Patient acceptability of the physiotherapy First Contact Practitioner (FCP) role in Primary Care: A realist evaluation

Background: Approximately 30% of GP consultations are due to musculoskeletal disorders (MSKDs) which is significantly affecting workload. Physiotherapists are trained to assess, diagnose and treat MSKDs and could provide an alternative to GP consultation for Primary Care patients as First Contact Physiotherapists (FCPs). Aim: Explore patient perceived acceptability of the FCP role using realist methods to understand what works for whom, how, why and in what circumstances.Methods: Phase one consisted of a realist review which identified initial programme theories regarding the factors that influence acceptability of any Advanced Practitioner in a first point of contact role. Databases were searched to identify relevant literature and bespoke, theory-specific data extraction sheets were created and utilised, Data were analysed through identification of contexts, mechanisms and outcomes (CMOs) to formulate hypotheses related to role acceptability. Generated hypotheses were validated through consultation with key stakeholders including a Patient Partner. Phase two of the project was a realist evaluation, a theory-driven method that tested the hypotheses generated in phase one using realist interviews. Two diverse GP practice case study sites were identified and interviews undertaken with: five patients per site; Reception staff; GPs; FCPs; and Practice Managers. Interview data were analysed against the test theories through identification of CMOs, and new theory was formed.Results: Thirty-eight qualitative, quantitative and mixed-methods studies relevant to theory were included for review. Theory areas identified in phase one included: ‘Previous Experience of Condition Management’; ‘Expectations of Condition Management’; ‘Professional hierarchy’; ‘Communication’; ‘Accessibility’; ‘Continuity of the Individual Practitioner’. Interview data in phase two supported all theory areas, except ‘Continuity of the Individual Practitioner’. CMOs that were relevant to both sites included the need for patients to have more awareness and understanding of the FCP. However, different FCP models and differing contexts resulted in CMOs unique to individual Practice sites; for instance, the context of an older population in Practice A affected patient expectations of GP involvement.Conclusion: Patients were predominantly accepting of the FCP role. Nevertheless, there was scope to increase acceptability to enhance service effectiveness. The findings highlighted the individuality of Practices, as they differed in their contexts and their implementation strategy. It is important to consider these contexts when implementing the FCP role in order to achieve the intended outcomes