First Contact Practice

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Following the introduction of the Additional Roles Reimbursement Scheme (ARRS) through the DES, a number of new roles have been introduced to Primary Care. A group of these roles are known as First Contact Practitioners (FCPs) and include Paramedics, Physiotherapists, Dietitians, Podiatrists and Occupational Therapists. These roles have been introduced to improve access for patients, reduce pressures on existing staff and improve the quality of care and services.

To ensure patient safety, Health Education England (HEE) have developed the Roadmaps to Practice which are minimum standard and competency frameworks that FCPs need to be verified against. All clinicians working as a FCP need to be recognised and signed off against this framework, this is irrespective of whether ARRS funded or a practice employee.

What is a First Contact Practitioner? 

A FCP is a diagnostic clinician working at Masters level managing undifferentiated and undiagnosed patients who are unlikely to have previously been seen and triaged by a GP.  A FCP is defined by the patients they see and the level they are working at rather than whether they are ARRS funded. FCPs are considered to be working at an Advanced level (academic level 7) and operating in between and Enhanced / Specialist Practitioner and an Advanced Clinical Practitioner.

Roadmaps to Practice

Each of the five FCP professions have a Roadmap to Practice framework. Each clinician that is working through the Roadmap needs access to a trained Roadmap Supervisor to support them through the process, undertake workplace based assessments and verify the knowledge and competence required for recognition.

The Roadmap consists of 2 stages:

  • Stage 1 – knowledge, skills and attributes
  • Stage 2 – competencies in Primary Care (This completes FCP level)

Sign off at stage 2 is the minimum requirement to be recognised as a FCP.

Routes for recognition:

Portfolio – this is now closed

Stage 1 (evidence of knowledge) can be completed by completion of a set of e-learning modules alongside a portfolio of evidence against the knowledge domains in the framework. The trained Roadmap Supervisor can sign off this stage using a checklist and progression to stage 2 can start.

Stage 2 (evidence of capability) is completed with a portfolio of evidence showing the application of skill against the domains in the framework. There are a number of workplace based assessments that need to be completed during this stage which will also form part of the portfolio evidence. Once the Supervisor is happy that the relevant level of skill has been evidenced they can sign the clinician off and complete a survey for recognition by the Centre for Advancing Practice.

Taught Route

A number of universities have developed specialist FCP modules to complete stages 1 and 2 through a taught programme. Individuals will complete a portfolio alongside the taught programme and time in practice to evidence the practical application. There are now a number of modules available nationally that are funded by NHSE. Please visit this page to see what is available Education Providers of FCP training | NHS England | Workforce, training and education (hee.nhs.uk). The clinician will still need access to a trained Roadmap Supervisor.

Supervision

There are specific requirements relating to supervision of FCPs undertaking the Roadmap to Practice. This is to ensure the clinician is supported appropriately, the supervisor is able to be assured of capability and to ensure patient safety whilst the skills are being evidenced.

To be able to supervise a FCP, you need to either:

  • Have attended the 2 day Roadmap Supervisor Training
  • Have attended an Advanced Practice Educator programme including the FCP top up
  • Be a GP Educator (it is recommended that you complete the FCP top up)

The 2-day training course is funded by NHSE. The sessions aren’t currently available however we expect to have some dates available within region shortly.

Each FCP requires the following supervision:

  • Daily de-brief sessions with a Clinical Supervisor (20-30 minutes)
  • Monthly Clinical Supervision sessions with a Clinical Supervisor
  • 6 weekly CPD Supervision sessions with an AP or someone that is familiar with the Roadmap process and requirements
  • Monthly Consultation Observation and monthly Case Based Discussion review (45-60 minutes)

CQC

CQC have recently announced on their website that they expect all FCPs to have been verified against stage 1 of the Roadmap before employment in Primary Care and have a plan to complete stage 2. They will be checking this during routine visits. Please see here for this information GP mythbuster 106: Primary care first contact practitioners (FCPs) – Care Quality Commission (cqc.org.uk)

Timescales

Whilst it is suggested as best practice to complete both stages 1 & 2 of the Roadmap in 6 months, it has been agreed locally that this can be within 18 months of employment.

DES

There is specific information in the DES relating to ARRS eligibility and the level that an individual should be, at the point of recruitment. Following these requirements will ensure that anyone recruited is at the right level to undertake the Roadmap to Practice and support the safe provision of care to patients.

Support and Resources

The BLMK ICB Primary Care Training Hub is here to support you alongside your usual Place leads.

We have Clinical Leads for Paramedics and Physiotherapists who are here to support practices, PCNs and individual clinicians:

Matthew Cooper – Physiotherapy Ambassador – matthew.cooper8@nhs.net

Tom McNally – Paramedic Ambassador – tom.mcnally1@nhs.net

Hannah Baker – Primary Care Workforce Transformation Manager is also available to support alongside our Clinical Leads and can be contacted at Hannah.baker11@nhs.net

Training

All First Contact Practitioners are eligible to attend the BLMK ICB Primary Care CPD Ptogramme. Please visit our CPD page here 2023/24 CPD Programme for Nurses and AHPs – BLMK ICB (work-learn-live-blmk.co.uk) to see what is on offer. If you can’t see what you are looking for, please contact us on blmkicb.blmk.traininghub@nhs.net to consider it for future programmes.

NHSE Resources

NHSE has a webpage dedicated to the Roadmaps to Practice here Roadmaps to Practice | Health Education England (hee.nhs.uk)

This webpage contains the following resources:

  • Profession specific Roadmap documents (which include the templates required for completion)
  • Summary of the changes implement in April 2024
  • Guidance on supervision
  • Stage specific information
  • Pre-recorded webinars with information on how to complete the Roadmap
  • FAQs

Rotational Models

For Paramedics, there is an alternative employment model whereby a Paramedic can be employed by an Ambulance Trust and support a PCN. This individual can be employed at a level 6 (Enhanced / Specialist) and be eligible for ARRS funding. There aren’t currently any rotational models available with BLMK Ambulance Trust partners but information will be shared once available.