Summer Report from Nick Downing, APPN Chair

Advanced Practice (AP) Physiotherapy is going through a period of rapid change and development. Whilst the terminology of Advanced Practitioner has been broadly accepted replacing Extended Scope Physiotherapists/Practitioners there remains a clear gap in understanding of titles, roles, banding, context and accreditation of AP roles.

As the APPN we are pushing to drive forward advanced practice roles and shout about the value and benefits that we, as physiotherapists, deliver. It is important to have a clear voice about our value in a rapidly changing healthcare environment where other AHPsare also using the title ‘Advanced Practitioner’. How do we differentiate and adapt alongside nurses, pharmacists etc. who are delivering advanced practice roles and building training and development pathways for their professions?  Should we stand apart or besides? Who leads who? With massive staff shortages across the NHS/Healthcare sector what will roles of the future look like?

The CSP released the AP physio paper in 2016 and structured the 4 pillars of Clinical Expertise, Leadership, Research and Education. Whilst clear that these should constitute elements of advanced practice, how and what do we measure against to demonstrate capability?

Health Education England (HEE) are driving apprenticeships in physiotherapy at AP level and are looking at Consultant level too. We need to have a voice at this table to influence and guide the direction of travel. In a recent conversation with a leading Higher Education Institute (HEI) we discussed the risk of AP level courses for all AHPs potentially undervaluing the core skills that Physiotherapists have, that are not so clearly a part of other AHP core training. Is it right or reasonable to differentiate ourselves and our skillset as a profession? And if we do so how does this fit with the wider tide of development, pressures and needs of the NHS and healthcare. How can we meaningfully demonstrate our skills/patient outcomes/service impact/change and leadership to the right people in the right places? Is our greatest risk to ride the current wave but to miss the boat on standing up for ourselves and our profession? What might this mean down the line in 1, 3, 5 years’ time?

HEIs are building AP programs to support a growth in Physio roles and 30% year on year increases in Physio training places to support the NHS long term view and drive for FCP roles. However, the need for the FCP roles is now. A graduate on a fast track development scheme is unlikely to reach an FCP role quickly so the cavalry is likely to arrive too late. Alternatively, to fill the demand that is there less experienced physios may move into FCP roles and the value of the role potentially gets watered down if outcomes/patient experience/decision making is lesser…

The APPN are actively involved in these conversations. First to seek to understand and then influence on behalf of our members and wider physio community. At our latest APPN meeting we discussed the work that is happening across the committee in various forums to move forward our position on all these questions with an aim of influencing and informing. The APPN now regularly meet with the CSP and are consulted on developments. We are meeting with the Consultant group to agree the best way ahead for some of the issues outlined. We are focused on ensuring that the APPN committee represents the current national developments and as such have actively engaged with HEIs to join the committee.

Historically we have been MSK focused. This was not a plan, more a realisation, and we would now like to address this with input from neuro, respiratory and other specialities. This will allow us to have a greater understanding of the broad AP issues and to support members more effectively. We are proactively working with other professional networks to collaborate and support each other to ensure we offer best value for members and with the aim to make it clear to all on where to seek support and advice on specific issues be that AP, injection therapy, acupuncture….

Our new mission and vision helps us to guide the direction of travel but your voice is key. We continue to want your feedback and discuss this within the committee meetings to ensure that our output – study days, research grants, leadership, education and clinical excellence are all promoted in line with what you as the membership need. Please keep sending ideas, thoughts and concerns to us.

Nick Downing

APPN Chair

Summer 2019