I recently had some feedback from my trust about osteopaths interviewing for FCP jobs. Osteopaths are doing well at getting through to interview. Previously many osteopaths used to talk about treating patients but that has greatly improved now so there is better understanding of the role. It also evident that osteopaths are clinically very good. The area for improvement now is to understand more about the MSK pathways and the role of FCP within those pathways.
As an FCP you have many options open to you in the management of patients – self-management, wait and see, arrange for blood tests or imaging, refer to physiotherapy service, refer to secondary care.
There are particular protocols for requesting imaging. For example we cannot refer for an MRI of the knee unless a plain x-ray has been done first. Some MRI scans should only be requested through secondary care. FCPs can request MSK MRI scans but generally GPs are not able to get referrals through.
Referring to secondary care the referral is triaged. The patient may then see a GPSI (GP with special interest), Extended Scope Physiotherapist or go straight through to the consultants team. We can refer to orthopaedics, rheumatology, neurology and neurosurgery. As a crude summary orthopaedics and neurosurgery are for surgical considerations whereas rheumatology and neurology are for diagnosis and management of conditions.
FCPs are considered MSK experts. Therefore how a patient is managed within and going on from Primary Care is down to your diagnostic reasoning.
It is important to know about the NICE guidelines and evidence base for conditions to inform your management. For example if you suspect a patient has Rheumatoid Arthritis how would you manage their condition. The history, progression and examination will inform your diagnosis – metacarpal and metatarsal squeeze is used to assess for synovitis. You can request bloods and appropriate imaging or do you refer to rheumatology straight away. From the NICE guidelines – refer urgently if there is suspected persistent synovitis of undetermined course affecting the small joints of hands or feet, more than one joint is affected, or there has been a delay of 3 months or longer between onset of symptoms and seeking medical advice. Investigations you may request include rheumatoid factor, anti-CCP and x-ray of the hands and feet – investigations should not delay referral if there is a strong suspicion of RA due to synovitis. Negative rheumatoid factor does not negate a diagnosis of RA.
This is just one example of how knowing the pathways will inform your management. Other key pathways include other inflammatory arthopathies, and the low back pain and sciatica pathway.
Hopefully these tips will be helpful for informing your preparation for FCP jobs, if you have any questions or comments do get in touch.