Advancing your practice

Professional advisers Alex Nambyiah and Tamsin Baird evidence your impact across the four pillars of advanced practice

Advancing your practice
Advancing your practice [Illustration: Patrick George]

The advanced practice (AP) agenda in the UK is exciting, dynamic and offers broad career development opportunities. 

Each UK country has an AP framework that sets out a definition and the capabilities required. AP describes a level of practice at master’s level or equivalent. All registered healthcare professionals from a range of backgrounds can achieve this level by fully meeting the four pillars of AP: clinical, leadership, education and research.

Although there are four defined pillars, in reality these are integrated and each learning experience will likely be influenced by, and develop all these pillars to some degree. However, it is useful to think about opportunities to develop each area of your practice.

How can the four pillars be demonstrated in practice?   

Clinical

  • Assessing and managing risk and complexity using critical thinking and expert decision making 
  • understanding and addressing population needs  
  • embedding evidenced based practice (EBP)
  • working with high levels of autonomy within limits of competence and professional scope
  • demonstrating excellent person-centred care, supporting shared decision making and empowering others
  • role modelling excellent clinical practice

Education

  • Education of yourself and others, actively contributing to the culture of learning within your organisation creating a quality learning environment, inspiring others to grow
  • supporting the wider healthcare team to develop knowledge and skills
  • active involvement in practice-based learning, curriculum delivery and/or mentoring
  • coordinating, delivering and evaluating in service training 
  • coaching and mentorship of others 

Leadership

  • Leadership of yourself and others, creating change and continuous improvement.
  • leading person-centred care
  • transformation and service development
  • influencing and negotiation
  • networking

Research

  • Embedding critical appraisal and use of research within your practice, evaluating current practice of yourself and others clinical audit, leading or engaging in research
  • evaluation of service delivery
  • undertaking quality improvement processes
  • dissemination and implementation of best practice

Top tips

Get a mentor  

Seek advice and inspiration from experienced clinicians to help you identify and engage with a range of learning opportunities.

Show evidence of impact and integration across all of the AP pillars

Do not just focus on the clinical pillar. Ensure that you integrate all of the pillars and try to streamline learning opportunities that that have the potential to reflect master’s/PhD level.

Develop a wide base of core knowledge

AP education includes both formal and informal learning alongside university modules and courses. Take advantage of online learning resources including webinars and podcasts. 

Take control of your own development

Keep an open mind and look for opportunities such as secondments with universities, government bodies or research. Look at AP level job descriptions to guide you on the areas to develop.

Constantly reflect on what you are doing and why

Collect evidence, get feedback and assess yourself against relevant frameworks.

Shadow others

Seeing others in the role will help you plan your learning, educate and inspire you.

Network 

Join networks such as the Advanced Practice Physiotherapy Network (APPN). Many run conferences and offer educational grants.

Do not rush to advance your career

We all have less favourable clinical areas of work, but do not underestimate the experience that you gain. Use every experience even if it feels like a sideways move.

Be prepared to face challenges

Development often occurs outside of normal working hours and sometimes requires funding. Surround yourself with support. Don’t give up, there will be setbacks, but it is worth it!

Inspiring examples in practice  

The CSP’s AP web pages have many examples of physiotherapists around the country. Below we have highlighted how some of the case studies have had impact across the four pillars. 

Katie Kinch is an advanced practice paediatric physiotherapist in NHS Fife

Clinical
I am responsible for the assessment, diagnosis and management of referrals to a general paediatric orthopaedic clinic and lead clinician for the management of orthopaedic needs of children with neurodisability. I also jointly work with a paediatric neurology consultant in a motor disorder clinic.

Education
I have a local role in clinical education for the children and young people (CYP) physiotherapy team, paediatric medical team and GP trainees. Nationally I am involved with the foundation course for the Association of Paediatric Chartered Physiotherapists neurodisability group and carry out study days for Cerebral Palsy Integrated Pathway National Network and British Neurotoxin Network Paediatrics.

Leadership

  • NHS Fife paediatric orthopaedic service lead role
  • clinical leadership role within CYP physiotherapy community team
  • chair of the Association of Paediatric Chartered Physiotherapists neurodisability group
  • board member of the British Neurotoxin Network Paediatrics
  • Scotland representative for Cerebral Palsy Integrated Pathway National Network
  • Fife representative for Cerebral Palsy Integrated Pathway Scotland
  • helped to establish the Scottish Paediatric Physiotherapy Injectors group
  • supporting/advising/liaising with other regions in development of AP roles in paediatric orthopaedics and paediatric physiotherapy led focal spasticity services

Research
I carry out service development, audits and quality improvement projects within the paediatric orthopaedic clinic and CYP team.
Jo Jennings is an orthogeriatric advanced practitioner at South Warwickshire NHS Foundation Trust (SWFT); seconded as simulation and clinical skills lead.

Clinical
Although I am currently shielding, I usually shadow clinical colleagues to keep up to date with the clinical environment. As simulation and clinical skills lead, I prepare and deliver clinical scenarios for simulation teaching.

Education
I write e-learning packages for clinical skills and deliver the Quality Service Improvement and redesign course at SWFT. 
I also work as an hourly paid lecturer at Coventry University teaching the undergraduate physiotherapists and as a community tutor teaching Warwick University’s medical students in conjunction with SWFT.

Leadership
I co-lead the development of the simulation service at SWFT and work as specialist advisor for the Care Quality Commission. I also co-lead the Health Education England AP credential in older people and am a member of the following groups:

  • CSP’s professional committee
  • British Geriatric Society’s (BGS) education and training committee
  • BGS Nurse and AHP council
  • APPN executive committee

Research
I have undertaken several quality improvement projects and currently I am undertaking a research project in simulation. 
I attend and speak at regional and national conferences and act as a quality improvement poster assessor and\or poster judge at the BGS national conference.

Chandrasekhar Dekka is a clinical director and lead for Nexus Health, a provider of FCP services

Clinical
I am an advanced physiotherapist in general MSK conditions and rheumatology and carry out discussions and public health promotion with patient participation groups. I am also pursuing a PG certificate in sonography.

Education
I have an educational role for the GPs in MSK and for the GP surgery staff regarding the  role of FCP and streamlining referrals. I also provide clinical support, clinical supervisions and peer support to my colleagues.

Leadership
As FCP implementation and clinical lead for a MSK service, I regularly meet primary care network directors and work on implementing local pathways such as sinister pathology, cauda equina syndrome and secondary care.

Research
I am currently doing masters level university courses and I regularly conduct audits and evaluate the service. 
Martin O’Hanlon is an MSK FCP primary care/advanced practice physiotherapist in Newry & District GP Federation, Northern Ireland

Clinical
I work in GP practices assessing, diagnosing, treating and signposting patients with MSK problems. This sometimes involves requesting bloods and imaging to help aid diagnosis and plan treatment. I also prescribe medication to help manage MSK problems and administer joint and soft tissue injections.

I attend injection supervision sessions regularly to review and update current EBP and participate in non-medical prescribing sessions to discuss medicines management issues and changes to practice.

Education
I carry out teaching sessions with GP trainees and act as a clinical resource for GPs in the practice for MSK issues. I keep up to date  with current pharmacological management of osteoporosis and educate the FCP team to develop their prescribing knowledge to manage osteoporosis as per EBP. 

Leadership

  • developing the FCP role in the Newry & District Federation
  • working with colleagues to help discuss caseloads and share knowledge/learning
  • working as part of a wider multidisciplinary team in primary care with a focus of improving public health and narrowing health inequalities in the area

Research
I completed two master’s modules in AP, a PG certificate in medicines management and prescribing and I am working towards a master’s in physiotherapy.

I lead a joint project with practice pharmacists aiming to reduce opioid prescribing for MSK problems and working on advancing the role of physical activity in primary care for management of MSK problems and wider physical and mental wellbeing. I have regular engagement in patient and public involvement and gain feedback  to help advance the services provided.

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