Workforce

Physiotherapy assistants in the musculoskeletal outpatients setting

Physiotherapy assistants accounted for approximately 20% of the physiotherapy workforce across Stoke on Trent Community Health Services. Although their job descriptions clearly stated that the post was primarily clinical, their role depended heavily on the qualified physiotherapists and how they utilised the clinical skills of physiotherapy assistants. As a result in some clinics/clinical areas physiotherapy assistants had a predominant clinical role whereas in others they fulfilled what was primarily an administrative role. This latter trend led to physiotherapy assistants not being able to utilise their clinical skills and to job dissatisfaction as well as disparity in the clinical service provided to patients of equal clinical needs.

Telephone-based triage and diagnostic accuracy of spinal pathologies

Advanced Level Physiotherapy (ALP) is a term used to describe a level of practice for a physiotherapist to be working at. It includes utilising a combination of advanced skills, knowledge and clinical reasoning to successfully and safely manage patients, recognising where a clinical presentation is outside an individual's scope, and taking appropriate action. Utilising advanced clinical reasoning and making appropriate radiology referrals enables physiotherapists to exclude serious pathology and determine the appropriate pathway for a patient. Being able to safely triage and direct patients to conservative management or escalate to an orthopaedic review where suitable is the cornerstone of a clinically-effective service, and highlights the benefits of having experienced physiotherapists on hand to guide patients appropriately. Many studies have looked at whether the diagnostic accuracy of physiotherapists is comparable to orthopaedic consultants, but the diagnostic accuracy of a telephone based ALP triage service has not previously been investigated. The aim of this study was to audit the diagnostic accuracy of radiology investigations performed for spinal pain (cervical, thoracic, lumbar and sacroiliac) by a telephone based ALP triage service.

Working with complex persistent pain

To describe the role of an Advanced Physiotherapy Practitioner (APP) working within a multidisciplinary team with people with complex persistent pain in acute hospital, outpatient and community settings.

To describe relevant physiotherapy skills required in these settings

To describe the clinical outcomes of the service

Transformation of Therapy Services

To examine the key factors influencing the transformation of Therapy Services within our institution, creating links to sustainable service quality improvements. In 2014 Salisbury NHS Foundation Trust (SFT) carried out a service wide consultation of Physiotherapy and Occupatonal Therapy provision with the aim of transforming Therapy Services. The key outcome from the consultation was the re-organisation of Therapy Services into defined team "clusters" under a single management structure, creating a Head of Therapy Services who reports directly to the Chief Operating Officer and Director of Nursing. The key challenges were addressing the collaborative working within Therapies and across the hospital taking into consideration professional isolation within Directorates, localities, Wiltshire and Wessex Deanary; staffing, recruitment and retention; morale and innovation; and patient flow.

Community Respiratory Team

To demonstrate how a specialist respiratory physiotherapy service placed in the community can prevent unnecessary hospital admissions in patients with COPD.

Development of Botulinum Toxin-A service in Fife, Scotland

I wanted to highlight the cost savings gained following a review and change of service delivery to children with focal spasticity in a district general hospital.  The purpose of the review and change was to improve the service we provided to children and their families in terms of timeliness on intervention, proximity to home and follow-up with known clinicians. 

Although the data is from 2014, we continue to inject less that 10% of our children under a general anaesthetic compared to 78% in 2009.

This service is led and delivered by a physiotherapist working in an extended role – initially Clinical Specialist, now Advanced Physiotherapy Practitioner with support from Orthopaedic and Neurology consultants.

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