Facilitators and barriers regarding the implementation and interprofessional collaboration of a first contact physiotherapy service in primary care in Wales: a qualitative study

Abstract

Future primary care services in Wales are likely to face higher demand for musculoskeletal ailments because of an ageing population and difficulties retaining and recruiting general practitioners. First contact physiotherapists provide specialist musculoskeletal management within primary care and offer a solution to this issue; however, no studies have yet explored first contact physiotherapist services in Wales. Consequently, little is known about the experience of working as a first contact physiotherapist in Wales. The aim of this study was to explore the experiences of first contact physiotherapists in primary care in south east Wales regarding the implementation, interprofessional collaboration and the facilitators and barriers to providing the service. A qualitative, Heideggerian hermeneutical phenomenological study was performed. A purposive sample of eleven physiotherapists were recruited for the study from an NHS health board in south east Wales, comprising three different first contact physiotherapist models. Data were collected through individual semi-structured interviews. Data analysis was conducted via a three-step format. Participants viewed the first contact physiotherapist role as positive as it represented role and career advancement. Adequate training and mentorship were not provided to support the role. Participants perceived that patients and the wider multidisciplinary team did not fully understand the role of the first contact physiotherapist. Inappropriate use of services was common, with first contact physiotherapists often acting as the second contact practitioner, leading to duplication of effort and the development of unnecessary waiting lists. The degree of interprofessional collaboration appeared to influence the clarity of the role of the first contact physiotherapist, with a reduced clarity of role in models where first contact physiotherapists were not often present. Burnout was perceived as a risk for participants with low levels of experience in advanced practice and was dependent on the model worked in. Participants perceived a lack of specific aims for the first contact physiotherapy service and ambiguity over who was responsible for service leadership, leading to inappropriate use of services. Clear operational leadership and strategies to increase interprofessional collaboration are required to increase the clarity about the roled of the first contact physiotherapist and ensure service efficacy. There is a need in Wales for a professional development, mentorship and governance framework to ensure sustainability and efficacy of first contact physiotherapy services.