R. Goodwin1, F. Moffatt2, P. Hendrick2, T. Avery3, M. Golding Day1, S. Stynes4, A. Bishop4, P. Logan1
1University of Nottingham, Division of Rehabilitation, Ageing and Wellbeing, Nottingham, United Kingdom, 2University of Nottingham, Division of Health Sciences, Nottingham, United Kingdom, 3University of Nottingham, School of Medicine, Nottingham, United Kingdom, 4Keele University, Keele, United Kingdom
Background: First Contact Physiotherapy (FCP) is a rapidly evolving model where expert musculoskeletal (MSK) physiotherapists undertake the first patient consultation; enhancing and expediting care and freeing-up General Practitioner (GP) capacity.
Purpose: A national evaluation of the UK FCP model was undertaken (2018/2020). We report the qualitative component which evaluated the FCP model against six predefined success criteria.
Methods: Participants included patients, GPs, physiotherapists, and practice administration staff, recruited nationally from six FCP sites. Data were collected via focus groups and interviews. Thirty-nine participants were recruited that included 19 patients. Data were transcribed verbatim and analysed using both deductive and inductive thematic analysis.
Results: Analysis showed all success criteria were met: GPs had confidence in the FCP service and FCP competence. Patients demonstrated self-efficacy and confidence in self-management techniques and a positive experience of FCP. Physiotherapists showed confidence in their competence to offer work-related advice and patients benefited from this advice. Staff reflected a positive experience of working within FCP services.
Five further themes were developed that highlighted facilitators and barriers to FCP implementation.
Communication
Three communication strategies were identified
(i) advertising
(ii) signposting,
(iii) systems and processes.
Traditional advertising was ineffective and signposting described as essential to facilitate access to FCP. Alignment of both IT and non-IT systems of communication facilitated FCP services.
Patient understanding of FCP
Some patients had a lack of understanding of physiotherapy and FCP. Patient understanding was often misaligned with modern-day physiotherapy practice. Where FCPs had advanced practice skills, patients expected them to have had adequate training.
Embeddedness
It took time for the FCP service to become embedded in the general practice but once embedded, the obstacles facing the FCP service diminished. Consistency of the FCP service facilitated this as did having the FCP co-located in the practice.
Contribution of FCP
FCPs’ contribution to the general practice was seen in four sub-themes. Collecting data to demonstrate the effectiveness of FCP was important. Current FCP provision was insufficient to unburden the GPs but did positively influence their work experience. All participant groups were satisfied with FCP services. FCP was described as introducing MSK expertise to general practice.
Reconceptualising physiotherapy work.
The physiotherapists welcomed the GP model of working. There was debate about the scope and model of practice. Co-located models appeared most impactful. Advanced practice skills were seen as desirable rather than essential. Providing employment advice was seen as integral to the FCP role. It was felt that FCP provided the profession with the opportunity to develop alongside other professions by moving into the new model of a multidisciplinary general practice team.
Five further themes were developed that highlighted facilitators and barriers to FCP implementation.
Communication
Three communication strategies were identified
(i) advertising
(ii) signposting,
(iii) systems and processes.
Traditional advertising was ineffective and signposting described as essential to facilitate access to FCP. Alignment of both IT and non-IT systems of communication facilitated FCP services.
Patient understanding of FCP
Some patients had a lack of understanding of physiotherapy and FCP. Patient understanding was often misaligned with modern-day physiotherapy practice. Where FCPs had advanced practice skills, patients expected them to have had adequate training.
Embeddedness
It took time for the FCP service to become embedded in the general practice but once embedded, the obstacles facing the FCP service diminished. Consistency of the FCP service facilitated this as did having the FCP co-located in the practice.
Contribution of FCP
FCPs’ contribution to the general practice was seen in four sub-themes. Collecting data to demonstrate the effectiveness of FCP was important. Current FCP provision was insufficient to unburden the GPs but did positively influence their work experience. All participant groups were satisfied with FCP services. FCP was described as introducing MSK expertise to general practice.
Reconceptualising physiotherapy work.
The physiotherapists welcomed the GP model of working. There was debate about the scope and model of practice. Co-located models appeared most impactful. Advanced practice skills were seen as desirable rather than essential. Providing employment advice was seen as integral to the FCP role. It was felt that FCP provided the profession with the opportunity to develop alongside other professions by moving into the new model of a multidisciplinary general practice team.
Conclusion(s): As a first national evaluation of FCP this research is important. It showed that all success criteria of the FCP model were met. Five themes provided novel evidence of important issues pertaining to FCP implementation.
Implications: There are a number of key areas that need addressing if the proposed FCP model is to achieve its aim of improving clinical care and creating GP capacity for other patients.
Funding, acknowledgements: Chartered Society of Physiotherapy, National Health Service England and Improvement
Keywords: Musculoskeletal physiotherapy, first contact practitioner, primary care
Topic: Musculoskeletal
Did this work require ethics approval? No
Institution: Keele University, UK
Committee: Keele University, UK
Reason: Service evaluation so no ethical approval was required. Data collection met GDPR and NHS Information Governance requirements..
All authors, affiliations and abstracts have been published as submitted.
