To explore the experiences of physiotherapy independent prescribing working with musculoskeletal conditions in UK Primary Care, including how physiotherapists established themselves as autonomous prescribers.
A semi structured interview template (designed with input from a public and patient involvement group) was used to collect qualitative data. General practitioners (GPs) and physiotherapists with experience and/or interest in independent prescribing and/or musculoskeletal services in primary care were recruited via purposive sampling. The UK Heath Research Authority granted ethical approval. Thematic Analysis was applied to the data.
13 physiotherapists and two GPs were interviewed. Nine of the physiotherapists were working in primary care First Contact Physiotherapy roles, seven of whom were physiotherapy independent prescribers.
The need to gain credibility, trust and acceptance as an independent prescriber emerged as a key theme.
Respect and professional positioning amongst other professionals. particularly GPs and nurses. were important. The delay between nurses (2006) and physiotherapists (2013) achieving independent prescribing rights in the UK had an impact on physiotherapists feeling like “second class citizens”. During this time, physiotherapists reported losing out to nurses in terms of role opportunities particularly in primary and community care settings.
Trust and acceptance as part of the multi-disciplinary team of independent prescribers (GPs, physiotherapists, nurses, pharmacists, paramedics) in primary care was developing, but physiotherapists needed to demonstrate quality of service and value for money by evaluating their prescribing outcomes within the context of their physiotherapy practice. Due to enhanced knowledge and skills, prescribing physiotherapists were able to influence the holistic patient journey more, and have higher level conversations with colleagues, particularly pharmacists and GPs.
Patient expectations and views were generally positive and accepting, although the physiotherapist being able to prescribe was not the priority for the patient in their physiotherapy intervention, but rather seen as a bonus.
Convenience and access were viewed as important by the patient; the ability and safety of the physiotherapists as prescribers was not questioned by patients.
Gaining legislative independent prescribing rights that aligned with other health professionals was pivotal to professional credibility and thus autonomy.
Making prescribing matter and being able to evidence that within their practice was crucial for achieving long term interpersonal, professional and organisational trust and role autonomy.
For many physiotherapists in senior and/or advanced practice roles, becoming an independent prescriber is seen as the “last tier” of professional standing and autonomy. How the physiotherapy profession builds on this concept in future whilst keeping up with developments and advances in other professions, needs innovative consideration.
Individual physiotherapy responsibility to earn credibility and trust by excellent and safe prescribing practices, without compromise to their physiotherapy principles, was evident.
Independent Prescribing
Primary Care
