{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T02:31:09Z","timestamp":1788229869782,"version":"build-2803163510"},"reference-count":77,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2024,12,1]],"date-time":"2024-12-01T00:00:00Z","timestamp":1733011200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002001","name":"Health and Social Care Delivery Research (HSDR) Programme","doi-asserted-by":"publisher","award":["16\/116\/03"],"award-info":[{"award-number":["16\/116\/03"]}],"id":[{"id":"10.13039\/501100002001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journalslibrary.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["Health Soc Care Deliv Res"],"abstract":"<jats:sec id=\"abs1-1\"><jats:title>Background<\/jats:title>\n<jats:p>First-contact physiotherapists assess and diagnose patients with musculoskeletal disorders, determining the best course of management without prior general practitioner consultation.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-2\"><jats:title>Objectives<\/jats:title>\n<jats:p>The primary aim was to determine the clinical and cost-effectiveness of first-contact physiotherapists compared with general practitioner-led models of care.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-3\"><jats:title>Design<\/jats:title>\n<jats:p>Mixed-method realist evaluation of effectiveness and costs, comprising three main phases:<\/jats:p>\n<jats:list list-type=\"order\">\n<jats:list-item><jats:p>A United Kingdom-wide survey of first contact physiotherapists.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Rapid realist review of first contact physiotherapists to determine programme theories.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>A mixed-method case study evaluation of 46 general practices across the United Kingdom, grouped as three service delivery models:<\/jats:p>\n<jats:list list-type=\"alpha-lower\">\n<jats:list-item><jats:p>General practitioner: general practitioner-led models of care (no first contact physiotherapists).<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>First-contact physiotherapists standard provision: standard first-contact physiotherapist-led model of care.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>First-contact physiotherapists with additional qualifications: first-contact physiotherapists with additional qualifications to enable them to inject and\/or prescribe.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:list-item>\n<\/jats:list>\n<\/jats:sec>\n<jats:sec id=\"abs1-4\"><jats:title>Setting<\/jats:title>\n<jats:p>United Kingdom general practice.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-5\"><jats:title>Participants<\/jats:title>\n<jats:p>A total of 46 sites participated in the case study evaluation and 426 patients were recruited; 80 staff and patients were interviewed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-6\"><jats:title>Main outcome measures<\/jats:title>\n<jats:p>Short Form 36 physical outcome component score and costs of treatment.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-7\"><jats:title>Results<\/jats:title>\n<jats:p>No statistically significant difference in the primary outcome Short Form 36 physical component score measure at 6-month primary end point between general practitioner-led, first-contact physiotherapist standard provision and first-contact physiotherapist with additional qualifications models of care. A greater number of patients who had first-contact physiotherapist standard provision (72.4%) and first-contact physiotherapist with additional qualifications (66.4%) showed an improvement at 3 months compared with general practitioner-led care (54.7%). No statistically significant differences were found between the study arms in other secondary outcome measures, including the EuroQol-5 Dimensions, five-level version. Some 6.3% of participants were lost to follow-up at 3 months; a further 1.9% were lost to follow-up after 3 months and before 6 months. Service-use analysis data were available for 348 participants (81.7%) at 6 months. Inspecting the entire 6 months of the study, a statistically significant difference in total cost was seen between the three service models, irrespective of whether inpatient costs were included or excluded from the calculation. In both instances, the general practitioner service model was found to be significantly costlier, with a median total cost of \u00a3105.50 versus \u00a341.00 for first-contact physiotherapist standard provision and \u00a344.00 for first-contact physiotherapists with additional qualifications. Base-case analysis used band 7 for first-contact physiotherapist groups. A sensitivity analysis was undertaken at band 8a for first-contact physiotherapists with additional qualifications; the general practitioner-led model of care remained significantly costlier.<\/jats:p>\n<jats:p>Qualitative investigation highlighted key issues to support implementation: understanding role remit, integrating and supporting staff including full information technology access and extended appointment times.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-8\"><jats:title>Limitations<\/jats:title>\n<jats:p>Services were significantly impacted by COVID-19 treatment restrictions, and recruitment was hampered by additional pressures in primary care. A further limitation was the lack of diversity within the sample.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-9\"><jats:title>Conclusions<\/jats:title>\n<jats:p>First-contact physiotherapists and general practitioner models of care are equally clinically effective for people with musculoskeletal disorders. Analysis showed the general practitioner-led model of care is costlier than both the first-contact physiotherapist standard provision and first-contact physiotherapist with additional qualifications models. Implementation is supported by raising awareness of the first-contact physiotherapist role, retention of extended appointment times, and employment models that provide first-contact physiotherapists with professional support.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-10\"><jats:title>Future research<\/jats:title>\n<jats:p>Determining whether shifting workforce impacts physiotherapy provision and outcomes across the musculoskeletal pathway.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-11\"><jats:title>Study registration<\/jats:title>\n<jats:p>The study is registered as Research Registry UIN researchregistry5033.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-12\"><jats:title>Funding<\/jats:title>\n<jats:p>This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16\/116\/03) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 49. See the NIHR Funding and Awards website for further award information.<\/jats:p>\n<\/jats:sec>","DOI":"10.3310\/rtky7521","type":"journal-article","created":{"date-parts":[[2024,12,21]],"date-time":"2024-12-21T13:11:04Z","timestamp":1734786664000},"page":"1-187","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical and cost-effectiveness of first contact physiotherapy for musculoskeletal disorders in primary care: the FRONTIER, mixed method realist evaluation"],"prefix":"10.3310","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0499-4829","authenticated-orcid":true,"given":"Nicola E","family":"Walsh","sequence":"first","affiliation":[{"name":"Centre for Health and Clinical Research, University of the West of England, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3863-6835","authenticated-orcid":true,"given":"Alice","family":"Berry","sequence":"additional","affiliation":[{"name":"Centre for Health and Clinical Research, University of the West of England, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0737-8255","authenticated-orcid":true,"given":"Serena","family":"Halls","sequence":"additional","affiliation":[{"name":"Centre for Health and Clinical Research, University of the West of England, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3726-5179","authenticated-orcid":true,"given":"Rachel","family":"Thomas","sequence":"additional","affiliation":[{"name":"Centre for Health and Clinical Research, University of the West of England, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2177-3577","authenticated-orcid":true,"given":"Hannah","family":"Stott","sequence":"additional","affiliation":[{"name":"Centre for Health and Clinical Research, University of the West of England, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9384-1866","authenticated-orcid":true,"given":"Cathy","family":"Liddiard","sequence":"additional","affiliation":[{"name":"Centre for Health and Clinical Research, University of the West of England, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3090-2334","authenticated-orcid":true,"given":"Zoe","family":"Anchors","sequence":"additional","affiliation":[{"name":"Centre for Health and Clinical Research, University of the West of England, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8035-9758","authenticated-orcid":true,"given":"Fiona","family":"Cramp","sequence":"additional","affiliation":[{"name":"Centre for Health and Clinical Research, University of the West of England, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4248-9700","authenticated-orcid":true,"given":"Margaret E","family":"Cupples","sequence":"additional","affiliation":[{"name":"Centre for Public Health, Queen\u2019s University Belfast, Belfast, Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7885-0564","authenticated-orcid":true,"given":"Peter","family":"Williams","sequence":"additional","affiliation":[{"name":"School of Mathematics and Physics, University of Surrey, Guildford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2049-9406","authenticated-orcid":true,"given":"Heather","family":"Gage","sequence":"additional","affiliation":[{"name":"Surrey Health Economics Centre, University of Surrey, Guildford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2253-7880","authenticated-orcid":true,"given":"Dan","family":"Jackson","sequence":"additional","affiliation":[{"name":"Surrey Health Economics Centre, University of Surrey, Guildford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4038-0442","authenticated-orcid":true,"given":"Paula","family":"Kersten","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dave","family":"Foster","sequence":"additional","affiliation":[{"name":"Patient Research Partner, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6807-2957","authenticated-orcid":true,"given":"Justin","family":"Jagosh","sequence":"additional","affiliation":[{"name":"Centre for Advancement in Realist Evaluation and Synthesis, Vancouver, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6221","published-online":{"date-parts":[[2024,12]]},"reference":[{"key":"key2024122118380800_ref1-bib1","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1016\/S0140-6736(12)61689-4","article-title":"Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990\u20132010: a systematic analysis for the Global Burden of Disease Study 2010","volume":"380","author":"Murray","year":"2013","journal-title":"Lancet"},{"key":"key2024122118380800_ref2-bib2","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.1016\/S0140-6736(12)61729-2","article-title":"Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990\u20132010: a systematic analysis for the Global Burden of Disease Study 2010","volume":"380","author":"Vos","year":"2013","journal-title":"Lancet"},{"key":"key2024122118380800_ref3-bib3","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1186\/1471-2474-11-144","article-title":"Annual consultation prevalence of regional musculoskeletal problems in primary care: an observational study","volume":"11","author":"Jordan","year":"2010","journal-title":"BMC Musculoskelet Disord"},{"key":"key2024122118380800_ref4-bib4","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.pain.2004.04.017","article-title":"The prevalence of pain and pain interference in a general population of older adults: cross-sectional findings from the North Staffordshire Osteoarthritis Project (NorStOP)","volume":"110","author":"Thomas","year":"2004","journal-title":"Pain"},{"key":"key2024122118380800_ref7-bib7","volume-title":"Autumn Statement 2016","author":"HM Treasury"},{"key":"key2024122118380800_ref9-bib9","volume-title":"Performance Tracker 2022\/23: Spring Update","author":"Institute for Government","year":"2023"},{"key":"key2024122118380800_ref12-bib12","author":"British Medical Association. Pressure in General Practice Data Analysis. British Medical Association; 2024. URL:"},{"key":"key2024122118380800_ref13-bib13","volume-title":"Five Year Forward View","author":"NHS England","year":"2014"},{"key":"key2024122118380800_ref14-bib14","doi-asserted-by":"crossref","first-page":"657","DOI":"10.3399\/bjgp11X601541","article-title":"Musculoskeletal disorders: time for joint action in primary care","volume":"61","author":"Margham","year":"2011","journal-title":"Br J Gen Pract"},{"key":"key2024122118380800_ref15-bib15","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1001\/jamainternmed.2013.962","article-title":"Point-of-care prognosis for common musculoskeletal pain in older adults","volume":"173","author":"Mallen","year":"2013","journal-title":"JAMA Intern Med"},{"key":"key2024122118380800_ref16-bib16","doi-asserted-by":"crossref","first-page":"h2308","DOI":"10.1136\/bmj.h2308","article-title":"Choosing wisely in the UK: the Academy of Medical Royal Colleges\u2019 initiative to reduce the harms of too much medicine","volume":"350","author":"Malhotra","year":"2015","journal-title":"BMJ"},{"key":"key2024122118380800_ref17-bib17","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1017\/S1463423616000189","article-title":"Physiotherapy as a first point of contact in general practice: a solution to a growing problem?","volume":"6","author":"Goodwin","year":"2016","journal-title":"Prim Health Care Res Dev"},{"key":"key2024122118380800_ref18-bib18","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1002\/msc.1100","article-title":"The clinical effectiveness of the extended\u2010scope physiotherapist role in musculoskeletal triage: a systematic review","volume":"13","author":"Oakley","year":"2015","journal-title":"Musculoskeletal Care"},{"key":"key2024122118380800_ref19-bib19","volume-title":"First Contact Physiotherapy Case Studies","author":"Chartered Society of Physiotherapists"},{"key":"key2024122118380800_ref20-bib20","volume-title":"GPs Support Physios as a First Point of Contact in Surgeries","author":"Chartered Society of Physiotherapists","year":"2016"},{"key":"key2024122118380800_ref21-bib21","doi-asserted-by":"crossref","first-page":"e012987","DOI":"10.1136\/bmjopen-2016-012987","article-title":"STEMS pilot trial: a pilot cluster randomised controlled trial to investigate the addition of patient direct access to physiotherapy to usual GP-led primary care for adults with musculoskeletal pain","volume":"7","author":"Bishop","year":"2017","journal-title":"BMJ Open"},{"key":"key2024122118380800_ref22-bib22","volume-title":"First Contact Physiotherapy","author":"Physiopedia"},{"key":"key2024122118380800_ref23-bib23","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.physio.2021.08.002","article-title":"Evaluation of the first contact physiotherapy (FCP) model of primary care: patient characteristics and outcomes","volume":"113","author":"Stynes","year":"2021","journal-title":"Physiotherapy"},{"key":"key2024122118380800_ref25-bib25","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s12961-019-0433-2","article-title":"Health research systems in change: the case of \u2018Push the Pace\u2019 in the National Institute for Health Research","volume":"17","author":"Moran","year":"2019","journal-title":"Health Res Policy Syst"},{"key":"key2024122118380800_ref26-bib26","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.physio.2020.04.005","article-title":"Provision of first contact physiotherapy in primary care across the UK: a survey of the service","volume":"108","author":"Halls","year":"2020","journal-title":"Physiotherapy"},{"key":"key2024122118380800_ref27-bib27","doi-asserted-by":"crossref","first-page":"e060347","DOI":"10.1136\/bmjopen-2021-060347","article-title":"Benefits of realist evaluation for rapidly changing health service delivery","volume":"12","author":"Jagosh","year":"2022","journal-title":"BMJ Open"},{"key":"key2024122118380800_ref28-bib28","volume-title":"Realist Evaluation","author":"Pawson","year":"2004"},{"key":"key2024122118380800_ref29-bib29","author":"Jagosh","journal-title":"Introduction to Realist Evaluation and Synthesis [video 57 minutes]"},{"key":"key2024122118380800_ref30-bib30","volume-title":"Realistic Evaluation","author":"Pawson","year":"1997"},{"key":"key2024122118380800_ref31-bib31","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1186\/s13012-018-0811-0","article-title":"A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: an exemplar","volume":"13","author":"Rycroft-Malone","year":"2018","journal-title":"Implement Sci"},{"key":"key2024122118380800_ref32-bib32","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/1741-7015-11-21","article-title":"RAMESES publication standards: realist syntheses","volume":"11","author":"Wong","year":"2013","journal-title":"BMC Med"},{"key":"key2024122118380800_ref33-bib33","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/j.1468-0009.2012.00665.x","article-title":"Uncovering the benefits of participatory research: implications of a realist review for health research and practice","volume":"90","author":"Jagosh","year":"2012","journal-title":"Milbank Q"},{"key":"key2024122118380800_ref34-bib34","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1177\/1098214010371972","article-title":"Unpacking black boxes: mechanisms and theory building in evaluation","volume":"31","author":"Astbury","year":"2010","journal-title":"Am J Eval"},{"key":"key2024122118380800_ref35-bib35","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/s13012-015-0237-x","article-title":"What\u2019s in a mechanism? Development of a key concept in realist evaluation","volume":"10","author":"Dalkin","year":"2015","journal-title":"Implement Sci"},{"key":"key2024122118380800_ref36-bib36","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1136\/bmjqs-2017-006757","article-title":"Realist synthesis of intentional rounding in hospital wards: exploring the evidence of what works, for whom, in what circumstances and why","volume":"27","author":"Sims","year":"2018","journal-title":"BMJ Qual Saf"},{"key":"key2024122118380800_ref37-bib37","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1080\/14767430.2020.1723301","article-title":"Retroductive theorizing in Pawson and Tilley\u2019s applied scientific realism","volume":"19","author":"Jagosh","year":"2020","journal-title":"J Crit Realism"},{"key":"key2024122118380800_ref38-bib38","doi-asserted-by":"crossref","first-page":"1609406919859754","DOI":"10.1177\/1609406919859754","article-title":"Data analysis and synthesis within a realist evaluation: toward more transparent methodological approaches","volume":"18","author":"Gilmore","year":"2019","journal-title":"Int J Qual Methods"},{"key":"key2024122118380800_ref39-bib39","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1186\/s13012-015-0321-2","article-title":"Using realist review to inform intervention development: methodological illustration and conceptual platform for collaborative care in offender mental health","volume":"10","author":"Pearson","year":"2015","journal-title":"Implement Sci"},{"key":"key2024122118380800_ref41-bib41","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1002\/msc.1737","article-title":"The impact of remote consultations on the health and wellbeing of first contact physiotherapists in primary care: a mixed methods study","volume":"21","author":"Anchors","year":"2023","journal-title":"Musculoskeletal Care"},{"key":"key2024122118380800_ref43-bib43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4172\/2167-1044.1000313","article-title":"Development and validation of an instrument that assesses individual differences in threat and challenge appraisal","volume":"7","author":"Tomaka","year":"2018","journal-title":"J Depress Anxiety"},{"key":"key2024122118380800_ref44-bib44","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1111\/sms.12928","article-title":"Adverse life events, cardiovascular responses, and sports performance under pressure","volume":"28","author":"Moore","year":"2018","journal-title":"Scand J Med Sci Sports"},{"key":"key2024122118380800_ref45-bib45","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"key2024122118380800_ref46-bib46","doi-asserted-by":"crossref","DOI":"10.3399\/BJGP.2023.0560","article-title":"First contact physiotherapy: an evaluation of clinical effectiveness and costs [published online ahead of print 1 March 2024]","author":"Walsh","year":"2024","journal-title":"Br J Gen Pract"},{"key":"key2024122118380800_ref47-bib47","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1002\/1529-0131(200108)45:4<384::AID-ART352>3.0.CO;2-0","article-title":"Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities","volume":"45","author":"Angst","year":"2001","journal-title":"Arthritis Rheum"},{"key":"key2024122118380800_ref48-bib48","doi-asserted-by":"crossref","first-page":"f43","DOI":"10.1136\/bmj.f43","article-title":"Effectiveness of PhysioDirect telephone assessment and advice services for patients with musculoskeletal problems: pragmatic randomised controlled trial","volume":"346","author":"Salisbury","year":"2013","journal-title":"BMJ"},{"key":"key2024122118380800_ref49-bib49","volume-title":"User\u2019s Manual for the SF-36v2 Health Survey","author":"Ware","year":"2007"},{"key":"key2024122118380800_ref50-bib50","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1007\/s11136-011-9903-x","article-title":"Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)","volume":"20","author":"Herdman","year":"2011","journal-title":"Qual Life Res"},{"key":"key2024122118380800_ref51-bib51","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1097\/00007632-198303000-00004","article-title":"A study of the natural-history of back pain: development of a reliable and sensitive measure of disability in low back-pain","volume":"8","author":"Roland","year":"1983","journal-title":"Spine"},{"key":"key2024122118380800_ref52-bib52","volume-title":"Musculoskeletal Health Questionnaire (MSKHQ)","author":"Oxford University Innovation","year":"2014"},{"key":"key2024122118380800_ref53-bib53","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/1471-2296-9-13","article-title":"The general practice assessment questionnaire (GPAQ): development and psychometric characteristics","volume":"9","author":"Mead","year":"2008","journal-title":"BMC Fam Pract"},{"key":"key2024122118380800_ref54-bib54","volume-title":"The Economic Evaluation of Mental Health Care","author":"Knapp","year":"1995"},{"key":"key2024122118380800_ref55-bib55","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1370\/afm.1935","article-title":"Measuring patient safety in primary care: the development and validation of the \u2018patient reported experiences and outcomes of safety in primary care\u2019 (PREOS-PC)","volume":"14","author":"Ricci-Cabello","year":"2016","journal-title":"Ann Fam Med"},{"key":"key2024122118380800_ref56-bib56","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1002\/hec.3564","article-title":"Valuing health-related quality of life: an EQ-5D-5L value set for England","volume":"27","author":"Devlin","year":"2018","journal-title":"Health Econ"},{"key":"key2024122118380800_ref57-bib57","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1177\/1356389016638615","article-title":"The craft of interviewing in realist evaluation","volume":"22","author":"Manzano","year":"2016","journal-title":"Evaluation"},{"key":"key2024122118380800_ref58-bib58","doi-asserted-by":"crossref","first-page":"100095","DOI":"10.1016\/j.ocarto.2020.100095","article-title":"Barriers and enablers to uptake of a contemporary guideline-based management program for hip and knee osteoarthritis: a qualitative study","volume":"2","author":"Wallis","year":"2020","journal-title":"Osteoarthr Cartil Open"},{"key":"key2024122118380800_ref59-bib59","article-title":"Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review","volume":"4","author":"Hurley","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"key2024122118380800_ref60-bib60","author":"Bostock","journal-title":"One in Five GP Appointments Last More Than 20 Minutes"},{"key":"key2024122118380800_ref61-bib61","volume-title":"Musculoskeletal Health","author":"NHS England"},{"key":"key2024122118380800_ref62-bib62","volume-title":"FCP Services","author":"Chartered Society of Physiotherapy","year":"2021"},{"key":"key2024122118380800_ref63-bib63","volume-title":"Opioid Prescriptions Cut by Almost Half a Million in Four Years as NHS Continues Crackdown","author":"NHS England","year":"2023"},{"key":"key2024122118380800_ref64-bib64","doi-asserted-by":"crossref","first-page":"e28","DOI":"10.1017\/S1463423623000142","article-title":"The experiences of physiotherapy independent prescribing in primary care: implications for practice","volume":"24","author":"Mullan","year":"2023","journal-title":"Prim Health Care Res Dev"},{"key":"key2024122118380800_ref65-bib65","doi-asserted-by":"crossref","first-page":"e001287","DOI":"10.1136\/bmjoq-2020-001287","article-title":"Unintended consequences: quantifying the benefits, iatrogenic harms and downstream cascade costs of musculoskeletal MRI in UK primary care","volume":"10","author":"Sajid","year":"2021","journal-title":"BMJ Open Quality"},{"key":"key2024122118380800_ref66-bib66","volume-title":"Enabling Self-management and Coping with Arthritic Pain Using Exercise","author":"Hurley"},{"key":"key2024122118380800_ref67-bib67","volume-title":"Getting the Most Out of the Fit Note: Guidance for Healthcare Professionals","author":"Department for Work and Pensions","year":"2023"},{"key":"key2024122118380800_ref68-bib68","volume-title":"Working Days Lost in Great Britain","author":"Health and Safety Executive","year":"2022"},{"key":"key2024122118380800_ref70-bib70","doi-asserted-by":"crossref","first-page":"2373","DOI":"10.1007\/s11136-018-1883-7","article-title":"Changes in health-related quality of life (EQ-5D) dimensions associated with community-based musculoskeletal physiotherapy: a multi-centre analysis","volume":"27","author":"Caplan","year":"2018","journal-title":"Qual Life Res"},{"key":"key2024122118380800_ref71-bib71","volume-title":"Estimates of the Population for the UK, England and Wales, Scotland and Northern Ireland","author":"Office for National Statistics","year":"2022"},{"key":"key2024122118380800_ref73-bib73","volume-title":"GP Patient Survey 2022","author":"NHS England"},{"key":"key2024122118380800_ref74-bib74","volume-title":"Pickering Medical Practice, North","author":"NHS England","year":"2020"},{"key":"key2024122118380800_ref75-bib75","volume-title":"Appointments in General Practice, October 2022","author":"NHS Digital","year":"2022"},{"key":"key2024122118380800_ref76-bib76","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1017\/S1463423617000615","article-title":"Physiotherapy-as-first-point-of-contact-service for patients with musculoskeletal complaints: understanding the challenges of implementation","volume":"19","author":"Moffatt","year":"2018","journal-title":"Prim Health Care Res Dev"},{"key":"key2024122118380800_ref77-bib77","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.physio.2021.08.003","article-title":"Evaluation of the First Contact Physiotherapy (FCP) model of primary care: a qualitative insight","volume":"113","author":"Goodwin","year":"2021","journal-title":"Physiotherapy"},{"key":"key2024122118380800_ref78-bib78","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1186\/s12913-020-05918-8","article-title":"A comparative case study of prescribing and non-prescribing physiotherapists and podiatrists","volume":"20","author":"Carey","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"key2024122118380800_ref79-bib79","doi-asserted-by":"crossref","first-page":"102616","DOI":"10.1016\/j.msksp.2022.102616","article-title":"A multi-site prospective, observational study of physiotherapist independent prescribing activity across musculoskeletal clinics in the United Kingdom","volume":"61","author":"Noblet","year":"2022","journal-title":"Musculoskelet Sci Pract"},{"key":"key2024122118380800_ref80-bib80","volume-title":"Multi-professional Framework for Advanced Clinical Practice in England","author":"Health Education England","year":"2017"},{"key":"key2024122118380800_ref81-bib81","volume-title":"First Contact Physiotherapy Career Development in Northern Ireland","author":"Chartered Society of Physiotherapy","year":"2021"},{"key":"key2024122118380800_ref82-bib82","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1002\/msc.1527","article-title":"Implementation of a provider based musculoskeletal first contact physiotherapy service model: key points to consider","volume":"19","author":"Ingram","year":"2020","journal-title":"Musculoskeletal Care"},{"key":"key2024122118380800_ref83-bib83","doi-asserted-by":"crossref","first-page":"1","DOI":"10.12968\/ijtr.2022.0053","article-title":"Facilitators and barriers regarding the implementation and interprofessional collaboration of a first contact physiotherapy service in primary care in Wales: a qualitative study","volume":"30","author":"Lewis","year":"2023","journal-title":"Int J Ther Rehabil"},{"key":"key2024122118380800_ref84-bib84","doi-asserted-by":"crossref","first-page":"e315","DOI":"10.3399\/BJGP.2023.0433","article-title":"A qualitative investigation of the Additional Roles Reimbursement Scheme in primary care","volume":"74","author":"Jones","year":"2023","journal-title":"Br J Gen Pract"},{"key":"key2024122118380800_ref85-bib85","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s12875-024-02271-1","article-title":"Understanding paramedic work in general practice in the UK: a rapid realist synthesis","volume":"25","author":"Stott","year":"2024","journal-title":"BMC Prim Care"},{"key":"key2024122118380800_ref86-bib86","volume-title":"Unit Costs of Health and Social Care 2021","author":"Jones","year":"2021"},{"key":"key2024122118380800_ref87-bib87","volume-title":"2020\/21 National Cost Collection Data Publication","author":"NHS England"}],"container-title":["Health and Social Care Delivery Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2046883","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/sites\/journalslibrary\/files\/journal_data\/RTKY7521\/RTKY7521.xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2046883","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,21]],"date-time":"2024-12-21T13:11:27Z","timestamp":1734786687000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/hsdr\/RTKY7521"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12]]},"references-count":77,"alternative-id":["10.3310\/RTKY7521"],"URL":"https:\/\/doi.org\/10.3310\/rtky7521","relation":{},"ISSN":["2755-0079"],"issn-type":[{"value":"2755-0079","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12]]},"assertion":[{"value":"This content has been made freely available to all.","name":"free","label":"Free to read"},{"value":"09-2018","name":"contractual_start_date","label":"contractual_start_date","group":{"name":"article_history","label":"Article History"}},{"value":"06-2023","name":"editorial_review_begun","label":"editorial review begun","group":{"name":"article_history","label":"Article History"}},{"value":"01-2024","name":"accepted_for_publication","label":"Accepted for publication","group":{"name":"article_history","label":"Article History"}}]}}