Investigating consultation models in General Practice: a scoping review

Consultation models provide structure for healthcare clinicians when interacting with patients and help clinicians to process the information they gain throughout the consultation (Denness, 2013). They can improve communication between clinicians and patients, which in turn can lead to better patient outcomes, patient satisfaction, and clinician job satisfaction REF. A range of different consultation models are used by GPs. Commonly used models include Pendleton (Pendleton, 1984), Neighbour (Neighbour, 2015), and Calgary-Cambridge (Silverman et al., 2016). Learning about consultation models and how they are relevant to good practice is a key part of training for General Practitioners. The Calgary-Cambridge model is used for teaching consultation skills in the majority of medical schools in the UK (Gillard S et al., 2009, O’Neill, 2015 ), and has been shown to improve patient centredness (Bombeke et al., 2012). With diversification of the General Practice multi-disciplinary team, it is not only GPs who are performing consultations in General Practice settings. The use or adaptation of established GP consultation models by other health professionals, eg. Paramedics (Hastings, 2024), Pharmacists (Da Costa et al., 2020), and Nurses (McLeish & Snowden, 2017), has been studied. A qualitative study (Hastings, 2024) and a narrative literature review (Da Costa et al., 2020) found that although using a GP consultation model can assist with structuring consultations, profession-specific consultation models would support clinicians more effectively in providing high-quality, person-centred care. First Contact Physiotherapists (FCPs) are one of the professions who, over the last 10 years, have become part of the General Practice team. FCPs are expert clinicians who provide specialist care for patients with MSK conditions in GP practices as a first point of contact. This role can increase capacity in General Practice and ensure that patients receive early expert diagnosis, management, advice, and appropriate onward referral as needed (Chartered Society of Physiotherapy, Principles of Effective and Sustainable First Contact Physiotherapy Services, 2022). FCP consultations need to be conducted differently to consultations typically conducted in conventional physiotherapy clinics. This is because the primary purpose of an FCP consultation is to undertake safety screening, to provide an initial diagnosis and to provide first line MSK management, whereas conventional Physiotherapy consultations are focussed primarily on rehabilitation (HEE, MSK FCP Services Implementation Guide, n.d.). Furthermore, the average appointment time for an FCP consultation is considerably shorter (typically 20 minutes for an FCP consultation (Halls et al., 2020) compared to 30-60 minutes for a conventional Physiotherapy appointment). Embedding FCPs in General Practice has been found to be clinically and cost effective (Walsh et al., 2024), but there is evidence that some FCPs are struggling to adapt to the different demands of FCP consultations . Bater and Sellars (2022) found FCPs had moderate to high levels of burnout, and Nozedar and O’Shea (2023) found high levels of exhaustion or risk of exhaustion in FCPs. These survey studies are supported by qualitative findings of high levels of complexity in FCP work, the majority of FCPs feeling at risk of or experiencing burnout (Greenhalgh et al., 2020), and expressing worries around clinical uncertainty (Ingram et al., 2023). It is likely that the way they perform consultations, has led to some of these difficulties that FCPs face. There is also the consideration that as FCP services expand across the UK, less experienced Physiotherapists are moving into FCP roles, who will require more support to deliver safe, high-quality consultations (Stott et al. 2025). There is currently no evidence regarding FCPs’ use of consultation models, or which consultation model might be most effective to support clinicians in providing high-quality, patient-centred consultations. This is a protocol for a scoping review to identify consultation models used by GPs, FCPs and other healthcare clinicians in GP settings and to explore evidence supporting effectiveness of these models and specific components within them.