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Time to drive community careers forward

The government plans to shift more therapy from the acute sector into community care systems. The CSP has backed this approach, but says there must be proper career frameworks in both settings. Matthew Limb reports

The CSP has been warning government health officials that more attention must be paid to developing career structures in the community if ministers' plans to deliver more care outside acute settings are to be achieved. Recent discussions between the Society and the Department of Health have highlighted a range of issues, including the perceived lack of  consistent career structures for AHPs across the community.

Both parties agree that Agenda for Change (AfC)  provides the means of fairly matching physiotherapy jobs into the new pay bands.  But what needs to happen now is for career development 'avenues' to be opened up for community physios and assistants in every primary care trust. Throughout the UK community physiotherapists are at the centre of radical moves to redesign services, with new developments such as self-referral and rapid response teams. They work in a variety of settings, often alongside other health professionals, which brings opportunities to broaden their learning and increase skills - becoming team leaders and developing specialist clinical roles.

More varied and flexible working patterns  should allow community physios to consolidate their education and training. But the way some services are structured may make it difficult for community staff to 'climb the career ladder' and to develop their role, says CSP research and policy officer Penny Bromley. She told Frontline: 'Some community trusts don't have a culture of involving themselves in clinical education or research - activities which help in developing a portfolio of skills that assist career advancement.'

In addition, some physiotherapy staff working in smaller locality-based services may feel isolated from professional peers, and  distant from the central physiotherapy service or trust management structure. As a result there can be a lack of opportunities to develop leadership skills or advanced clinical roles.

Some of the problems are long standing, and the old Whitley grading criteria often masked issues of career and skill development in the community. Under AfC the issues are coming to the surface, and have been tackled effectively in some areas.  It is now essential, says the Society, for these examples of good practice to be widely and rapidly dispersed.

Pen Robinson, director of CSP member networks and relations, says the issues are complex but that historically, the higher grades of physiotherapy have tended to be built on increased specialisation. She told Frontline: 'Often in community services, unless working around a particular client group such as a paediatric service, you have a much more generalised but equally valuable range of skills and activities.'

She highlights another kind of specialisation, 'which probably isn't as clearly recognised as it should be': understanding the community in which people live and work, and the complex links involving other bodies such as social services, education, voluntary agencies and charities.

Ms Robinson continues: 'So often the specialist services that the community physio may bring to their community are not necessarily physiotherapeutic but much broader, in understanding the context in which that community functions. 'Through the new knowledge and skills framework, and the work being undertaken by Skills for Health, we need to identify much more coherently the knowledge and skills that are required for physiotherapists to function at a really high level in the community, which many do.'

The CSP believes government policies are well intentioned, and aimed at ensuring more AHPs work in community settings at the forefront of service changes. Examples of good practice exist, but there should be a more consistent, proactive approach across the sector to developing AHP roles.

Through the NHS staff council the Society will be reviewing all the results from AfC rollout, so that career opportunities for AHPs in the community can be tracked alongside those of the acute sector.

The Department of Health says it too favours developing AHP roles in the community, and supporting staff in gaining the required skills. Both issues can be addressed by the NHS career framework project, which is underway across the UK and is looking at the 'generic, common, shared and specific competences required to deliver services'.

According to the department, the project will include a specific community focus, looking at how competencies are combined into different kinds of roles and the learning programmes and qualifications that are needed to support them. Data will be collected from 'good practice sites' to capture the detail of individual practice in the community. Julia O'Sullivan, the CSP's head of continuing professional development, will represent the Society on this work and expects it to be taken forward at a meeting later this month.

Case study: Paul Chapman - community service manager in Rotherham

Community physiotherapist Paul Chapman is pleased with the way his career has turned out so far but concedes that chance, not choice, has often been more of a guiding hand.

'There hasn't been any formal structure to plot my way through,' he told Frontline. 'It's been very much a case of making it up as you go along.' After almost 20 years in the profession, Mr Chapman is now a superintendent II, managing an adult community service for Rotherham primary care trust (PCT). He is directly responsible for around 40 staff who work in various teams - domiciliary, clinic, and orthopaedic triage. In addition, he oversees a community rehabilitation team and staff who work in intermediate care.

'One of the reasons I went to work in the community was that I didn't want to specialise in a specific area,' he says. 'It gave me variety.' Mr Chapman qualified as a physiotherapist in 1986 and completed his rotation at Leicester General Hospital. He then did a senior II rotation and began to develop interests in musculoskeletal and neurorehabilitation physiotherapy. He says: 'At that point, I didn't know where I wanted to go next. One of my friends said, why don't you come and work in the community because you'll get all of that.' Taking the advice, he spent two years doing community work in Leicester as a senior II. After his post was upgraded, he worked for eight years as a senior I.

Mr Chapman continues: 'Then I got the usual itchy feet, disillusionment, all sorts of things, and decided I needed to move on.' He arrived at Rotherham in 1999, taking up what was then a superintendent III post, and his responsibilities gradually increased. He now has a strategic input at the PCT and deputises for the head physiotherapist in her absence. 'I would say I've been fortunate,' he adds. 'I've been in the right place at the right time.'

Mr Chapman pays tribute to his employers at Leicester and Rotherham - 'two very proactive services' - and the support he has enjoyed from his line managers. He says he was encouraged to pursue postgraduate education and study various management modules, which have bolstered his career.

But he acknowledges that these circumstances may not always apply to colleagues in other locations. For some of them, planning a career in a community setting can be 'difficult and frustrating'. Asked if there is an adequate support structure for physiotherapists pursuing careers in the community, Mr Chapman replies: 'I would probably say no to that. There isn't any positive career structure, unlike say in respiratory or musculoskeletal, where you can say I'm going to work at this for five years then move on to this.

'In Rotherham we have a community service, and we also have a paediatric service, a mental health service and a learning disabilities one as well. Some trusts don't have that, they might be managed by other services or by other trusts.'  He continues: 'Historically, you couldn't work in the community unless you were a senior physio. Here, we've tried to break down those boundaries and we've set up junior rotations. We are trying to develop some sort of career structure within the trust, but it's a model we're making up as we go along.'

The rewards of community working are considerable, says Mr Chapman. Although he enjoys working closely with colleagues from physiotherapy and other health professions, he values working 'independently' with patients. 'You see the patient as they really are. If a patient says they're struggling with the stairs, you can see the stairs they're struggling with. Trying to reproduce that in the hospital environment is very difficult.'

He adds: 'You have to be very adaptable. We have a multicultural society in Rotherham, you have to adapt to that. There are areas of deprivation and areas of wealth. You see life as it really is.' Mr Chapman welcomes Agenda for Change as a positive step forward for the profession, although his own post has yet to be matched with an AfC profile under job evaluation. 'It was difficult to place my job against a profile, with my experience and the things I was actually doing,' he says. 'When I look at the jobs advertised in Frontline I can never find one that compares with mine.' As a result, he has had to fill in a 36-page job assessment questionnaire. But he hopes the process will be resolved soon, and the outcome will reflect the way he feels about his job.

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