Primary contact physiotherapy in urgent care

Urgent Care Clinics (UCCs) have become a vital hub for delivering quality healthcare, taking pressure off emergency departments (EDs) across Australia. 

To date, little research had been carried out on the role that primary contact physiotherapists (PCPs) play in UCCs. 

A project led by a recent Pat Cosh Trust grant recipient is aiming to address this need. Dr Rachael McMillan APAM is a senior clinician physiotherapist in ED and UCC settings at Barwon Health and a researcher in the School of Medicine at Deakin University. 

Her research project, ‘Evaluation of primary contact physiotherapy in a state-funded Victorian Urgent Care Centre: a mixed-methods study’, was recently awarded a 2025 Pat Cosh Trust Strategic Grant worth $149,989. ‘

As a physio, most of my clinical experience was in musculoskeletal and elite sport prior to completing the advanced practice physiotherapy training (in ED and UCC settings). 

‘I now work as a PCP in Barwon Health’s UCC and ED. 

‘This project is essentially a series of five studies that will provide an opportunity to evidence the scope and implementation of Barwon Health’s unique PCP- and nurse practitioner [NP]-led UCC.’ 

Barwon Health’s UCC was established in 2020 and was originally led by NPs and staffed by both NPs and registered nurses. 

In 2022, due to the number of patients presenting with musculoskeletal injuries, PCPs were introduced to the service to help manage the workload. 

Barwon Health’s UCC is the first public UCC to integrate primary care physiotherapists into an established NP/registered nurse-led model of care, with the service seeing more than 48,000 presentations since commencing in 2020. 

The project will look at many factors related to this PCP- and NP-led UCC, such as scope of practice, numbers and types of patients seen, waiting times, length of stay, referral pathways, discharge destinations and adverse events against established emergency care benchmarks, eg, Australasian College for Emergency Medicine guidelines, Victorian ED and UCC performance targets and published literature. 

An economic analysis in comparison to medical/GP-led and ED models will also be undertaken. 

The project will examine the acceptability of the PCP service to stakeholders including healthcare providers, patients and patient families and the satisfaction of patients, patient families and PCPs with the PCP service. 

All of this information will be used to inform best practice for developing models of primary care for PCP- and NP-led UCCs as well as to support the continuing development of advanced practice physiotherapy in Australia. 

‘The PCPs and NPs work together to lead assessment of all the injuries that come into the UCC and we do have emergency medicine consultants, whom we can contact for any complex injuries that might need medical input. 

‘But essentially the PCPs and NPs are managing these injuries independently in the UCC, which is not only reducing the burden on emergency departments but also serving the community in terms of these low-acuity or musculoskeletal injuries.

‘Physios are specifically trained in musculoskeletal health and have a unique skill set to provide best care for the majority of the injuries that people come into the urgent care centre with. 

‘It is important to note that physios are contributing as part of a team and there are other injuries that can be presented, eg, injuries relating to significant wounds or other areas that are not musculoskeletal – the NPs will take the lead on them.

‘The Pat Cosh Trust grant will allow us to have dedicated research time to evaluate the service and to employ a health economist to undertake a comprehensive economic analysis. 

‘There is a lot of planning, data collection and analyses required for this comprehensive assessment. 

‘One of the studies will involve focus interviews with patients, patient families and clinicians, which also takes considerable preparation and time. This project would not be possible without the Pat Cosh Trust grant.’