Kenneth Chance-Larsen 03.25.2025

Challenges in primary care

We are living longer, and as the population ages, there is an increasing burden of disease and a higher demand for healthcare services. Governments are concerned about recruiting sufficient healthcare personnel for primary care. Therefore, it is necessary to explore whether new forms of collaboration and the redistribution of tasks can alleviate some of the pressure on primary care.

Norway and England have publicly funded healthcare systems that invest significant resources in musculoskeletal health, accounting for up to a third of consultations in primary care and a third of sick leave in Norway. This represents a substantial part of a general practitioner's (GP's) workload, which is why there is a political push for new models of working and task shifting between professions to relieve the pressure on GPs. Limited resources and increasing demand in primary care can be managed by rethinking collaboration, with the distribution of responsibilities and tasks being done in new ways.

Can experiences from the introduction of a new model of care and task shifting for musculoskeletal disorders in the United Kingdom in 2019 be transferred to the Norwegian setting? This model allows physiotherapists in England to work in GP practices as first contact practitioners, and English health authorities aim for all adults with musculoskeletal disorders to be able to consult such physiotherapists. This doctoral thesis investigates the usefulness of the experiences from England for the Norwegian context.

Four studies

Chance-Larsen has investigated how various structural conditions affect collaboration and task-shifting, as well as how political directives and changes can help address challenges in primary care. Through the four studies included in this doctoral thesis, Chance-Larsen first describes the development of a national musculoskeletal capabilities framework for first contact practitioners in England, a framework now utilised for system change and professional development. The thesis then presents an evaluation of a postgraduate training programme for the first contact practitioner role in England, and a study of how GPs and physiotherapists approach task shifting within musculoskeletal health in Norwegian primary care.

Task shifting and better collaboration offer opportunities

In his thesis, Chance-Larsen contributes new insights into how task shifting in primary care can help strengthen health services for people with musculoskeletal disorders. The doctoral research indicates that professions tend to protect their boundaries, leading to friction when these professional limits are changed or expanded. This can result in unforeseen consequences at both the system level and the «street level» where patients and healthcare personnel meet. At the same time, this friction can contribute to the development of locally adapted solutions that are adopted by those involved.

Taken together, the studies in the thesis indicate how resource use and quality in musculoskeletal healthcare in primary care can be improved through formal and informal collaboration between professions and by providing the right care at the right time. However, such improvements are dependent on the political and economic foundations of primary care making task shifting both professionally and economically attractive for practitioners. Furthermore, new forms of collaboration are dependent on professional organisations and practitioners embracing new working methods and the shifting of traditional boundaries between professions.

Personalia

Kenneth Chance-Larsen (b. 1969) holds a BSc (Hons) degree in physiotherapy from the University of Brighton and a MSc Manual Therapy degree from Manchester Metropolitan University, both in the United Kingdom. He is an Associate Professor at the Department of Health and Functioning, Western Norway University of Applied Sciences (HVL). The doctoral work was funded and conducted at HVL. Chance-Larsen has been a PhD candidate in the PhD programme Health, Functioning, and Participation at the Faculty of Health and Social Sciences, HVL.

Trial lecture

Tuesday the 25th of March 2025, 10:15 AM.

Place: Aud. M005, Campus Kronstad.

Title of the trial lecture: Patients in primary care present with increasingly complex musculoskeletal presentation. How does research evidence support the physiotherapy management of this patient group?

Public defence

Tuesday the 25th of March, 1 PM.

Place: Aud. M005, Campus Kronstad.

Thesis title: "Skill-Mix Change and Task Shifting for Musculoskeletal Disorders in Primary Care: From Framework Development and Workforce Training to Opportunities for Service Improvement."

The trial lecture and the public defence will be held in English.

Assessment committee

Committee chair: Associate Professor Tove Ask, Western Norway University of Applied Sciences

1^st Opponent: Associate Professor Fiona Moffatt, University of Nottingham, UK

2^nd Opponent: Professor Erik Lønnmark Werner, University of Oslo

Chair of the public defence

Vice dean of research, Marjolein M. Iversen, HVL.

The trial lecture and public defence will be streamed from this link (zoom).

Supervisors

• Professor Tobba Sudmann, Western Norway University of Applied Sciences
• Associate Professor Michael Backhouse, University of Warwick, UK
• Professor John Richard Collier, University of Chichester, UK