Faced with the burden of musculoskeletal care in New Zealand, this study explores 19 participants’ views on the drivers and barriers to developing musculoskeletal advanced physiotherapy practitioner (APP) roles in New Zealand. An exploratory case study methodology was applied, and semi-structured interviews were conducted as one of the multiple data sources. A purposive sampling strategy was used. Data were analysed using qualitative content analysis. This publication primarily focuses on the results of the semi-structured interviews. The results of this research identify unique drivers for the APP role development in the New Zealand context, such as surgeon engagement, legislative requirements, and profession-led issues, in addition to global drivers. Interviewees identified that the barriers relate to New Zealand’s dual healthcare system and its nuances that impact patients and physiotherapists. Additional barriers include a lack of title and recognition, funding and career pathway, training, and inter-professional and intra-professional barriers. This research explores the reasons for the limited uptake of APP roles in the New Zealand context despite strong drivers. Interviewees advocate the development of APP roles as first-contact practitioners for patients presenting with musculoskeletal complaints to improve patient journey, streamline services, and provide timely, effective, and efficient care. They recommend that APP roles are tailored to meet New Zealand’s unique healthcare drivers.