JMIR Publications

ABSTRACT

Background:

First Contact Practitioners (FCPs) are increasingly embedded in UK primary care to provide direct access to musculoskeletal (MSK) assessment and management, but face significant variation in governance, scope of practice, and supervisory support. Real-world data feedback that helps clinicians reflect on their practice against evidence-based standards could support safe, high-quality care, but no validated tool of this kind currently exists for this relatively new and structurally complex role.

Objective:

To co-design the PRISM (Primary Care Individual Social Norms MSK) dashboard and accompanying guidance document with FCP experts, and to map the resulting metrics against national clinical guidelines and quality indicator frameworks.

Methods:

We conducted a qualitative co-design study using a modified Nominal Group Process across two structured workshops with 10 purposively sampled participants, including practising FCPs, physiotherapy leaders, and a patient and public involvement representative. Consensus-based ranking identified candidate metrics, quality indicators, and contextual filters, while critical realist thematic analysis of workshop data surfaced the structural and governance conditions shaping how PRISM should function. Following the workshops, the co-designed metric set was independently mapped against 15 NICE musculoskeletal guidelines and the Braybrooke et al. primary care MSK quality indicator framework.

Results:

Participants reached consensus on a core metric set, three categories of contextual filters, and content priorities for an accompanying guidebook. When mapped against the NICE guidelines, all 15 were at least partially supported by PRISM, with 10 directly supported and none unaddressed. Against the 11 Braybrooke quality indicator themes, all were at least partially supported, including 6 of 9 process and structural themes directly supported. Exercise prescription and self-management advice emerged as the most evidence-significant metrics across both frameworks. Participants identified data quality, supervisory variation, and the risk of social norms feedback being misread as performance judgement as key implementation risks, leading to the dashboard being designed to function both within structured clinical supervision and as a standalone reflective practice tool.

Conclusions:

Co-design with FCP experts produced a dashboard metric set that maps credibly against national evidence-based quality standards, demonstrating that structured co-design with clinical experts is an effective and replicable method for grounding digital health tools in evidence for new and structurally complex clinical roles. The critical realist analysis identified governance variation and supervisory quality as preconditions for safe implementation, which will be tested empirically in an upcoming feasibility trial. Clinical Trial: not applicable.