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Approximately 30% of general practitioner (GP) consultations are due to musculoskeletal disorders (MSKDs). Physiotherapists are trained to assess, diagnose and treat MSKDs and provide an alternative to GP consultation for primary care patients as first contact physiotherapists (FCPs). To explore patient perceived acceptability of the FCP role using realist methods to understand what works for whom, how, why and in what circumstances. A realist evaluation was undertaken, which involved three stages forming the theory area framework