The Chartered Society of Physiotherapy The Chartered Society of Physiotherapy

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Your comments: 1 July 2015

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Forward thinking

Back in 2005 the King’s Fund warned that the writing was on the wall for the NHS as it stood. I sensed that both nationally and locally, our profession was under threat from funding cuts and in some measure from the nursing profession. I took this message to some of our leaders who said to speak to commissioners about our essential services and a new way of working.  
 
In 2007 I was fortunate to find a listening ear in our trust’s new ‘patient-centred’ chief executive. He took on board a vision for a multidisciplinary team (MDT) based at our community hospital, reaching out into the community, which was at that time up for reconfiguration. It was adopted by local authorities and went on to win awards under the leadership of a visionary rehabilitative occupational therapist. It serves in- and outpatient needs and Brookfields is seen as a beacon of hope by older people in Cambridge. An emergency response vehicle followed with an on-board MDT, a model which is now being copied throughout England. 
 
There is indeed life after a shake-up and each time we read Frontline we read of these innovations. The Five year forward view, under Simon Stevens (NHS England’s chief executive), is not just for show. It really does deliver and I remain convinced after many years of serving a variety of health needs, we must never be afraid to raise our voices and the profile of our profession which is becoming more central to that deliverance by the day.
 
  • Margaret Coles

Safety first

The Society of Musculoskeletal Medicine offers training and professional support to CSP members working in musculoskeletal (MSK) practice at all stages of their careers.
 
We are concerned about the potential for overuse of corticosteroid injection therapy in MSK physiotherapy service delivery, and in particular where injection therapy is used as a sole intervention rather than part of a rehab programme.
 
We are unsure of the reasons for this, but our members report that restricted care pathway algorithms and a focus on one-stop intervention clinics may be factors limiting more comprehensive rehabilitation and treatment options for patients.
 
Physiotherapeutic injection therapy is an advanced practice activity that offers real improvement in functional outcomes for patients presenting with a range of MSK and neurological disorders. It may be performed under either ultrasound guided or surface anatomy marked needle placement but in all cases effective long-term outcomes are predicated upon good clinical assessment, clear differential diagnosis and sound clinical reasoning.
 
We are concerned that such changes in practice, if proven, may result in poorer patient outcomes and the potential for clinical challenge to a physiotherapist’s practice and allegations of negligence if the patient believes they have been harmed by injection therapy.
 
We were pleased to be part of the cross-professional network collaboration to introduce minimum expectations of initial training in injection therapy and we now ask that the CSP considers the need to introduce further practice direction on the safe and effective use of injection therapy as part of physiotherapy practice.
 
Paul Hattam, chair, education committee, Society of Musculoskeletal Medicine (SOMM), Jill Kerr, Jonathan Smith, Emily Goodlad, Elaine Atkins, Anne-Marie Ainscough-Potts, Alison Smeatham, Fleur Kitsell

CSP professional adviser Pip White replies:

The use of injection therapy by physios is generally safe thanks to the high standards promoted by our professional networks. As care delivery contexts evolve we must remain vigilant to new risks to practice. I am happy to start discussions with SOMM, and other groups, to see what further guidance may help members to ensure continued patient safety. Email: whitep@csp.org.uk
 

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