Patients arriving at their GP with a painful knee or back are increasingly being sent to a First Contact Physiotherapy Practitioner (FCPP) instead of a doctor, but many of these 20-minute appointments leave patients dissatisfied and clinicians burnt out. This matters because musculoskeletal conditions account for roughly one in five GP appointments, yet the GP workforce is shrinking. FCPPs are meant to fill that gap, but there is no evidence on what consultation model—a structured framework for patient-clinician interaction—actually works in the short, fast-paced primary care setting. Without one, consultations risk being ineffective and inconsistent. If this research succeeds, it will produce a tested consultation model and support tools co-designed with patients and clinicians. That could reduce FCPP burnout, improve patient outcomes, and make primary care more efficient without requiring more GP time. The model would be disseminated through professional networks, podcasts, and conferences, so it could reshape how thousands of NHS physiotherapy consultations are conducted each week.
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Background Musculoskeletal (MSK) conditions are an increasing concern with individual, economic and health care impacts. MSK conditions account for around 20% of General Practitioner (GP) appointments, but the GP workforce is diminishing. First Contact Physiotherapy Practitioners (FCPPs) have a central role in the management of MSK conditions within primary care, reducing the burden on GPs. FCPPs provide expert MSK care for patients in General Practice, ensuring timely access to diagnosis, early management and onward referral if needed. FCPP consultations need to be conducted differently to conventional Physiotherapy consultations because the average appointment time is shorter (20 minutes). My research shows that some patients are receiving ineffective and disappointing consultations from FCPPs. Furthermore, many FCPPs are struggling to manage these consultations and are experiencing high levels of burnout and exhaustion. There is currently no evidence regarding whether FCPPs are using any consultation models (CMs) (a structure that helps guide interactions between patient and clinician), or what model might be most effective to support FCPPs to provide effective, high-quality consultations. Aim To maximise the effectiveness of First Contact Physiotherapy Practitioner consultations in General Practice. Objectives To explore and understand existing CMs and components of effective consultations that are relevant to MSK care in general practice. To develop a logic model, a prototype FCPP CM, and tools necessary to support FCPPs to use the CM. To assess acceptability of the FCPP CM and refine the model. Methods A sequential explanatory mixed methods approach with three phases encompassing five work packages will be undertaken: Phase 1: Evidence synthesis/consultation component recommendations WP1 - Identify CMs, analyse consultation components, identify evidence of effectiveness. Method: Scoping review and intervention component analysis. WP2 - Collaborate with stakeholders to identify priorities for change and key consultation components. Method: Modified Delphi consensus process (initial round informed by WP1). Phase 2: Consultation model and support tool/s development WP3 - Develop a logic model that will underpin effective consultations. Method: Discussions with Project Advisory Group to integrate evidence from WP1/2 to produce logic model and define behaviour change requirements for implementation of consultation process and components. WP4 - Co-design a CM and support tools. Method: Series of workshops with stakeholders using experience-based co-design informed by WP1/2/3. Phase 3: Consultation model acceptability evaluation WP5 - Evaluate acceptability of CM and support tools. Method: Mixed method evaluation using qualitative think-aloud interviews conducted with stakeholders and the Theoretical Framework of Acceptability tool. Anticipated Impact The CM and support tool/s will aid FCPPs in providing effective, high-quality care for patients with MSK conditions. Dissemination The findings will be disseminated to FCPP communities of practice who offer peer-support and education to FCPPs, and Physiotherapy focused podcasts will be used to publicise the work. Social media sites will be used to widely disseminate the CM/tools, including Physiotherapy specific sites such as iCSP (online forum of the Chartered Society of Physiotherapy website), which has an active FCPP-specific network. The work will be presented at conferences as poster and oral presentations, and publications in both academic and professional journals.
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