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J. Mullan1, J. Smithson2, N. Walsh1, I. Frampton2
1University of the West of England, School of Health and Social Wellbeing, Bristol, United Kingdom, 2University of Exeter, Exeter, United Kingdom
Background: Legislative change in the UK in 2013, enabled physiotherapists holding a post graduate non-medical prescribing qualification to independently prescribe certain drugs that assist in patient management. Independent prescribing by physiotherapists is a relatively contemporary development in role change and purpose, occurring alongside the development of physiotherapy First Contact Practitioner (FCP) roles in primary care.
Purpose: The purpose of this research was to explore the experiences of musculoskeletal (MSk) physiotherapy independent prescribing within UK primary care, and identify the implications for physiotherapy professional identity. It is well established that identity changes accompany career transitions (Ibarra, 1999), thus the findings were considered in the context of Ibarra’s model of Adaption in Role Change (Ibarra, 1999); namely the three tasks identified as influential in developing professional identity in new roles (Ibarra, 1999).
Methods: A critical realist approach was used, with qualitative data collected via 15 semi-structured interviews with Physiotherapists (N=13) and General Practitioners (GPs) (N=2) in primary care. Thematic analysis was applied.
Results: The 13 physiotherapy participants were all involved in MSk primary care services, with eight being physiotherapy independent prescribers.
The results are presented within the tasks framework of Ibarra’s (1999) Adaption in Role Change.
Identification of a role model.
This was difficult for the prescribing pioneers, as with independent prescribing being relatively new to the profession there were both limited others in role, and limited individuals who were experienced physiotherapy prescribers. GPs and prescribing nurse practitioners were not fully applicable as role models: they were working differently as prescribers in generalist roles, rather than more specific to the Musculoskeletal FCP role.
Development of provisional selves as a way to achieving possible selves.
Results demonstrated frustration regarding external constraints to achieving possible selves, and reduced trust, freedom, and autonomy in experimenting with provisional selves using a full range of prescribing decisions. Some evidence of mixed views (within the physiotherapy profession of direction of travel) with prescribing, compounded this by creating professional identity uncertainty.
Evaluating experiments against internal standards and external feedback.
Within the reality of low prescribing rates and multiple patient outcome variables, the difficulties in demonstrating specific impact as a physiotherapy prescriber were highlighted. Challenges in evidencing the potentially practice-enhancing hidden effects of becoming a physiotherapy prescriber, such as more holistic conversations, were highlighted.
The results are presented within the tasks framework of Ibarra’s (1999) Adaption in Role Change.
Identification of a role model.
This was difficult for the prescribing pioneers, as with independent prescribing being relatively new to the profession there were both limited others in role, and limited individuals who were experienced physiotherapy prescribers. GPs and prescribing nurse practitioners were not fully applicable as role models: they were working differently as prescribers in generalist roles, rather than more specific to the Musculoskeletal FCP role.
Development of provisional selves as a way to achieving possible selves.
Results demonstrated frustration regarding external constraints to achieving possible selves, and reduced trust, freedom, and autonomy in experimenting with provisional selves using a full range of prescribing decisions. Some evidence of mixed views (within the physiotherapy profession of direction of travel) with prescribing, compounded this by creating professional identity uncertainty.
Evaluating experiments against internal standards and external feedback.
Within the reality of low prescribing rates and multiple patient outcome variables, the difficulties in demonstrating specific impact as a physiotherapy prescriber were highlighted. Challenges in evidencing the potentially practice-enhancing hidden effects of becoming a physiotherapy prescriber, such as more holistic conversations, were highlighted.
Conclusions: Other than the small group of GPs with special interest in MSk (GPSIs), there was a lack of role models focussing on MSk primary care as a speciality, rather than working as generalists. Controlled drug legislation, permitted physiotherapy formulary, IT access, prescribing risk and structural changes to Primary Care Networks and MSk care pathways brought uncertainty or constraints, thus challenging the opportunities for participants to experiment with provisional selves to develop possible selves.
Implications: Concern was raised that in future long-term sustainability, the gaps and steps involved between provisional selves and possible selves of MSk prescribing advanced practice may be increased. To mitigate this, the importance of gaining clinical experience within a cross organisational MSk pathway for staff development, to bridge the gap, was strongly promoted.
Funding acknowledgements: Self funding
Keywords:
Professional Identity
Physiotherapy Prescribing
Role Adaption
Professional Identity
Physiotherapy Prescribing
Role Adaption
Topics:
Service delivery/emerging roles
Primary health care
Professional practice: other
Service delivery/emerging roles
Primary health care
Professional practice: other
Did this work require ethics approval? Yes
Institution: NHS
Committee: Health Research Authority approval via the NHS Integrated Research Application System
Ethics number: IRAS project ID 238300, Protocol number 1718/29.
All authors, affiliations and abstracts have been published as submitted.
