Transformation Directorate

Musculoskeletal first contact practitioner services in primary care

Within the Halton area, the Musculoskeletal Clinical Assessment and Treatment Service (MSKCATS) team:

  • provides services for a population of 126,000
  • serves 15 GP practices
  • conducts daily paper triage
  • has support from a consultant rheumatologist and consultant anaesthetist who both provide weekly primary care clinics within MSKCATS


Warrington and Halton NHS Foundation Trust began with service user engagement events to understand the issues with the existing musculoskeletal (MSK) service. The main issues identified were:

  • waiting times (approximately 12-14 weeks)
  • inconsistent approach from GPs with respect to management of musculoskeletal conditions
  • limited resources - 2.5 whole time equivalent (WTE) clinical staff and 2.0 WTE administrative staff


For MSK FCP services to position highly-skilled and regulated MSK practitioners at the first point of contact in primary care. This would reduce waiting times as telephone consultations are used initially and then a face-to-face assessment is arranged if it is required.

Solution and impact

A three-month pilot in one of the GP practices evaluated the impact of MSK first contact practitioner posts. This was in collaboration with the service provider of MSKCATS (Warrington and Halton Hospitals NHS Foundation Trust ) and Any Qualified Provider (AQP). Both patient and GP feedback helped evaluate the pilot.

  • December 2014 - stakeholder engagement event where the clinical commissioning group (CCG) looked at the future of MSK services
  • May 2015 - process mapping event with providers and commissioners to look at pathway development, including formation of transformational change groups and meetings held with different patient forums in GP practices
  • October 2015 - Lisa Horne appointed MSK clinical lead for Halton CCG to lead the project
  • November 2015 - trial of the new service in local GP practice for three months
  • May 2016 - Halton CCG agrees to implement first point of contact service
  • May 2016 - funding secured to increase clinical staff from 2.5 WTE to 5.5 WTE and administration staff from 2.0 WTE to 3.0 WTE
  • Promotion of service included local radio interviews, business cards, leaflets, local press articles and updates to the Warrington and Halton Hospitals NHS Foundation Trust website updated
  • IT training for new computer system
  • Overhaul of patient information and advice leaflets
  • Pathway development with secondary care consultants


  • Shorter waiting times (3-4 weeks)
  • Appropriate clinical decisions made early on in the patient journey
  • Beneficial effect on local Physiotherapy waiting list
  • £500,000 cost saving for Halton CCG in the first six months, due to a reduction in investigations, injections and onward referral


Patient contacts MSKCATS directly via a designated phone number and is allocated an appointment.


  • Supporting remote healthcare
  • Monitoring vital signs
  • Virtually connecting with a healthcare practitioner


  • For remote consultations or home monitoring

Find out more

Chartered Society of Physiotherapy website - transformation of MSK services in Halton

Key contact

Lisa Horne, MSKCATS clinical lead and AMPP, Warrington and Halton Foundation Trust