The experiences of uncertainty amongst musculoskeletal physiotherapists in first contact practitioner roles within primary care

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Abstract
Aim: The aim of this research was to explore the experiences of uncertainty amongst Musculoskeletal First Contact Practitioners working in primary care.Background: The Musculoskeletal First Contact Practitioner role involves advanced physiotherapists providing an alternative to the GP by acting as first point of contact for people presenting to primary care with musculoskeletal conditions. Limited research into the role exists but the first‐contact aspect, clinical complexity and time pressures are deemed to contribute to uncertainty within the role.Method: A qualitative research design was undertaken using a hermeneutic interpretative phenomenological approach. Data was collected using semi‐structured interviews with subsequent thematic analysis of the data.Findings: Eight participants working as Musculoskeletal First Contact Practitioners across England were recruited using purposive sampling. Five themes were identified: (1) Role clarity within primary care, (2) Burden of responsibility, (3) Preparedness for the primary care environment, (4) ‘I'm not really sure how long I am going to stay in this role’, (5) Mitigating uncertainty.Conclusion: This study demonstrates the multifaceted phenomenon of uncertainty amongst Musculoskeletal First Contact Practitioners. Uncertainty appeared to be influenced by the primary care environment, preparedness for the role and perceived burden of responsibility. Diagnostic uncertainty was prevalent with concerns of missing serious pathology evident. The impact of uncertainty on wellbeing was linked to possible burnout and retention issues. Consultation approaches, access to support networks and a cultural shift in tolerating uncertainty were reported to mitigate uncertainty. Further research into possible differences in experiences related to employment models appears warranted.

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