"Direct Access Physiotherapy and Medical Task Sharing and Shifting, I'm on Board, But There Are Some Caveats": A Qualitative Study Exploring Family Physicians' Conditional Acceptability and Perceptions of New Physiotherapy Models of Care in French Primary Care.

backgroundIn France, two care models have recently been introduced to improve access to physiotherapy for patients with musculoskeletal complaints: direct access to physiotherapists (PTs) and medical task sharing and task shifting between family physicians (FPs) and PTs. While these models aim to improve timely access to non-pharmacological care, French FPs' perceptions and acceptability remain largely unexplored.

objectiveTo explore French FPs' acceptability and perceptions regarding direct access physiotherapy and FP-PT task sharing and task shifting for patients with musculoskeletal complaints in primary care.

methodsWe conducted a qualitative study using semi-structured interviews with 18 FPs, with one FP included per French region (18 regions). Twenty-seven FPs were contacted and 18 agreed to participate. Interviews were transcribed verbatim and analysed in NVivo using an inductive thematic analysis informed by Braun and Clarke's six phases. Saturation was operationalised as the absence of substantially new codes or candidate themes during iterative analysis; this threshold was reached after 14 interviews and confirmed by four additional interviews.

resultsFPs described both models as acceptable in principle, but not unconditionally. For direct access, they emphasised the need for clear patient selection criteria, structured training, clinical guidelines, and secure communication channels. For task sharing and task shifting, acceptability depended on formal protocols, competence assurance, and explicit medico-legal accountability. Across both models, a cross-cutting tension emerged: FPs reported high confidence in PTs they knew and worked with, while simultaneously questioning the readiness of the profession to assume expanded responsibilities without stronger governance.

conclusionFrench FPs did not reject these models, but their acceptance was cautious, conditional, and strongly context dependent. Implementation will likely require staged deployment, postgraduate training pathways, shared information systems, and explicit legal and organisational safeguards.