Advanced Physiotherapy Practitioners (APPs) are now available in most GP surgeries across Forth Valley.

APPs provide a first contact service for patients with any musculoskeletal problem. This means patients do not need to be seen by a doctor first and can make an appointment directly with the APP via reception at their local surgery.

The APP works independently to assess, diagnose and form a management plan for conditions including:

Spinal

• Neck, thoracic and low back pain
• Sciatica/disc problem
• Referred arm pain from neck
• Osteoporosis

Upper Limb

• Shoulder pain /Frozen shoulder/Sub-acromial impingement/Rotator cuff/AC joint
• Elbow pain/Tennis elbow/Golfers’ elbow
• Wrist and hand pain/Dequervains/Carpal Tunnel Syndrome/Trigger fingers/OA of thumb and fingers

Lower Limb

• Hip pain/Trochanteric bursitis/OA hip/groin strain
• Knee pain/ sprain/bursitis/patella femoral problems/OA knee
• Ankle pain/sprain/tendinitis/plantar fasciitis/arch pain/hallux valgus/metatarsalgia

General

• Soft tissue injury/sprain/strain/repetitive strain/sport injury
• Possible problem with muscle, ligament, tendon, joint, bone or bursa
• Arthritis
• Patients whose mobility has changed/needs assessed
• Patient who is post-orthopaedic surgery who needs advice/assessment
• Hypermobility

The APP will deliver evidence based interventions when required and can refer on to secondary care services if necessary (e.g. Orthopaedics, Neurology, Rheumatology, Pain service). Some APPs can also prescribe medication or offer joint/soft tissue injections where appropriate. If medication or a fit note is required following assessment by the APP this can be arranged by them without the need for a further GP appointment.

Very often patients can be managed with input from the APP without being referred to another clinician however, patients who require ongoing physiotherapy will be referred onto the core MSK physiotherapy service.

There are a small number of patients who are not suitable to be assessed by the APP service and would require a GP/Advance Nurse Practitioner/Physician Assistant appointment, these include:

• Children under 16
• Patient with a rheumatological condition that only requires medical management
• Antenatal women
• Postnatal women (less than 6 weeks after delivery) where the condition relates to the pregnancy as these should be managed by the Women’s Health team
• Housebound patients
• Pain from a suspected non-musculoskeletal cause
• Patients only requiring prescriptions or fit notes
• Neurological Conditions
• Respiratory Conditions
• Headaches