Simon Ingram

Background: Musculoskeletal (MSK) conditions represent an increasing challenge within the NHS. Rising demand has driven a national shift towards more community‐based care and supported self‐management. Community Appointment Days (CAD) are community‐based, full‐day events providing access to clinical expertise, community partners and voluntary sector services. The collaborative ethos facilitates a personalised and holistic approach to musculoskeletal health. This evaluation aimed to explore the acceptability of the CAD model.Methods: Following a CAD in the Southwest of England, patient experience was collected using the Friends and Family test and CollaboRATE measure for level of shared decision‐making. Interviews were conducted with patients, and a focus group was held with staff. The Theoretical Framework of Acceptability (TFA) informed the interview and focus group guides, and data analysis. Thematic analysis employed a hybrid deductive/inductive approach.Results: The CAD was attended by 130/160 (81%) patients. Experience measures were completed by 97/130 (75%) patients. The Friends and Family test demonstrated that most patients were ‘extremely likely’ (n = 63, 65%) or ‘likely’ (n = 32, 33%) to recommend a CAD. The average CollaboRATE score was 10.8/12. One‐to‐one interviews were completed with 13 patients, and a focus group with 10 staff. Four themes were identified: (1) a positive response to the CAD ethos; (2) the importance of effective planning and communication; (3) effective implementation of the CAD; and (4) potential impact and integration with existing musculoskeletal pathways.Conclusion: The CAD was perceived as an acceptable, personalised, and holistic model of care that supports self‐management and cross‐sector collaboration for supporting MSK health.

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.