Patient acceptability of the physiotherapy first contact practitioner role in primary care: A realist informed qualitative study

Abstract

Background Approximately 30% of general practitioner (GP) consultations are due to musculoskeletal disorders (MSKDs). Physiotherapists are trained to assess, diagnose and treat MSKDs and provide an alternative to GP consultation for primary care patients as first contact physiotherapists (FCPs). Aim To explore patient perceived acceptability of the FCP role using realist methods to understand what works for whom, how, why and in what circumstances. Methods A realist evaluation was undertaken, which involved three stages: forming the theory area framework; testing the theory framework and refining the programme theory. The theory framework was formed through realist synthesis. Realist interviews tested this framework. Data were collected from two GP practice case study sites and interviews were undertaken at each site. N = 20 participants were interviewed in total. In each practice, this constituted patients (n = 5), GPs (n = 1), FCPs (n = 2), receptionists (n = 1) and practice managers (n = 1). Interview data were analysed against preliminary hypotheses and, where appropriate, new theory areas were created. Results The evaluation highlighted that acceptability of the FCP role was influenced by ‘expectations’, ‘accessibility’ and ‘promoting the role’. Whilst some findings were shared by both practices, different contexts resulted in unique practice findings. Conclusion Patients were predominantly accepting of FCPs, nevertheless, there was a scope to increase acceptability through an implementation strategy that considered the contexts of the individual patient, as well as wider practice contexts.

Patient view of the advanced practitioner (AP) role in primary care: A realist‐informed synthesis

“…This review highlighted the importance of the receptionist's role in increasing patient understanding of the AP, a similar finding to Goodwin et al (2020). A context not identified by this review is the receptionist workload in individual practices which may influence patient awareness of APs (Morris et al, 2021).…”

“…The majority of TAs were in agreement, however, the TA 'communication' suggested that it was the illusion of time created (through communication) that is the mechanism underpinning patient acceptance of the role, as opposed to a longer consultation (TA 'Accessibility'). This is further explored in Morris et al (2021).…”

Evaluation of the First Contact Physiotherapy (FCP) model of primary care: a qualitative insight

“…Consequently, patient access to FCP services was on the whole reliant on signposting from reception/ administration staff. This has been previously described and could present a challenge to receptionists in terms of explaining new J o u r n a l P r e -p r o o f consultation methods to patients [9,20,21] and this potential unintended consequence of FCP, needs considering within the wider agenda.…”

Patient satisfaction with the first contact physiotherapy service: Results from the national evaluation survey

“…It is reassuring in terms of FCP efficacy that most respondents did not seek support from another HCP following their FCP appointment/ s. On the one hand this lends weight to the advanced clinical skill set of the FCPs (Health Education England, n.d.). However, those skills most frequently attributed 'advanced practice' (injections, nonmedical prescribing and referral for diagnostic investigation) have been described as being utilised infrequently (Goodwin et al, 2021;Langridge, 2019;Morris et al, 2020). It is interesting to note that of those respondents who did seek additional HCP input, the majority attributed this to persistent pain.…”