National guidance documents support the development of first contact practitioner (FCP) physiotherapist services for the management of musculoskeletal (MSK) conditions in primary care. During the development of an FCP pilot, it became clear that GPs had a range of hopes and concerns about this service development. This evaluation aimed to 1) explore these issues using anonymous free text questionnaire response, 2) then use these responses to structure the mid-way evaluation of the FCP pilot. The objective of this evaluation was to gain a more structured understanding of GPs perceptions of potential risks and benefits of the FCP pilot.
A FCP pilot was established in three GP practices. A baseline questionnaire was circulated to all GPs for anonymous completion. This captured GPs estimation of their MSK caseload and used free text boxes to allow respondents to articulate their expectations and concerns for the pilot. Analysis was inductive thematic analysis. At six-months a follow-up questionnaire was created incorporating these expectations/concerns, and the same population of GPs were recruited. These statements were rated on a 5-point Likert scale, anchored with strongly disagree to strongly agree.
Results: Baseline questionnaire. There were 31 GPs based at three GP practices. The baseline questionnaire received n=17 responses (54% response rate). GPs estimate mean 19% of their caseload were MSK consultations. GPs expectations could be considered in three themes: 1) GP work load, 2) Better patient experience, and 3) new models of working. GP concerns for the implementation of FCP services were: 1) Process for FCP appointments, 2) Clinical trust and communication, 3) reduced GP trainee exposure to MSK, and 4) no concerns. Six-month follow up questionnaire The follow-up questionnaire received n=14 responses (45% response rate). GPs estimated that 23% of their caseload were MSK consultations. GPs agreed that the pilot had reduced their MSK caseload (78% agree or strongly agree), that their caseload was more medically appropriate for a GP (71%), that FCP liaised with GPs appropriately (100%), that reception staff signposted to FCP appropriately (76%) and that GP confidence in FCP had increased (92%). The main concern was under-utilisation of the FCP pilot (57%). Coronavirus curtailed the FCP service, and further evaluation was suspended. These results cannot necessarily be generalised outside the context of this pilot.
Conclusion(s): Six months after the development of an FCP service, GPs reported the pilot had met their requirements, and few of their concerns had arisen. They were particularly positive about clinical liaison with FCP colleagues. Further evaluation is required to understand the impact of widening primary care teams to include physiotherapy FCP services.
Cost and savings
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In line with other qualitative evaluations of FCP service, communication between GPs, FCPs and reception staff is vital.
Top three learning points
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No funding was received for this service evaluation.