“Tis the season to be jolly”

A couple of thoughts about this year and the year ahead for MSK Physiotherapists

by Neil Langridge, NHS Consultant Physiotherapist

At this time of year it’s a great time to look back as well as looking forward. To do this personally and professionally I think is a great way to re-set the scene for oneself, and it also to develop goals and aims for the coming year. I like to look back at the previous year, and this year in particular I think has been a shift in the MSK world that really we should be “jolly” about as well as mindful that there is so much work ahead for the profession.

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There have been some real advances in what might be available for the physiotherapists of the future. Advanced practice has really taken off, it’s just the start but there have been some enormous leaps forward. Work developing the “Multi-professional  framework for advanced clinical practice” although published 14 months ago, will certainly begin to influence many opportunities for physiotherapists and AHPs. This is now driving advanced practice models such as the apprenticeship model which was approved in 2018 which will see employers, Universities, and clinicians working together to gain improved care, careers, and clinical practice.

Education

First contact work has gained further credibility with more data, more service transformation and courses being developed in Universities to support this work. It has seen its own framework underpinning it, data tools to help monitor it, cost calculators to help plan for it as well as clinicians coming together to help drive it. Health Education England working with partners in NHS England and the CSP have driven this to the table where STPs (Sustainability and Transformation Partnerships) are discussing it as part of remodelling and CCGs were mandated to provide pilots across England.

These pieces of work were well presented in the fantastic piece of work “AHPs into Actionand this document will help continue to inform how AHPs can continue to re-design and transform. Physiotherapists within the MSK field were used as examples in this document and once again highlights the national profile of what we do and can do.

The NIHR document “Moving forward – physiotherapy for musculoskeletal health and well-being” highlights some of the wonderful research that has led our practice and continues to inform the future.

Whether you agree or disagree with the messages the CSP have been driving many new initiatives in the promotion of the profession and activity. The wonderful campaign video that supported “Rehab matters” was very well put together, and really emphasised the need for rehab to be at the heart of our medical futures and values. The “Love activity, hate exercisecampaign had some controversy but it certainly once again brought home the importance of activity within our communities. PhysioUK 18, was in my opinion, a great success and was sensibly priced to encourage those who had not networked and gained CPD at this event in the past, the opportunity to experience a varied and interesting programme.

At a more local level, the” BigRs” movement continues to create conversation and developments. I have been fortunate enough to attend these, speak at them and also be part of the ongoing strands of work around trying to help develop the profession. I really like this model of critical enquiry, development, and challenge, but it’s done in such a way it encourages those involved via the winning of hearts and minds, building a model around respectful dialogue and leaving emotion and personal conflicts at the door. The “Physio Matters” team and “Connect Health” should be congratulated on their work so far with this and I look forward to the future work from this group.

From a personal and professional point of view, I am aiming to try to see how our MSK team can start to impact on the health and well being of the population we serve. Our main challenges this year are to try to improve our public health outcomes, look to engage with schools, local community groups and just widen the impact of physical exercise and good health models for our communities. This is something I am particularly looking forward to. We also have the challenges of supporting staff in tough environments; we have therefore looked to support staff at MSc levels, build improved local educational opportunities, seeing staff progress into specialist roles.

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I am looking to drive a Band 8a clinical lead in physiotherapy only, not as an Orthopaedic triage specialist, but as someone totally focussed on rehabilitation. I have witnessed these discussions across SoMe and want to act on them within my service. We have a Band 4 sports rehab role near ready to be advertised, this is something I am really keen on, the old style remedial gymnast, leading some of our classes and using skills in class taking and rehabilitation to complement what we do across all the services to de-medicalise where appropriate and where we can. The changes in CCG directives in many surgical options means we as a profession are ideally placed to resolve these lines of practice, it will be a matter of getting houses in order to achieve this.

These initiatives have been massively helped by the information I have received on SoMe and the discussions have prompted my local conversation, driving plans for 2019, so thanks to those I have learnt from.

I am looking forward to seeing the HEE funded FCP e-Learning programme to be completed. This was initially started by just asking SoMe colleagues for help and the interest and comments were staggeringly helpful. I now have an amazing team of contributors and all of the modules have a person-centred approach underpinning them.  The modules will, I think, be a valuable free to access resource. SoMe will be the platform to support its launch.

As in any reflections, there are concerns and worries, as it can’t be all “jolly”, things we wish we had done better, I certainly spend time thinking on this. I know we must continue to move forward and not harp back to historical philosophies.  We cannot ever really rest in developing an evidence-base that makes sense and change practice for the physiotherapists of tomorrow, in so doing, challenging the out-dated practice of today and consequently place our profession in the most professional light possible. I always look back in how I could have managed situations, people, working relationships and patients better and these are always my constant wishes to improve on.

The balance in being brave, critical and balanced in thinking whilst engaging change is a tough one to make, but one I will always strive for. I will continue in 2019, to push my service forward, see staff flourish, improve my own practice, be critical where necessary, and challenge those who I feel hold those processes back with personal, emotional views that inhibit the profession on the multi-professional and national stages. In my opinion being critical is an absolute must for development, offering an alternative view an absolute, but most importantly, do so in a way that commands respect from multiple perspectives through the skill and mastery of facilitating change that as a profession, I believe, we must develop further.

We have a fantastic profession and there are loads to be proud (and jolly) about, however, I don’t see things through rose tinted glasses, and I do know there are HUGE changes to make, but I still see the glass as half-full and I remain happy and positive (most of the time) about the future. In any culture there will be a mix of people and views, and I through 2019, will keep developing my knowledge of these, engage with those who offer different views, and challenge those whose values I just cannot find concordance with, as it is the professional values and behaviours of some that can at times influence the many. As well as being critical of the evidence base, I think the many should also develop and be confident enough to enhance critical enquiry across multiple mediums, sadly I know many who just feel inhibited through fear of reaction in SoMe and how they might be labelled.

So, in conclusion 2018 for Physiotherapy and the MSK arm of the profession has been a really advancing year in my opinion, there are loads to get involved in within the national new models of care, SoMe driven initiatives, evidence-based programmes, and local clinical practice progression, and so perhaps if you take those on they may aid your 2019 goals, like they have mine, good luck therefore with whatever you hope to achieve in 2019.

I wish anyone who is good enough to take the time to read this, my best wishes and kindest regards for the coming year.

Neil.

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