Introduction of Advanced Practice Physiotherapy in Dutch Primary Care is a Search for Possibilities, Added Value, and Mutual Trust; A Qualitative Study Among Advanced Practice Physiotherapist and General Practitioners.

Background: Despite the increasing deployment and added value of Advanced Practitioner in Physiotherapy (APP) in musculoskeletal care internationally, APP is not widely accepted in Dutch primary care yet. This may be due to constraints in the implementation of APP within the Dutch health care system. The aim of this study was to explore experiences and perceptions of APP and General Practitioners (GP) in implementing APP in Dutch primary care. Methods: This was an explorative and interpretive qualitative study among 13 APPs and 3 GPs that were in various stages of implementing an APP care model. Semi-structured interviews were conducted from January to March 2021. The topic list was based on existing literature, personal input of researchers, and the Constellation Approach framework. Data were analysed using a thematic inductive approach.Results: Four main themes emerged from the data; 1) The start-up of an APP practice requires trust and clear added value for the GP, 2) Starting APP must be strongly supported by GP, 3) Positioning of APP is still unclear, and 4) Ownership of patients with musculoskeletal complaints. These four themes put forward perceived difficulties in gaining trust, lack of clarity regarding the added value of APP, ambiguity of the APP’s professional profile and positioning, lack of reimbursement structure, and APP’s struggle in seeking balance with current care. Conclusion: This study shows that the implementation of an APP model of care is challenging. The deployment of APP does not sufficiently align with the core values of GPs, and GPs seem reluctant to hand-over some control over patient care to APPs. APP does not appear to have ownership of the implementation, given its strong dependence on the practice, values and needs of the GP.Trial registration: Ethical approval is obtained from the Medical Ethics Committee of the VU University Medical Centre in Amsterdam; reference number 2020.17. All participants were asked written informed consent before participating in this study.