The experiences of uncertainty amongst musculoskeletal physiotherapists in first contact practitioner roles within primary care

Abstract

AimThe aim of this research was to explore the experiences of uncertainty amongst Musculoskeletal First Contact Practitioners working in primary care.BackgroundThe Musculoskeletal First Contact Practitioner role involves advanced physiotherapists providing an alternative to the GP by acting as first point of contact for people presenting to primary care with musculoskeletal conditions. Limited research into the role exists but the first‐contact aspect, clinical complexity and time pressures are deemed to contribute to uncertainty within the role.MethodA qualitative research design was undertaken using a hermeneutic interpretative phenomenological approach. Data was collected using semi‐structured interviews with subsequent thematic analysis of the data.FindingsEight participants working as Musculoskeletal First Contact Practitioners across England were recruited using purposive sampling. Five themes were identified: (1) Role clarity within primary care, (2) Burden of responsibility, (3) Preparedness for the primary care environment, (4) ‘I'm not really sure how long I am going to stay in this role’, (5) Mitigating uncertainty.ConclusionThis study demonstrates the multifaceted phenomenon of uncertainty amongst Musculoskeletal First Contact Practitioners. Uncertainty appeared to be influenced by the primary care environment, preparedness for the role and perceived burden of responsibility. Diagnostic uncertainty was prevalent with concerns of missing serious pathology evident. The impact of uncertainty on wellbeing was linked to possible burnout and retention issues. Consultation approaches, access to support networks and a cultural shift in tolerating uncertainty were reported to mitigate uncertainty. Further research into possible differences in experiences related to employment models appears warranted.

Using Twitter (X) to Mobilize Knowledge for First Contact Physiotherapists: Qualitative Study

“…Visual posts were reported by participants as being most engaging, aligning with a 2019 systematic review which found that healthcare professionals believe infographics reduce the time burden of reading full texts [31]. Social connection with peers, researchers, and opinion leaders through following, retweeting and liking posts was seen as important in the FCP context, as most work in isolation away from FCP peers and many split their time working across multiple practices [13,14,15]. Participants described feeling reassured when reading tweets relating to clinical questions, evidence and constantly changing policy and guidance for the FCP role; findings useful in light of recent interviews with FCPs exploring common feelings of uncertainty regarding the FCP context and role [13,14].…”

“…Social connection with peers, researchers, and opinion leaders through following, retweeting and liking posts was seen as important in the FCP context, as most work in isolation away from FCP peers and many split their time working across multiple practices [13,14,15]. Participants described feeling reassured when reading tweets relating to clinical questions, evidence and constantly changing policy and guidance for the FCP role; findings useful in light of recent interviews with FCPs exploring common feelings of uncertainty regarding the FCP context and role [13,14]. Many expressed a fear of missing out on something on Twitter, perhaps echoing this uncertainty.…”

“…In contrast to traditional physiotherapy departments, most FCPs typically work as the sole FCP in a general practice away from peers [13][14] and many split their time working across multiple practices, services or additional roles. Within the primary care context of the rapid evolution and implementation of FCP, variation in practice and training [15] and feelings of uncertainty about the FCP role [14], little is known about where FCPs obtain knowledge for clinical practice outside of their teams. The aim of this study was therefore to explore how Twitter is, and can be, used to mobilise knowledge to inform FCP clinical practice.…”

Access to first contact physiotherapy appointments in primary care: A scoping review

“…The term ‘triage’ was used by nine sources, five of which used the term on its own (Bater & Sellars, 2022; iCSP 1‐3, 2021; McDermott et al., 2022), two of which used the term ‘reception triage’ (Doran, 2021a; Halls et al., 2020), and two of which used the term ‘GP triage’ (R. Goodwin et al., 2021; Greenhalgh et al., 2020). ‘Patient self‐referral’ or ‘self‐booking’ was used by four sources (Akehurst et al., 2019; Doran, 2021b; Halls et al., 2020; Jagosh et al., 2022), and ‘GP referral’ or GP involvement in the patient accessing an FCP appointment was referred to in seven sources (Doran, 2021a; R. Goodwin et al., 2021; Greenhalgh et al., 2020; Halls et al., 2020; iCSP 1‐3, 2021; Pike, 2020). Involvement of Reception was stated as an access method in five of the sources (Hensman‐Crook, 2019; iCSP 1, 2021; Jagosh et al., 2022; Pike, 2020; Wise, 2019), for example, direct from reception and booked via reception.…”

“…Personnel involved in patients accessing FCP appointments were described as ‘reception/receptionists’ or ‘admin/administration/administrators’ in 17 of the sources (Bater & Sellars, 2022; CSP, n.d.; Davies et al., 2021; Doran, 2021a, 2021b; Goodwin, n.d.; R. Goodwin et al., 2020; Halls et al., 2020; HEE, 2020; Hensman‐Crook, 2019; Jagosh et al., 2022; McDermott et al., 2022; Morris et al., 2021; Pain, 2022; Pike, 2020; Wise, 2019; Ingram et al., 2023), GPs in 10 of the studies and other materials (Doran, 2021b; R. Goodwin et al., 2021; Greenhalgh et al., 2020; Halls et al., 2020; iCSP 1‐3, 2021; McDermott et al., 2022; Pike, 2020), ‘ANPs’ in three (R. Goodwin et al., 2020; Halls et al., 2020; iCSP 1, 2021), ‘primary care team’ in one (CSP, n.d.), and ‘healthcare staff’ in one (R. Goodwin et al., 2020). Three of the studies did not provide any information regarding personnel involved (Akehurst et al., 2019; Bater & Sellars, 2022; Wood et al., 2022).…”