RESOURCE Receptionists attempt continuity

of FCP. Extended Access service book follow-ups. FCP provides

patient with their email.

LATENT: Injecting FCP.

192 most of the time people are just happy to be seen and seen quickly and people don’t mind travelling either” (FCP 4)

FCP 3 did not do virtual assessments, as he felt uncomfortable providing advice without seeing the patient. Consequently, continuity was never achieved for those patients who saw him in a face-to-face appointment. Although he read the notes from the virtual assessment, he wanted to hear the patient’s story from them, as it facilitated clinical-reasoning. Occasionally he experienced patients expressing dissatisfaction with having to repeat themselves:

“I think it’s always worth recapping and I know that does upset some patients that you kind of get the ‘Is it not all on my notes?’ type thing but I think, for me, I want

to hear it from the horse’s mouth, so to say.” (FCP 3)

Patient responses expanded upon this hypothesis. Patients 7, 8, 10 and 11 all expressed a preference to see the same FCP. Concurring with staff responses, patients 10 and 11 did not want to repeat their history. Patients 8 and 10 also valued the consistency that came from the same FCP managing their MSKD, as they would not receive several interpretations of exercises (Patient 8) and the FCP would be aware of what the patient was capable of (Patient 10):

“I would always prefer to see the same person. I have more confidence that they know me. I don’t have to go through the pre-amble every time, which becomes

tiring.” (Patient 10)

Patient 10’s response also demonstrates the importance of being confident that the FCP knew the patient. Patient 8 held a similar view, as he perceived that the FCP – being knowledgeable on his condition – would be able to better monitor his progress and increase the patient’s confidence:

“if I see the same physio they can monitor my record and my progress, whereas if I see different people, a different person, they have to look at my record all the time

and then they have to put their input” (Patient 8)

Patient 8 stated that through one FCP monitoring his progress he would feel he was

‘making progress, makes me more confident’. However, this is not in line with the aim of the FCP role (see p.245 for further discussion).

193 Patient 7 also expressed satisfaction in the FCP providing her with his email address, so that any questions could be addressed by the same practitioner. She perceived him as caring as a result:

“*FCP 4* gave me his email address and said ‘If you have a problem or you want to talk about it email me and I’ll see what I can do.’ Now this is something that you’re usually used to but doesn’t happen very often so I think this is why my pleasure of

seeing *FCP 4* was such a pleasure because he said ‘If you need …’ you know

‘contact me.’ Which was the first time anybody had said that in a long time.”

(Patient 7)

Patient 7 implied continuity being preferential for the FCP injecting as the FCP could track the effectiveness of the treatment. Although neither FCPs were able to inject, the patient was questioned on this skill as a hypothetical situation. Her response indicates a belief that the practitioner would be able to connect their assessment to injection as a treatment:

“They could see how things were improving or if they weren’t improving and they would be in control of what was happening to the patient. More than referring backwards and

forwards” (Patient 7)

194

6.4 Theory Area Overlap

This section will describe the interconnected nature of the theory areas. As there are a myriad of overlaps, in this section only the most frequently overlapping theory areas will be discussed, as well as the overlaps that may have the greatest implications for service development (see Table 6.5).

Table 6.5 - Theory area overlap Practice B

Overlapping theory areas CMO title Expectation, Accessibility,

Hierarchy, Promoting the role, Experience

The role of the Receptionist in changing patient expectations

Accessibility, Experience, Expectations, Promoting the role

Expectations on the number of

appointments based upon experience of traditional physiotherapy

Experience, Expectations The effect of patients’ private physiotherapy experience

Expectations, Experience Patients adamant that they access the GP

195 6.4.1 Overlap 1 – The role of the Receptionist in changing patient expectations This overlap connected five theory areas and highlights how the Receptionist may not be able to change the patient expectation that they should be accessing the GP due to a perception of hierarchy (see Figure 6.12 for CMO).

Receptionist 2, FCP 4 and Patient 7 all highlighted a patient expectation of the GP as the first step in care; this expectation was based on previous experience of GPs traditionally always being the first contact. However, GP 2 and Receptionist 2 highlighted that this expectation could be altered by the Receptionist reassuring the patient that the FCP was the right professional to access for their MSKD. Nevertheless, it was not always possible for the Receptionists to change the patient’s expectation; this was due to patient perceptions of the status and qualifications of a Receptionist. This raises discussions on which

professions are able to champion the service, and who patients trust as advocates:

“It’s clearly not always fully possible to assess and assure somebody by phone, especially if you’re a Receptionist, but they usually accept it, once they've got some

idea of what the diagnosis is.” (GP 2)

“The route that it took was via the Receptionist, which I don’t think is right because I don’t think that she is qualified to say ‘Oh you don’t need to see a GP, you need to

see a physiotherapist, I’ll have somebody ring you’” (Patient 7) Figure 6.12 - Overlap 1 CMO

MECHANISM 2. CONTEXT

Patient experience of GPs as the first contact resulted in expectation that they need to see the GP first.

3. UNINTENDED RESPONSE