Physiotherapy-as-first-point-of-contact-service for patients with musculoskeletal complaints: understanding the challenges of implementation

Mofatt, Fiona; Goodwin, Rob; Hendrick, Paul

Abstract

Background: Primary care faces unprecedented challenges. A move towards a more comprehensive, multi-disciplinary service delivery model has been proposed as a means with which to secure more sustainable services for the future. One seemingly promising response has been the implementation of physiotherapy self-referral schemes, however there is a significant gap in the literature regarding implementation.
Aim: This evaluation aimed to explore how the professionals and practice staff involved in the delivery of an in-practice physiotherapy self-referral scheme understood the service, with a focus on perceptions of value, barriers and impact.
Design and setting: A qualitative evaluation was conducted across two UK city centre practices that had elected to participate in a pilot self-referral scheme offering ‘physiotherapy-as-a-first-point-of-contact’ for patients presenting with a musculoskeletal complaint.
Methods: Individual and focus group interviews were conducted amongst participating physiotherapists, administration/reception staff, general practitioners (GPs) and one practice nurse (in their capacity as practice partner). Interview data were collected from a total of 14 individuals. Data were analysed using thematic analysis.
Results: Three key themes were highlighted by this evaluation. First, the imperative of effecting a cultural change – including management of patient expectation with particular reference to the belief that GPs represented the ‘legitimate choice’, re-visioning contemporary primary care as a genuine team approach, and the physiotherapists’ reconceptualisation of their role and practices. Second, the impact of the service on working practice across all stakeholders – specifically re-distribution of work to ‘unburden’ the GP, and the critical role of administration staff. Finally, beliefs regarding the nature and benefits of physiotherapeutic musculoskeletal expertise – fears regarding physiotherapists’ ability to work autonomously or identify ‘red flags’ were unfounded.
Conclusion: This qualitative evaluation draws on the themes to propose five key lessons which may be significant in predicting the success of implementing physiotherapy self-referral schemes.

Citation

Mofatt, F., Goodwin, R., & Hendrick, P. (2018). Physiotherapy-as-first-point-of-contact-service for patients with musculoskeletal complaints: understanding the challenges of implementation. Primary Health Care Research and Development, 19(2), 121-130. doi:10.1017/S1463423617000615

• Journal Article Type: Article
• Acceptance Date: Aug 17, 2017
• Online Publication Date: Sep 12, 2017
• Publication Date: Mar 1, 2018
• Deposit Date: Dec 8, 2017
• Print ISSN: 1463-4236
• Publisher: Cambridge University Press (CUP)
• Peer Reviewed: Peer Reviewed
• Volume: 19
• Issue: 2
• Pages: 121-130
• DOI: https://doi.org/10.1017/S1463423617000615
• Public URL: https://nottingham-repository.worktribe.com/output/1124109
• Publisher URL: https://www.cambridge.org/core/journals/primary-health-care-research-and-development/article/physiotherapyasfirstpointofcontactservice-for-patients-with-musculoskeletal-complaints-understanding-the-challenges-of-implementation/B1F605DBA35FFD1201C132804747