Abstract
Background
Patients at risk of preventable sickness absence frequently attend at primary care. First contact physiotherapists (FCP) may provide an optimal way of reducing this risk; however, there is significant variability in clinical practice, limited research directing best practice and this work and health role is traditionally seen as outside of the ‘therapeutic relationship’. If FCP’s training and development in this area is considered, FCP’s will be able to effectively conduct fitness for work and sickness absence certification within UK primary care settings.
Aims
This study aimed to reach expert consensus for work-related competencies for FCP practice for patients at risk of preventable sickness absence.
Methods
A modified Delphi technique involved a UK-wide FCP expert panel completing three rounds of an online questionnaire. The initial 30-competency questionnaire, based on two separate Nominal Group Techniques in a FCP and Association of Chartered Physiotherapists in Occupational Health and Ergonomics (ACPOHE) physiotherapist cohort and Health Education England’s published Roadmap to Practice, covered occupational health specific items (knowledge and skills) related to the topic. Consensus threshold was set a priori at 70% level of group agreement. Items not reaching consensus were modified and new items added based on themes from qualitative data from the open-ended free text questions present in each section. Items that reached values greater than or equal to 70% of agreement among experts were considered definitive for the competency items. Items between 51% and 69% of agreement were included for the next round and those items with less than or equal to 50% of agreement were considered unnecessary and were excluded. In the third round, the occupational health (OH) specific contents for primary care were classified according to the degree of consensus as follows: strong (≥70% of agreement), moderate (51–69% of agreement) and weak (50% of agreement) based on the maximum consensus reached.
Results
Of the 30 initial competencies, 20 (67%) reached a strong degree of consensus and 2 (7%) reached a moderate degree of consensus and 8 (27%) competencies were not recommended (≤50% of agreement). 20 OH specific competencies reached a priori consensus level of agreement to provide the final group list.
Conclusions
This paper provides an empirically derived list of OH competencies for FCP education in primary care ‘first point of care’ physiotherapy with a high level of expert agreement and high retention rate between rounds.
Contribution of the paper
The role of certifying sickness absence and providing fitness for work advice within primary care settings has normally been conducted by General Practitioners, largely due to the legislative aspects that require a ‘Fit Note’.
FCPs may be ideally suited in ensuring that work is considered at an early stage to help support and prompt conversations about work.
Most individual’s health needs are addressed within Primary Care (first point of contact in the NHS).
There is a lack of empirical evidence on the competencies needed for the new ‘first point of contact role’ whereby FCPs manage undiagnosed and undifferentiated musculoskeletal (MSK) conditions.