The Chartered Society of Physiotherapy The Chartered Society of Physiotherapy


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Judith Spence

Pledge:  Spread the word about the major clinical and financial benefits of a MSK physiotherapist in Emergency Departments - right person, right place, right time.

What inspired you to pledge this change?

I have worked within the A&E department for 23 years. Physiotherapists have the best skills to assess and treat patients with soft tissue injuries. We should be there, frontline, to see these patients when they present to A&E. I felt frustrated that this wasn’t happening. We should promote what we do as physiotherapists. By involving physiotherapists there will be improved earlier management, and faster referral to outpatient departments as necessary

When did you start enacting your pledge? 

I have been doing it for years. However the Physiotherapy Works event gave me the drive to keep going as it has been a slow process it

What impact has [your pledge] it had?

We are establishing a seven day frontline service where patients will be triaged to physiotherapists. Since I work part-time, another MSK Band 7 physiotherapist has been employed to work with me to run the 5 day service. Additional MSK Band 7s from across the Trust will also complement the team at weekends.  This is great progress.

There will be challenges ahead, especially for other Band 7s as working at frontline will be different from what they do day to day. 

Patient care should focus on the best quality treatment with the right person. Patients will spend less time in A&E and can see a physiotherapist first, rather than only on referral from a doctor or an extended nurse practioner (ENP). Those patients who need it will receive acute treatment and they can be referred to other out-patients departments in a timelier manner  

How did the change develop you?

I am less frustrated. You have to be self-motivated and keep pushing. When you see the changes taking place you are reminded why you are doing it.

I’m fairly assertive and to push the agenda you need to be confident in yourself and have objective reasons for the change that you are proposing. It would be progress if everyone- medical lead A&E, orthopaedic radiologist, orthopaedic trauma team lead and physiotherapists would sit together to discuss the whole service – to establish a more efficient pathway where patients can be transferred smoothly and in a more timely fashion.

I have learnt to be self-motivated and driven and I have found that persistence eventually pays off. You need to nurture all relationships within and outside the department. Other staff can feel threatened by change and it is essential to have mutual respect for other professionals, recognising our different, but equally important, roles. 

What is your message to others who are considering taking something on?

Audit, audit, audit. You need objective evidence to back what you are trying to change. Important things to concentrate on are: trying to influence commissioners to reduce the current shortage of physiotherapists on heath boards. Audit- publishing and presenting findings. Keep up-to-date in the best practice and management of MSK problems and feed this information back to doctors and ENPs working in the A&E department.

What further support from the CSP would you find useful?

I think possibly more focus events like Physiotherapy Works which help promote our profession and encourage us to facilitate change on the ground.

Final message?  

Management has the tendency to focus on achieving patient turnaround targets.  Whilst this is important I believe that quality of treatment is paramount.


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