessing Needs and Engaging
Recommendations included in this phase focus on developing priorities and strategies that support equitable care.
Responsible agents: Service providers and implementers
| 10. Prioritise care and platform | Consider developing a priority plan. Triage MSK patients based on risk. Identify suitable treatment platforms and tailored self-management interventions for MSK management to address these needs. Address equity, acceptability challenges and the unique needs of vulnerable and marginalised populations (i.e. older adults, ethic minority groups). |
| 11. Strengthen communication strategies | Establish a clear communication pathway among FCPS healthcare providers, leadership, team members, and patients. |
STAGE 2: During public health emergency
Phase 3: Executing
Recommendations included in this phase focus on actionable interventions for rapid adaptation during public health emergencies.
Responsible agents: Service providers and implementers
| 12. Rapidly conduct risk assessment/analysis | Quickly perform a risk assessment to evaluate the threats public health emergency posed on FCPS, staff and patients, guiding decisions on when to act/adapt or not. |
| 13. Promptly request funding allocation | Evaluate the funding required for FCPS continuity and submit timely requests to support its rapid adaptation. |
| 14. Adapt to changing context | Adapt to evolving contextual needs by implementing comprehensive risk mitigation measures such as PPE use, hand hygiene, restructuring (e.g., demarcations, removing waiting areas) and vaccination programs. |
| 15. Optimise workforce | Within emergency department, part-time staff may expand their hours, during surge, redeployment of staff from other physiotherapy units with excess capacity should be considered. |
| 16. Optimise service delivery settings and platforms | Maintain the provision of self-management advice and consider redirection of service delivery such as signposting and specific referrals to community and specialist services for continued care. |
| 17. Use digital technology | Establish digital platforms at the facility to enable MSK care delivery, strengthen communication strategies and initiate rapid in-service training. It is important to identify and address the gap in telehealth evidence for managing MSK conditions in emergency department settings. |
| Where possible, telehealth could be used for prehospital assessment, triaging and self-management advice. Follow established guidance telehealth regulation, considering accessibility, liability, safety and privacy. | |
| 18. Prioritise staff wellbeing | Provide accessible, ongoing and timely occupational health assessments and staff safety measures including mental health care, psychosocial support and promote self-care strategies to cope and recover from burn out during the time of crisis. It is important for management to receive training focused on supporting staff wellbeing. |
| Note that some modifications may be carried into the future following assessment and with continuous improvement. |
Phase 4: Reflecting and Evaluating
The recommendation included in this phase focus on the rapid assessment and evaluation of adapted strategies
Responsible agents: Service providers and implementers
| 19. Incorporate rapid assessment and evaluation | Monitor FCPS by facilitating continuous learning through rapid evaluations of adapted strategies. Utilise routine data and collect feedback from users and providers to drive ongoing and successive improvements. |
STAGE 3: Commence during and beyond public health emergency
Phase 5: Evolution and Maintenance
Recommendations in this phase emphasis the potential for sustaining implemented strategies.
Responsible agents: Service providers and implementers
| 20. Identify the short, medium or long-term use of adapted strategies | Document effective, sustainable strategies for integration into routine FCPS practice while distinguishing temporary contingency measures for future crisis use. Continue to adapt sustained strategies to context through continuous improvement. |
| 21. Create a roadmap for restoring FCPS: | Establish a clear plan for recovery gradually restoring modifications made to FCPS where necessary as public health pressure ease. |
| Note that some modifications may be carried into the future following assessment and with continuous improvement. |