Limited evidence exists on early COVID-19 related changes in First Contact Physiotherapy Services (FCPS) for musculoskeletal (MSK) patients within the UK primary care (PC) and Australian emergency departments (ED), knowledge that is crucial for understanding their level of responsiveness and readiness for future crises. This study explores the initial changes in FCPS during the COVID-19 pandemic in the UK and Australia. The UK and Australia represent a function of both country and their FCPS context (UK [PC], Australia [ED]). A cross-sectional survey was conducted from January-April 2023. Data were self-reported by physiotherapists in FCPS roles, managing MSK patients in the UK and Australia. Only responses from those who recalled changes in FCPS were included, with 153 participants analysed. Descriptive statistics and two-way ANOVA were used to examine the effects of timing of change, country, and their interaction on readiness and responsiveness to MSK patient needs. Overall, 75.7% of initial changes were perceived to have occurred within three months following the World Health Organisation's declaration of COVID-19 as a global pandemic. Participants from both countries differed significantly in their perceptions of how COVID-19 affected patient access to FCPS (p < 0.001). Changes in MSK patient presentation to FCPS varied significantly by both the timing of the change and the country (p < 0.001). Similarly, changes in the care delivery platform were significantly associated with the timing of change (p = 0.014) and the country (p < 0.001). While participants' responses generally indicated inadequate readiness, the overall perceived responsiveness was higher in the UK (using an arbitrary cut-off of ≥50%) compared to Australia. No significant effects of timing or country were found on either readiness or responsiveness. This highlights the need to strengthen FCPS readiness for more responsive future crises. It also suggests the need for contextual considerations when developing readiness strategies.

Non-medical prescribing is increasingly used to support workforce shortages that challenge global access to healthcare. Limited theoretical guidance exists on how to successfully undertake its implementation. This systematic review of reviews was used to (i) identify determinants to implementation of non-medical prescribing and (ii) develop a framework of factors that influence successful non-medical prescribing implementation. Inclusion criteria were reviews reporting barriers and facilitators to non-medical prescribing. Six electronic databases were searched January 2010- May 2024 with results recorded using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Informed by principles of meta ethnography, data from included reviews were extracted and synthesised following a structured approach. Themes were mapped to four stages of implementation: preparation; training; transition and sustainment. Consideration was given as to whether they operated at the micro, meso or macro level. An overarching determinant for each theme was identified and used to populate the ‘Prescribing Implementation Framework’. Nineteen reviews fulfilled the inclusion criteria,7 focussed on independent prescribing and 12 independent and or supplementary prescribing reporting that non-medical prescribing is largely acceptable to both service users and healthcare professionals. The Prescribing Implementation Framework comprises 13 determinants of effective implementation, 7 of which are located in the preparation phase. Thirty six out of 72 identified macro, meso or micro level factors were in the preparation phase, 11 training, 15 transition and 11 sustainment. There is pressing need to advance understanding of non-medical prescribing implementation by developing theoretically informed guidance to support the planning, execution and sustainability of its implementation globally. Our resultant multi-professional, systems-wide conceptual Prescribing Implementation Framework (PIF) emphasises the dynamic nature of determinants, change over time, and importance of interdependence. The newly develop PIF can help guide organisations with preliminary capacity/needs assessment, identify potential ‘pinch points’ and assist in formative evaluations of non-medical prescribing processes and outcomes to help enhance implementation in this area. CRD42024593690.

Background The disruption of health services by the COVID-19 pandemic prompted the WHO to advocate for rapid adaptation of healthcare. Little is known about the specific rapid adaptation strategies deployed in first contact physiotherapy services (FCPS) and how they were experienced by providers and patients. Study Aim To explore views and experiences of physiotherapists and key stakeholders on the rapid adaptation of FCPS during the COVID-19 pandemic in the UK and Australia. Methods A multiple case study design was employed across four case sites; UK (n = 2), Australia (n = 2), involving online semi-structured interviews with 22 participants in 2024 and document review. A case-based approach using framework analysis was applied, drawing on the public health emergency framework of readiness, responsiveness, and sustainability, alongside the consolidated framework for implementation research (CFIR). Results Gaps in readiness for adaptation, particularly in terms of planning and resources, were evident across FCPS in both countries. However, the findings highlight FCPS as an adaptable service, with strategies implemented within the first three to six months following the declaration of COVID-19 as a pandemic. The most notable adaptation variation was in telehealth, where alignment with service contexts influenced implementation and ongoing sustainability. New challenges not fully captured within CFIR constructs emerged, including the initial lack of acceptability, particularly related to telehealth, and the unpredictable nature of the pandemic. Conclusion To strengthen FCPS preparedness for the future, policies should proactively equip services with the resources and capabilities required to manage emergencies and associated contingencies, while accounting for contextual variations. Such forward planning would support an effective response and the long-term integration of beneficial adaptations, thereby strengthening service resilience.

Background:The COVID-19 pandemic significantly disrupted primary care and emergency departments globally, including the UK and Australia respectively, affecting services within these settings, such as first contact physiotherapy services (FCPS) for patients with musculoskeletal conditions. This disruption necessitated rapid adaptation to ensure continuity of care. Before this study, comprehensive adaptations across both primary care and emergency departments FCPS had not been documented. Additionally, the specific adaptation processes, strategies used, and experiences of both staff and patients during the COVID-19 pandemic were unclear. Variations in responses between the UK and Australia also remained unknown. Documenting these rapid adaptations and experiences is crucial for future preparedness, as it provides valuable insights to guide FCPS and similar services, preventing future disruptions and promoting continuity of care. Moreover, findings will contribute significant knowledge to the existing literature. Aim:This study explores rapid adaptation of FCPS for patients with musculoskeletal conditions during the COVID-19 pandemic in the UK and Australia. Methods:This is an ongoing three-phase sequential mixed-methods study. Phase 1 utilises a cross-sectional survey of physiotherapists in FCPS role in the UK and Australia to assess changes in healthcare delivery during the pandemic, as well as levels of readiness and responsiveness, highlighting similarities and differences. Phase 2 employs a case-study approach, including semi-structured interviews and a review of documents produced to direct the management and implementation of proposed changes in FCPS, to further understand the findings from Phase 1. In phase 3, mixed-methods integration facilitates the development of context specific recommendations for the rapid adaptation of FCPS and similar contexts. These recommendations will be presented to experts for feedback and further refinement. Discussion:The mixed-methods research will provide contextually rich account of FCPS rapid adaptation, providing key learnings that could be applied to implement evidence-informed rapid adaptation in FCPS during public health emergencies.

Non-medical prescribing (NMP) was introduced into the UK healthcare system and other countries to improve patient care and facilitate better access to medicine. However, very few studies have evaluated the cost-effectiveness of the prescribing authorities granted to certain healthcare professional groups. This study aims to evaluate the cost-effectiveness of prescribing by dietitians and therapeutic radiographers in England. A model-based cost-effectiveness analysis was conducted to evaluate the services provided by dietitian and therapeutic radiographer prescribers compared to services delivered by dietitian and therapeutic radiographer non-prescribers in terms of direct and indirect costs and effectiveness outcomes, e.g. quality-adjusted life year (QALY) and patient satisfaction, from the National Health Service (NHS) perspective. Unit costs were obtained from the NHS National Reference Costs 2021-22. Sensitivity analyses were performed to assess the robustness of the model parameters. The mean costs associated with NMP were higher for prescribers than non-prescribers due to training costs and consultation time to manage prescriptions. However, these costs were compensated by higher referrals by non-prescribers to other specialists for prescribing. NMP in either profession was perceived as positive by patients. Differences in QALY were not statistically significant among patients managed by prescribers and non-prescribers for either profession. Results were sensitive to the model assumptions and parameters. Our estimates suggest NMP might save £64,269 over five years per dietitian prescriber and £16,570 per therapeutic radiographer prescriber. Despite uncertainties around the cost-effectiveness of NMP, it may save money with minimal or no changes in quality-of-life outcomes for patients being managed by either profession.

Rapid adaptation of healthcare services during public health emergencies is key in ensuring continuous delivery of essential healthcare services. However, challenges associated with rapid adaptation can lead to disruptions in care delivery, impacting responses to population healthcare needs. To prepare for a prompt future response, it is important to identify and understand the barriers and facilitators influencing rapid adaptation efforts. A systematic integrative review was conducted between March and October 2022, with five healthcare-related databases searched from 2012. Weekly auto-alerts continued until March 2023. The Mixed-Methods Appraisal Tool was used for quality assessment and data extraction conducted using the Consolidated Framework for Implementation Research. Seventeen eligible studies utilised quantitative (10/17, 59%), mixed-methods (4/17, 23%) or qualitative designs (3/17, 18%). Most rapid adaptation in healthcare service delivery happened within 3 months after the World Health Organisation declared Coronavirus disease a pandemic (13/17, 76%), with telehealth being the key rapid adaptation that occurred. Inner setting and process factors served as both barriers and facilitators. Two additional factors not present in the consolidated framework, namely: (1) emergency command and control at the healthcare level and (2) acceptability and resilience, were identified as facilitators to rapid adaptation. This systematic integrative review underscores that while healthcare services rapidly adapted within the initial 3 months of the pandemic, inadequate readiness may have hindered their capacity to respond inclusively, potentially impacting on the sustainability of adapted services. Addressing these issues will support greater preparation for public health emergencies.

Background: Recent changes have allowed advanced level UK dietitians and therapeutic radiographers to prescribe medicines. To date, there has been no comprehensive review of this evidence. Aim: To undertake a rapid review of the role advanced practice dietitians and therapeutic radiographers have in relation to medicines management. Method: Searches of MEDLINE, CINAHL and economic databases were conducted for literature published from 1968–November 2023. Registered with Figshare, a narrative synthesis following PRISMA guidelines was undertaken. Findings: Twenty articles revealed a dearth of literature evaluating advanced practice or prescribing in either profession. A lack of clarity regarding advanced practice roles led to ambiguity and hindered implementation. Conclusion: There is a lack of evidence evaluating dietitian and therapeutic radiographer advance practice or prescribing. Urgent evaluation of dietitian and therapeutic radiography advanced practice, including prescribing, is required if their contribution to alleviating workforce shortages is to be better understood.

IntroductionNon-medical professionals in the United Kingdom (UK) have been granted prescribing rights to improve patient care quality and cost-effectiveness. There is limited evidence on how therapeutic radiographer prescribers have impacted medicine management or patient services.MethodsAn online survey was conducted amongst non-medical prescribing therapeutic radiographers in the UK between 2019 and 2022. The study teams initially analysed the individual data sets, subsequently combined, and secondary analysis was performed to provide a UK perspective, to understand the services provided and identify areas for improvement. Data was analysed using descriptive statistics from Microsoft Excel® and SPSS®.Results74 non-medical prescribing therapeutic radiographers who were predominantly over 40 years old and in full-time work participated. The main job categories were consultant radiographers (n = 23, 31.1%) and advanced practice practitioners (n = 18, 24.3%). Many use their prescribing qualifications (87.5%, n = 62), issuing a mean of 15 independent and seven items by supplementary and prescribing per week. Most received assessment and diagnostic skills training before prescribing courses (91.6%, n = 67). Respondents prescribed from a median of six areas, with the highest being in GI (82%), skin (68%), infections (58%), urinary tract disorders (55%) and ear, nose, and oropharynx conditions (54%).ConclusionThis study presents the first report on therapeutic radiographers prescribing in the UK, offering insights into current practices and highlighting the success of non-medical prescribing. Therapeutic radiographers’ roles continue to expand into advanced practice and medicine-prescribing responsibilities, contributing to holistic and patient-centred care.Implications for practiceThe results are relevant for nations grappling with oncology workforce shortages and contemplating similar roles for therapeutic radiographers. The study can be a valuable resource for policymakers and healthcare organisations worldwide.

In community nursing, the administration of insulin for people with type 2 diabetes can be delegated by registered nurses to healthcare support workers. Although a voluntary framework in England provides national guidance, little is known about its uptake. The project aim was to determine the roll-out, characteristics and support needs in relation to the delegation of insulin administration in community settings. An online survey was disseminated to community nursing services in England via social media and nursing networks. Of the 115 responding organisations, 81% (n=93) had an insulin delegation programme, with most initiated since 2018. From these services, 41% (n=3704) of insulin injections were delegated daily, with benefits for patients, staff and services reported, along with some challenges. Delegation of insulin administration is an established and valued initiative. Awareness of the national voluntary framework is increasing. National guidance is considered important to support governance arrangements and safety.

AIMS:To explore stakeholder perspectives on the benefits and/or disadvantages of the delegation of insulin injections to healthcare support workers in community nursing services.DESIGN:Qualitative case study.METHODS:Interviews with stakeholders purposively sampled from three case sites in England. Data collection took place between October 2020 and July 2021. A reflexive thematic approach to analysis was adopted.RESULTS:A total of 34 interviews were completed: patients and relatives (n = 7), healthcare support workers (n = 8), registered nurses (n = 10) and senior managers/clinicians (n = 9). Analysis resulted in three themes: (i) Acceptance and confidence, (ii) benefits and (iii) concerns and coping strategies. Delegation was accepted by stakeholders on condition that appropriate training, supervision and governance was in place. Continuing contact between patients and registered nurses, and regular contact between registered nurses and healthcare support workers was deemed essential for clinical safety. Services were reliant on the contribution of healthcare support workers providing insulin injections, particularly during the COVID-19 pandemic. Benefits for service and registered nurses included: flexible team working, increased service capacity and care continuity. Job satisfaction and career development was reported for healthcare support workers. Patients benefit from timely administration, and enhanced relationships with the nursing team. Concerns raised by all stakeholders included potential missed care, remuneration and task shifting.CONCLUSION:Delegation of insulin injections is acceptable to stakeholders and has many benefits when managed effectively.IMPACT:Demand for community nursing is increasing. Findings of this study suggest that delegation of insulin administration contributes to improving service capacity. Findings highlight the essential role played by key factors such as appropriate training, competency assessment and teamwork, in developing confidence in delegation among stakeholders. Understanding and supporting these factors can help ensure that practice develops in an acceptable, safe and beneficial way, and informs future development of delegation practice in community settings.PATIENT OR PUBLIC CONTRIBUTION:A service user group was consulted during the design phase prior to grant application and provided comments on draft findings. Two people with diabetes were members of the project advisory group and contributed to the study design, development of interview questions, monitoring study progress and provided feedback on study findings.

Abstract Background Globally, Multidisciplinary Teams (MDTs) are considered the gold standard for diagnosis and treatment of cancer and other conditions, but variability in performance has led to demand for improvement tools. MDT‐FIT (Multidisciplinary Team Feedback for Improving Teamwork) is an improvement programme developed iteratively with over 100 MDTs (≥1100 MDT‐members). Complex interventions are often adapted to context, but this is rarely evaluated. We conducted a prospective evaluation of the implementation of MDT‐FIT across an entire integrated care system (ICS). Methods MDT‐FIT was implemented within all breast cancer MDTs across an ICS in England (n = 10 MDTs; 275 medical, nursing, and administrative members). ICS managers coordinated the implementation across the three stages of MDT‐FIT: set up; assessment (self‐report by team members plus independent observational assessment); team‐feedback and facilitated discussion to agree actions for improvement. Data were collected using process and systems logs, and interviews with a purposively selected range of participants. Analysis was theoretically grounded in evidence‐based frameworks for implementation strategies and outcomes. Results All 10 MDTs participated in MDT‐FIT; 36 interviews were conducted. Data from systems and process logs covered a 9‐month period. Adaptations to MDT‐FIT by the ICS (e.g., coordination of team participation by ICS rather than individual hospitals; and reducing time protected for coordination) reduced Fidelity and Adoption of MDT‐FIT. However, the Acceptability, Appropriateness and Feasibility of MDT‐FIT remained high due to embedding implementation strategies in the development of MDT‐FIT (e.g., stakeholder engagement, interactive support). Conclusions This is a unique and comprehensive evaluation of the multi‐site implementation of a complex team improvement programme. Findings support the imperative of considering implementation strategies when designing such programmes to minimize potentially negative impacts of adaptations in “real world” settings.

Background: Paramedics working in advanced practice roles in the UK can now train to prescribe medicine. This is anticipated to benefit patient access to medicines and quality of care where there is a national shortage of doctors, particularly in primary care. Aim: To explore the experience of paramedics who are early adopters of independent prescribing in a range of healthcare settings in the UK. Design and setting: A qualitative study involving interviews between May and August 2019, with paramedics in the UK who had completed a prescribing programme. Methods: Individual interviews with a purposive sample of paramedics recruited via social media and regional paramedic networks. Interviews covered experiences, benefits and challenges of the prescribing role. A framework analysis approach was used to identify key themes. Results: Participants were 18 advanced paramedics working in primary care, emergency departments, urgent care centres and rapid response units. All participants reported being adequately prepared to prescribe. Key benefits of prescribing included improving service capacity, efficiency and safety, and facilitating advanced clinical roles. Challenges included technological problems, inability to prescribe controlled drugs and managing expectations about the prescribing role. Concerns were raised about support and role expectations, particularly in general practice. Conclusion: Paramedic prescribing is most successful in settings with a high volume of same-day presentations and urgent and emergency care. It facilitated advanced roles within multidisciplinary teams. Concerns indicate that greater consideration for support infrastructure and workforce planning is required within primary care to ensure paramedics meet the entry criteria for a prescribing role.

INTRODUCTION:Healthcare workforces are currently facing multiple challenges, including aging populations; increasing prevalence of long-term conditions; and shortfall of registered nurses. Employing non-registered support workers is common across many countries to expand service capacity of nursing teams. One task delegated to non-registered support workers is medication administration, which is considered a complex task, with associated risks. This is an important topic given the predicted global increase in patients requiring assistance with medication in community settings. This review explores the evidence on delegation of medication administration from registered nurse to non-registered support workers within community settings, to better understand factors that influence the process of delegation and its impact on service delivery and patient care. METHODS:The review followed key principles of Critical Interpretative Synthesis and was structured around Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Literature searches were conducted in MEDLINE, CINAHL, Embase, and ProQuest-British Nursing Index databases. Twenty studies were included. RESULTS:Findings are reported under four themes: 1, Regulatory and contextual factors; 2, Individual and team level factors; 3, Outcomes of delegation; and 4, Process of implementation and evaluation. Delegation was found to be a complex phenomenon, influenced by a myriad of interconnecting factors at the macro, meso, micro level. At the macro level, the consistency and clarity of government and state level regulations was found to facilitate or impede delegation of medication administration. Lack of clarity at the macro level, impacted at meso and micro levels, resulting in confusion around what medication administration could be delegated and who held responsibility. At the micro level, central to the interpretation of success was the relationship between the delegator and delegatee. This relationship was influenced by personal views, educational and systems factors. Many benefits were reported as an outcome of delegation, including service efficiency and improved patient care. The implementation of delegating medication administration was influenced by regulatory factors, communication, stakeholder engagement, and service champions. CONCLUSION:Delegation of medication administration is a complex process influenced by many interrelating factors. Due to the increased risk associated with medication administration, clear and consistent regulatory and governance frameworks and procedures are crucial. Delegation of medication administration is more acceptable within a framework that adequately supports the process, backed by appropriate policy, skills, training, and supervisory arrangements. There is a need for further research around implementation, clinical outcomes and medication errors associated with delegation of medication administration.

This study aimed to explore the experiences of men from African and African Caribbean heritage on transition to fatherhood and support received. Semi-structured interviews were undertaken with eight black fathers living in the south east of England. Four themes were identified: preparation for fatherhood; experiences post birth; influences on ideas about fatherhood; and reflections on transition and suggestions for support for future fathers. While some fathers benefited from formal support, others did not attend antenatal classes and there was uncertainty around healthcare roles identified during the men's experiences post birth. Findings highlight the importance of extended family and friends in providing advice and the importance of culture in forming the identity of African fathers.

With the demand for medication continually growing, Nicola Carey and Karen Stenner discusses how non-medical prescribing can ease the burden; showcasing a new online toolkit ‘Preparing to Prescribe’, that will aid the future training of prescribers

Background Increasing numbers of nurses, pharmacists and allied health professionals across the world have prescribing rights for medicines: over 90,000 of the eligible United Kingdom workforce are qualified as non-doctor prescribers. In order to inform future developments, it is important to understand the benefits and impact of prescribing by allied health professionals including physiotherapists and podiatrists. Aim: to compare outcomes of physiotherapist and podiatrist Independent Prescriber (PP- IP) patients with those of physiotherapist and podiatrist non-prescribers (PP-NPs). Outcome measures included patient satisfaction, ease of access to services, quality of life and cost implications. Design: a mixed method comparative case study Methods: Using mixed methods of data collection, outcomes were compared between 7 sites where care was provided from a PP-IP (3 podiatrist and 4 physiotherapist IPs) and 7 sites from a PP-NP (3 podiatrist and 4 physiotherapist NPs). Patients were followed up for 2 months (2015-2016). Results: 489 patients were recruited: n=243 IP sites, and n=246 NP sites. Independent prescribing was found to be highly acceptable, and equivalent in terms of quality of life (p>0.05) and patient satisfaction (p≤0.05) compared to care provided by NPs. PP-IP care delivery was found to be more resource intensive than PP-NP, with longer consultation duration for IPs (around 6.5 mins), and a higher proportion of physiotherapy patients discussed with medical colleagues (around 9.5 minutes). Conclusion This study provides new knowledge that PP-IPs provide high levels of care. PP-IP care delivery was found to be more resource intensive. Further research is required to explore cost effectiveness. A more focussed exploration within each profession using targeted outcome measures would enable a more robust comparison, inform future developments around the world and help ensure non-doctor prescribing is recognised as an effective way to alleviate shortfalls in the global workforce.

Background Increasing numbers of nurses, pharmacists and allied health professionals across the world have prescribing rights: over 90,000 of the eligible United Kingdom workforce are qualified as non-doctor prescribers. In order to inform future developments, it is important to understand the benefits and impact of prescribing by allied health professionals including physiotherapists and podiatrists. Aim: to compare outcomes of Physiotherapist and Podiatrist Independent Prescriber (PP-IP) patients with those of Physiotherapist and Podiatrist non-prescribers (PP-NPs). Outcome measures included patient satisfaction, ease of access to services, quality of life and cost implications. Design: a quasi-experimental, post-test control group design Methods: Using mixed methods outcomes were compared between 7 sites where care was provided from a PP-IP (3 podiatrist and 4 physiotherapist IPs) and 7 sites from a PP-NP (3 podiatrist and 4 physiotherapist NPs). Patients were followed up for 2 months (2015-2016). Results: 489 patients were recruited: n=243 IP sites, and n=246 NP sites. Independent prescribing was found to be highly acceptable, and equivalent in terms of quality of life (p>0.05) and patient satisfaction (p≤0.05) compared to care provided by NPs. PP-IP care delivery was found to be more resource intensive than NP-PP, with longer consultation duration for IPs (around 6.5 mins), and a higher proportion of physiotherapy patients discussed with medical colleagues (around 9.5 minutes). Conclusion This study provides new knowledge that PP-IPs provide high levels of care. PP-IP care delivery was found to be more resource intensive. Further research is required to explore cost effectiveness. A more focussed exploration within each profession using targeted outcome measures would enable a more robust comparison, inform future developments around the world and help ensure non-doctor prescribing is recognised as an effective way to alleviate shortfalls in the global workforce.