Advanced Physiotherapy Practitioner Network: UK Edition

Thanks to the APPN for inviting me to their committee meeting this month. We tried out my new fun quiz…

What is another name for Advanced Practitioner recognised in Australia and New Zealand? Specialist is another commonly used term.

Are the terms advanced practitioner or specialist protected in Australia or New Zealand? Yes, in New Zealand, the terms is regulated by the New Zealand Board of Physiotherapy. These terms are not regulated in Australia but they are part of a career pathway.

How do you become a specialist in Australia or New Zealand? In Australia there is a 2 year fellowship programme through the Australian Physiotherapy Association. In New Zealand there are no specific training programmes.

Can you spot the difference between Advanced Practice in Australia and New Zealand compared to the UK?

At present (December 2019) the term Advanced Practitioner is not protected or regulated in the UK. There is currently no specific training or qualifications required to become an Advanced Practitioner or have this as your job title. This is something that could change in the near future and we should learn from countries which have already implemented specific programmes and requirements.

The APPN Committee also answered some burning questions about what they thought about Advanced Practice…

#1: Word association…Advanced Practice….Experienced, complex clinical reasoning, Level 7, 4 pillars, specialist.

#2 What job roles or titles are used to describe Advanced Practitioners in your area of work? ESP, FCP, clinical lead, orthopaedic practitioner, APP, ACP, clinical specialist (if the term ESP is still hangin around in the workplace of the APPN committee there is hope for us all!)

#3 How is advanced practice accredited or tested in your area of work? The answer to this question was discussed as being very locally driven with most using competencies and peer review.

#4 What training support or mentorship is provided for advanced practitioners in your area of work? Again this was shaped by local practices but also national networks and organisations like the MACP and higher education institutes.

#5 What exciting new areas of clinical innovation in advanced practice are you aware of? womens health, learning disability, rheumatology, paediatrics, pain.

# How do advanced practitioners add value in your work place? knowledge of pathways, expert specialist knowledge, decreases delays, provide holistic care and utilise multi-professional approaches.

I was particularly interested to hear about the areas of clinical innovation that the committee were aware of. Being an MSK clinician I can easily get caught up in the MSK or FCP world but physiotherapists are becoming advanced in many different areas of medicine including Frailty and Emergency Medicine which is something I will be exploring on my Fellowship.

Thanks to the APPN. Look out for my article in the Spring edition of Horizon too.

Emergent Themes

Just a quick post this evening to launch my project themes.

These have been developed through discussions and interviews with contributors from the UK, Australia and New Zealand over the last few months. These themes will form the basis for my discussions throughout my Fellowship and are key areas for the future development of advanced practice.

I work in the NHS (in Gloucestershire Health and Care Services) in a split role between First Contact Practitioner Service in primary care and an advanced practice led orthopaedic assessment service. As such my interest in advanced practice is skewed towards an MSK bias. Advanced practive obviously includes many areas of physiotherapy but due to my are of clinical expertise I will focus mainly on MSK services.

Within this remit the themes emerging from my contributors so far are:
1) Education and training
2) Regulation and Governance 3) Clinical Innovation

I am particularly interested in sharing and learning about the challenges and successes with implementing advanced roles and services. I will be meeting with clinicians and leaders involved in implementing innovative advanced practice services and in the development of competencies, educational frameworks or regulatory structures for advanced physiotherapy practice.

Stay tuned…

Specialist Semantics

In the last few months since I have been concentrating on surfing, “Zooming” and making video calls in different time-zones; all in earnest for my upcoming Winston Churchill Fellowship travels. The aim is to gain an understanding about the complex topic of Advanced Practice from an international perspective.

This blog will demonstrate some of the fruits of my labor. This is a complex area with a few traps and pit falls in cultural context and language. I hope you will help me to continue my learning by offering your thoughts in the comments section below, especially from those I have spoken with as it is important these words are representative of our conversations.

In the Oxford English Dictionary there are two definitions offered of the word “Advanced”:

” Far on or ahead in development or progress. “

” New and not yet generally accepted. “

Advanced Practice is consistently far ahead and occasionally new and not yet generally accepted. Elements of what we see as advanced practice can be accepted practice in one country but disputed in others. For example, in some areas injection therapy may be seen as “far on or ahead” when discussing physiotherapy practice, in some areas it is well embedded and accepted while in others it is new and not yet widely practiced or governed for.

As an international term I have come to think of “Advanced Practice” as any level of practice above that which can be expected of an experienced clinician. After this the term “Advanced” becomes confused depending on the context its used in. Other such terms include “Specialist”, “Extended”, “Enhanced” and these all have different educational attainment levels, different levels of experience and different responsibilities.

Advanced Practice also seems to have a different flavour in each place I have looked, this could be due to the drivers of healthcare which exist in each country and the way this shapes practice.

I would like to outline below my current grip on the situation of Advanced Practice internationally. Through the very nature of my Fellowship I hope this view will grow and expand to add more clarity and nuance.

The UK Perspective: I am very grateful to Richard Collier for spending the time with me to understand more about the current understanding of Advanced Practice in the UK. Other contributors have been Neil Langridge, Amanda Hensman-Crook, Beverley Harden and many more. The information below is England- centric and I still have some work to do to understand the perspectives of the devolved nations.

As well as the insight of those great minds I have also drawn on the following documents: Multi-professional framework for advanced clinical practice in England, Musculoskeletal Core Capabilities Framework.

There are many conversations happening regarding Advanced Practice in the UK at moment, some of these conversations have been bought to light thanks to the spotlight on First Contact Practitioner services currently so I will make my thoughts as succinct as possible.

Advanced Practice in the UK is currently (Nov-2019) unregulated and is not a protected title. There are many job roles in use to describe Advanced Practice.

The Multi-professional framework discussed above provides an overarching framework for competencies of Advanced Clinical Practice. Advanced Clinical Practice is a level of practice which covers 4 specific pillars of practice; clinical expertise, research, education and leadership. Advanced Clinical Practice is not the same as being advanced in your clinical practice…this is because of the importance of the 4 pillar, you can be advanced in your clinical practice, your clinical reasoning even in clinical skills which are at top of license or beyond physiotherapy scope of practice but this may not be Advanced Clinical Practice unless there is evidence of leadership, education and research at a Masters Level (7). At present Advanced Clinical Practice is not a regulated level of practice or protected title but there is work within Health Education England to change that.

The Australian and New Zealand perspective to follow…

References

https://www.hee.nhs.uk/our-work/advanced-clinical-practice/multi-professional-framework

https://www.skillsforhealth.org.uk/services/item/574-musculoskeletal-core-skills-framework

Add title here: ACP/APP/FCP/MSK/LOL!

I am feeling a touch of shame this morning. A friend asked me what I do. We have known each other for some time but we don’t talk about work really. I was sharing the news about my Winston Churchill Fellowship and the next questions came “so what do you actually do?”. I did my best, taking up as little time as necessary so as not to bore the dinner table but also shining light on the pioneering work being done by AHPs. But despite my monologue the response was “so you’re a nurse trying to be a Doctor”. Oh the shame!

First of all I’d like to say that my friend is very educated and doesn’t work or interact with the healthcare industry so could this be an educated public’s view of Advanced Clinical Practitioners and Advanced Physiotherapists?

This also highlights the view of nurses and their ANP counterparts. Their role seems to be understood and accepted but are they still seen in the shadown of their medic colleagues rather than in their own achievements and qualities. We have inherited a hierarchical healthcare system which was mostly occupied by consultants, junior doctors and nurses until AHPs came along and started occupying the bottom rung.

What can we learn from the nurses battle with public perception in our own route to equal status?

A systematic review in 2017 (Jakimowicz et al.) found that ANPs struggled to negotiate and clarify the scope of their roles in spite of a growing move for more ANPs in primary care. The BMJ published an article 13 years ago called “Nurse-led General Practice” calling for a change in the way we think about primary care and yet ANPs are still struggling with their identity as viewed by colleagues and the public.

I hope that I can learn more about how services, organisations and clinicians have tackled this problem through my Fellowship. Perhaps an accrediting body such as that proposed by HEE (The Academy) which would require advanced practitioners to prove their worth would improve our standing in the public’s eye. In the meantime though what do we call ourselves and how do we explain to our friends over dinner that we don’t massage people’s legs and we’re not trying to be Doctors.

And the award goes to…

08/04/2019

Today I announced my Winston Churchill Memorial Trust (from now on just WCMT to save me from repetitive strain) Fellowship Award to the world, ie. Twitter.

It is refreshing (and relieving) to find that not only are my colleagues who I see every week very supportive and lovely but also colleagues who I have connected with briefly at meetings and who I have known only over the Twittersphere are also lovely and encouraging. Thank you all.

I had this grand idea in my mind that I would make a coordinated announcement via all social media outlets, bang, bang, bang! But hey ho, life, my non-medical prescribing studying (exam prep and coursework XXL) and trying to get home from work on time (crash on the m5 slipway-very sad) got in the way. I am certainly not a perfectionist but I do like to get things done. Love a good tick list. So here it is, my strategically planned social media campaign.. a brief Twitter hello and a blog site that I’m proud to say has 2 blog posts already!