| dc.description.abstract | Background The NHS Long Term Plan (NHS England, 2019) and the formation of Primary Care Networks (PCNs) in England, and the untenable workload and shortage of General Practitioners (GPs) in the UK are all driving changes in primary care, with increasing focus on seamless models of care, multi-professional working and empowerment of patients in prevention and self-management. As part of multi-professional advancing practice, new Physiotherapy First Contact Practitioner (FCP) roles are developing. Additionally, legislative change in the UK in 2013, now enables physiotherapists (holding a master’s level non-medical prescribing qualification) to independently prescribe certain drugs that assist in patient management. This opportunity for physiotherapists to be independent prescribers (IPs) is a contemporary development in role change and purpose, supported by comparatively new legislation, with a relative dearth of directly related research. PCNs and FCP roles are also in their infancy, hence the chosen context for this research. This research applied a critical realist approach informed by both practice-applied theory and underpinning theoretical concepts including the sociology of professions and professional identity. Aim The overall aim of the research was to explore the experiences of musculoskeletal (MSk) physiotherapy independent prescribing in primary care from the multiple perspectives of those involved, and from that, identify the implications for physiotherapy professional identity and practice. Method A critical realist approach was used with qualitative data collected via 15 semi-structured interviews (face to face or audio phone call) with physiotherapists and GPs specifically interested in, or working in, MSk primary care. Participant recruitment was through purposive sampling via professional interest groups, NHS and social enterprise employers. Participants held a range of roles (some overlapping): 13 physiotherapists (including eight IPs), two GPs, three MSk service managers, three physiotherapy consultants and two commissioners, working across 15 different sites and 12 different organisations. Nine physiotherapy participants were working in FCP roles (seven of whom were IPs) on part-time service level agreements from their main employer (e.g. secondary care or community trust). Interviews were recorded and transcribed. Thematic analysis was applied, primarily via theory driven code book deductive coding supported by inductive coding to identify new aspects from the data and give balance. Key findings Vertical boundary pushing into the prescribing remit of the medical profession was viewed as an opportunity to advance practice and provide comprehensive patient care, although some questioned the direction of travel of the physiotherapy profession. Physiotherapists were keen to create a niche as specialist MSk physiotherapists with additional prescribing attributes, rather than being viewed as “cheap” or “pseudo” GPs. GPs were supportive of physiotherapists prescribing. Whilst individuals were empowered by their independent prescribing qualification, they were frustrated by the current UK controlled drugs legislation, prescribing IT access and uncertainty about PCNs supporting sustainability of physiotherapy independent prescribing. Physiotherapists identified vulnerability, isolation and dealing with risk as potential issues, but noted patient mileage and clinical experience as vital to mitigate these. Unexpected ‘side effects’ of prescribing included more focused conversations and enhanced practice directly attributed to prescribing knowledge, and deprescribing. Implications Prescribing was viewed as pushing physiotherapy professional boundaries and challenging identity perhaps more than previous new scopes of practice. Application of Ibarra’s (1999) Adaption in Role Change model indicated a lack of role models in the journey between provisional selves to possible selves as prescribing FCPs. Participants identified the need to establish prescribing impact and worth within physiotherapy FCP roles, particularly around the difficult to measure aspects such as more holistic conversations. To support individuals, management of vulnerability and risk, development of self-efficacy in physiotherapy prescribing and a clear career pathway needs addressing. | en_GB |
