UNDERSTANDING EXPERIENCES OF FIRST CONTACT PHYSIOTHERAPY IN UK PRIMARY CARE: A REALIST QUALITATIVE STUDY

N. Walsh¹, H. Stott¹, S. Halls¹, R. Thomas¹, A. Berry¹, M. Cupples², C. Liddiard¹, F. Cramp¹, P. Kersten³, D. Foster⁴, J. Jagosh⁵

¹University of the West of England, Centre for Health and Clinical Research, Bristol, United Kingdom, ²Queen's University Belfast, Centre for Public Health, Belfast, United Kingdom, ³Canterbury Christchurch University, Faculty of Medicine, Health and Social Care, Canterbury, United Kingdom, ⁴Patient Research Partner, Bristol, United Kingdom, ⁵Centre for Advancement in Realist Evaluation and Synthesis (CARES), Vancouver, Canada

Background: First Contact Physiotherapy (FCP) is a service delivery model in the UK, whereby a specialist physiotherapist located within general practice undertakes assessment, diagnosis and management of patients presenting with musculoskeletal disorders (MSKDs), without the requirement for a prior GP consultation. Despite widespread implementation little is known about the impact of the FCP model on general practice and how variation within delivery may lead to different experiences and outcomes of the service amongst patients, FCPs and general practice staff and its impact on the healthcare system as a whole. To maximise the potential benefits of FCP provision, developing a better understanding of what works, for whom and how is required.

Purpose: To explore staff and patient experiences of FCP in primary care in the UK, and to create recommendations to support implementation in different contexts.

Methods: A realist qualitative study was embedded within a larger realist evaluation of the clinical and cost effectiveness of FCP. Realist methodology is a theory driven approach that seeks to identify the causal mechanisms that explain why certain outcomes are observed in different contexts. Qualitative interviews were undertaken with FCP staff, other practice healthcare professionals, administration staff and practice managers in 24 general practice case study sites across the UK. Data were analysed thematically and coded according context-mechanism-outcome configurations in accordance with realist methodology.

Results: Semi-structured, realist interviews were conducted with 80 participants across 24 sites. There were 8 programme theory areas identified in the interviews that impacted on the outcome of the FCP service. These were: Staff and patient awareness of the FCP; Communication amongst staff and team integration; FCP approach to patient assessment and management; FCP skillset (including the ability to prescribe and/or inject); Practice workload; Continued professional development and progression to advanced practice; Consultation format (remote or in-person); and the model of employment. The mechanisms adopted within practices to address these issues significantly impacted the perceived success or otherwise of the FCP service.

Conclusions: FCP services are implemented in different ways across the UK system and this is likely to impact on outcomes for patients, general practice sites and the healthcare system as a whole. Gaining better understanding of the contextual elements that impact services, and the different mechanisms that can be employed to assist successful implementation are likely to enhance service provision in the future. Further work is needed to gain a better understanding of the actual clinical and cost-benefits of FCP in primary care.

Implications: The results from this study will inform implementation guidelines, and assist service planners when commissioning FCP in primary care.

Funding acknowledgements: This study is funded by the NIHR HS&DR (NIHR 16/116/03).

Keywords:
First Contact Physiotherapy
Primary care
Implementation

Topics:
Primary health care
Musculoskeletal
Professional issues

Did this work require ethics approval? Yes

Institution: Health Research Authority and UWE Bristol

Committee: Northern Ireland and Faculty REC

Ethics number: 19/NI/0108 and HAS.18.07.204