Back pain costs the NHS nearly £5 billion, physiotherapists have an ever-increasing role to play in relieving strain on services
By Dr Gillian Yeowell, Dr Sue Greenhalgh and Prof James Selfe
In this new age of home working, back pain is increasingly familiar. Even before the pandemic, it was the fifth most common reason people would see any health care practitioner.
In fact, musculoskeletal (MSK) conditions account for approximately 30% of general practitioner (GP) consultations in England. They are estimated to cost the National Health Service (NHS) £4.76 billion each year, and this is likely to increase. However, GP numbers are remaining relatively static.
Because of this, physiotherapists are increasingly supporting GP and primary care services, taking on more responsibility in their roles as musculoskeletal specialists.
Though serious conditions only account for 1% of people presenting with back pain, physiotherapy can be the first opportunity for detection. Cancer, infection and cauda equina syndrome may masquerade as simple back pain but need urgent or emergency medical management. Early detection is vital.
Health ‘timebomb’
As the pandemic continues, recent reports say that patients are presenting with serious conditions later across health services. The reasons for this are currently unknown, however it could be speculated that daily news reports of the NHS being overwhelmed and the government messaging to ‘protect the NHS’ might deter people from seeking help. They may be worried about contracting COVID-19. They may have also heard that they may be seen online or over the phone and feel that they want to see someone to have a physical examination, choosing not to attend until they can be seen in person.
With this change in public health behaviour comes an added responsibility for services that are already tasked with supporting primary care services, such as GPs, urgent or even emergency care, to relieve wider impact on health systems.
Physiotherapists are increasingly taking on the role of First Contact Practitioners (FCP). The intention is to be the first point of contact and make sure patients see the right specialist at the right time, when they need it most. This means the first person to see a patient with pain due to serious causes is increasingly a physiotherapist, rather than a GP.
This new responsibility presents challenges - there’s an ongoing need to develop this role to be as effective as possible, while making sure physiotherapists receive the professional support they need. At Manchester Metropolitan University, we’ve carried out a study to examine the effects of this increasing responsibility on the physiotherapy profession, as more and more become the first point of contact in diagnosis and treatment.
A changing profession
At a time when health systems need to be as robust and efficient as possible, our research intends to support professionals and decision makers in understanding what will make this role as effective as possible, developing professional training and supporting health outcomes for patients, not just with the most serious of conditions, but across health services in dealing with such common conditions as musculoskeletal discomfort or pain.
By empowering our patients so they feel able to tell us about their concerns, we can help them to understand what to look out for, so that they present at an earlier stage. Our research into back pain focusses on serious conditions such as cauda equina syndrome, where we have created creating information cards in 30 different languages which physiotherapists can use with their patients, for identifying when to access emergency help. An animation has also been created to highlight when urgent care is needed.
Most of the time, thankfully, symptoms of back pain or musculoskeletal issues will turn out to be nothing to worry about. However, recognising the most serious conditions early will make all the difference in how a person recovers and improved quality of life. Physiotherapists play an ever-increasing key role in supporting primary care services and making sure patients get the right help they need as soon as possible.
