Background: First Contact Physiotherapy (FCP) is an emerging model of care whereby a specialist physiotherapist located within general practice undertakes the first patient assessment, diagnosis and management without a prior GP consultation. Despite institutional and professional body support for this model and NHS commitment to its implementation, data regarding current FCP provision are limited.Objectives: To identify current FCP service provision across the UK, including models of provision and key professional capabilities.Design: Cross-sectional online survey, targeting physiotherapists and service managers involved in FCP.Methods: Recruitment involved non-probability sampling targeting those involved in FCP service provision through emails to members of known clinical networks, snowballing and social media. The survey gathered data about respondents, FCP services and the role and scope of physiotherapists providing FCP.Results: We received 102 responses; 32 from service managers and 70 working in FCP practice from England (n=60), Scotland (n=22), Wales (n=14), and Northern Ireland (n=2). Most practitioners were NHS band 7 or 8a (91%, n=63), with additional skills (e.g. requesting investigations, prescribing). 17% (12/70) worked 37.5 hours/week; 37% (26/70) ≤10hours; most (71%, 50/70) used 20-minute appointments (range 10-30 minutes); varying arrangements were reported for administration and follow-up. Services covered populations of 1,200 to 600,000 (75% <100,000); access mostly involved combinations of self-booking and reception triage. Commissioning and funding arrangements varied widely; NHS sources provided 90% of services. Conclusions:This survey provides new evidence regarding variation in FCP practice across the UK, indicating that evidence-informed, context specific guidance on optimal models of provision is required. AUTHOR VERSION 3 Contribution of the Paper• This paper provides published evidence regarding the variation in FCP provision and the professional capabilities of the FCP workforce in primary care across the UK. This adds to the current literature which focuses on England only.• FCP services are rapidly emerging and expanding throughout the UK in response to the evolving needs of primary care. These new data provide a baseline indicator of current practice (e.g. professional capabilities, service drivers, models of provision), which need consideration to enable effective implementation of policy focused on the delivery of services in primary care.

Objective: This study explored stroke survivors’ experiences of altered body perception, whether these perceptions cause discomfort, and the need for clinical interventions to improve comfort. Design: A qualitative phenomenological study. Setting: Participants’ homes. Participants: A purposive sample of 16 stroke survivors were recruited from community support groups. Participants (median: age 59; time post stroke >2 years), were at least six-months post-stroke, experiencing motor or sensory impairments and able to communicate verbally. Interventions: Semi-structured, face-to-face interviews were analysed using an interpretive phenomenological approach and presented thematically. Results: Four themes or experiences were identified: Participants described (1) a body that did not exist; (2) a body hindered by strange sensations and distorted perceptions; (3) an uncontrollable body; and (4) a body isolated from social and clinical support. Discomfort was apparent in a physical and psychological sense and body experiences were difficult to comprehend and communicate to healthcare staff. Participants wished for interventions to improve their comfort but were doubtful that such treatments existed. Conclusion: Indications are that altered body perceptions cause multifaceted physical and psychosocial discomfort for stroke survivors. Discussions with patients about their personal perceptions and experiences of the body may facilitate better understanding and management to improve comfort after stroke.

Realist evaluation is a methodology that addresses the questions: ‘what works, for whom, in which circumstances, and how?’. In this approach, programme theories are developed and tested against available evidence. However, when complex interventions are implemented in rapidly changing environments, there are many unpredictable forces that determine the programme’s scope and architecture, as well as resultant outcome. These forces can be theorised, in real time, and included in realist evaluation outputs for current and future optimisation of programmes. Reflecting on a realist evaluation of first-contact physiotherapy in primary care (the FRONTIER Study), five important considerations are described for improving the quality of realist evaluation outputs when studying rapidly changing health service delivery. These are: (1) ensuring that initial programme theories are developed through creative thinking sessions, empirical and non-empirical literature, and stakeholder consultation; (2) testing the causal impact of formal and informal (eg, emergent) components of service delivery models; (3) contrasting initial programme theories with rival theory statements; (4) envisioning broad system impacts beyond the immediate implementation setting; and (5) incorporating rapidly evolving service developments and context changes into the theory testing process in real-time (eg, Additional Role Reimbursement Scheme, COVID-19). Through the reflections presented, the aim is to clarify the benefit of realist evaluation to assess emerging models of care and rapidly changing health service delivery.

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