The skills, knowledge and attributes needed as a first‐contact physiotherapist in musculoskeletal healthcare

Background Approximately 30% of general practitioner (GP) consultations are due to musculoskeletal disorders (MSKDs). Physiotherapists are trained to assess, diagnose and treat MSKDs and provide an alternative to GP consultation for primary care patients as first contact physiotherapists (FCPs). Aim To explore patient perceived acceptability of the FCP role using realist methods to understand what works for whom, how, why and in what circumstances. Methods A realist evaluation was undertaken, which involved three stages: forming the theory area framework; testing the theory framework and refining the programme theory. The theory framework was formed through realist synthesis. Realist interviews tested this framework. Data were collected from two GP practice case study sites and interviews were undertaken at each site. N = 20 participants were interviewed in total. In each practice, this constituted patients (n = 5), GPs (n = 1), FCPs (n = 2), receptionists (n = 1) and practice managers (n = 1). Interview data were analysed against preliminary hypotheses and, where appropriate, new theory areas were created. Results The evaluation highlighted that acceptability of the FCP role was influenced by ‘expectations’, ‘accessibility’ and ‘promoting the role’. Whilst some findings were shared by both practices, different contexts resulted in unique practice findings. Conclusion Patients were predominantly accepting of FCPs, nevertheless, there was a scope to increase acceptability through an implementation strategy that considered the contexts of the individual patient, as well as wider practice contexts.

Section: Discussionmentioning

confidence: 99%

Patient acceptability of the physiotherapy first contact practitioner role in primary care: A realist informed qualitative study

Morris

Moule

Pearson

et al. 2020

“…‘Red Flags’ are “clinical features that may be associated with the presence of serious, but relatively uncommon conditions, requiring urgent evaluation” (The Scottish Government, 2015, p. 16). Confidence, vigilance and clinical experience underpin safe practice and reduce the potential for serious pathology being overlooked (Langridge, ). An evaluation (Moffatt, Goodwin, & Hendrick, ) of first contact physiotherapy found that the management of clinical risk is reliant on having clinically experienced MSK physiotherapists with an extended scope of practice in post.…”

Section: Resultsmentioning

confidence: 99%

“…In particular, there was a perception that practice‐based education in a MSK FCP setting would give students an understanding of an advanced area of practice that they were unlikely to encounter elsewhere in their clinical education. Langridge () in a recent study, notes that the emergence of MSK physiotherapists in primary healthcare with the extended scope to independently prescribe and inject and to request medical imaging is moving physiotherapy into a new area of practice. Our participants perceived that by making students aware of this extended scope role through clinical education, it may aspire them to work towards becoming an MSK FCP in the future.…”

Section: Resultsmentioning

confidence: 99%

“…They are autonomous health professionals, whose role includes the assessment, diagnosis and management of MSK conditions (Chartered Society of Physiotherapy, Royal College of General Practitioners, & BMA, ). A recent study (Langridge, ), identified the skills, knowledge and attributes required for MSK FCP. These included: medical assessment and systems knowledge; an ability to think quickly in clinically uncertain contexts; a breadth of, and rounded field of knowledge, including of patient management and individualised care; interpersonal skills; clinical responsibility and experience, and; the capacity to deal with complexity in a time dependant environment.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Challenges and Learning Opportunities of Pre‐Registration Physiotherapy Placements in First Contact Settings: The Perspectives of Musculoskeletal First Contact Physiotherapists

Bassett

Jackson

2020

Objectives:As musculoskeletal first contact physiotherapy is rolled out into primary healthcare in Britain, this could offer up new practice-based educational opportunities for pre-registration physiotherapy students. Thus, the present study sought to explore the perceived challenges and learning opportunities of pre-registration physiotherapy placements in musculoskeletal first contact physiotherapy settings from first contact physiotherapists' perspectives.Methods: Using a qualitative strategy, 15 musculoskeletal first contact physiotherapists from different geographical locations in Britain, participated in telephone mediated semi-structured interviews. Participants were self-selected through a Chartered Society of Physiotherapy fortnightly bulletin and online forum for first contact physiotherapists, or recruited via snowball sampling. Interview transcripts were analysed according to framework analysis -and the findings were member-checked by proxy.Results: Three core themes emerged: operational challenges, challenges for preregistration physiotherapy students and learning opportunities for pre-registration physiotherapy students. Operational challenges included: ensuring sufficient support from first contact physiotherapy practice educators; financial cost implications of placements, and; lack of capacity within the existing first contact physiotherapy workforce to provide placements. Challenges for physiotherapy students involved: time pressures and stressors of a first contact physiotherapy placement; identifying red flags, and; complexity of patient presentations. Identified learning opportunities for physiotherapy students were: experience of a specialised physiotherapy role in a primary healthcare setting; bringing awareness of first contact physiotherapy as a potential career pathway, and; experience multidisciplinary team working in primary care. Conclusions:By seeking the perspectives of first contact physiotherapists, this study provides the first step for the development of placements in an emerging practice area.

“…These themes resonate with the CSP Framework. They are also not dissimilar to those identified by Langridge () who, when exploring competency for First Contact Practitioner roles, suggested: medical assessment and systems knowledge; speed of thought in an uncertain environment; breadth of knowledge; people and communication skills; common sense/simplify; and responsibility and experience were important factors.…”

Section: Discussionmentioning

confidence: 99%

Development, implementation and evaluation of a bespoke, advanced practice musculoskeletal training programme within a clinical assessment and treatment service

Stevenson

Bicker²,

Cliffe³

et al. 2020

Musculoskeletal disease is burdensome, costly and reported to be the 4th biggest reason for years lived with disability. Lower back and neck pain were the leading causes of disability in England from 1990 to 2016. Clinical Assessment and Treatment Services (CATs) have been established to provide expert assessment and management for this group of patients, with the aim of providing the majority of care within primary care, reducing referrals going through to secondary care. Such services require professionals with the appropriate skills and autonomy to fulfil this aim. This paper describes the development, implementation and evaluation of a bespoke Musculoskeletal Trainee programme within a large Clinical Assessment and Treatment Service. A 12‐month training schedule was designed to assist the transition of a Physiotherapist (Band 7) to Advanced Practitioner level (Band 8a). Trainees worked through a series of competencies, captured their experiences and collected evidence of achievement during the 12‐month period. Their experiences were explored using content analysis and common themes were identified. Three Physiotherapists were employed on the basis of undertaking this programme and successfully completed the programme. They highlighted the benefits of the programme being its bespoke nature and its flexibility to reflect their learning needs. Mentorship was a key component as they all identified that progressing to an autonomous role can be challenging. Learning new skills and working differently at a pace that suited them were seen as positives aspects. This programme describes the competencies and experiences of three individuals progressing to Advanced Practice Physiotherapists. This paper may assist those who manage and commission such services.