Breaking Out

With junior jobs in the NHS scarce, more graduates are finding work in 'non-traditional' sectors.

There are some new graduates out there who are frankly a bit fed up - but not for the usual reason. They are fed up with being portrayed as jobless and without a hope of a career. Quite honestly, they say, it's just not true. There is now a small but growing band of newly qualified physiotherapists who have taken the initiative and secured a first job in the private or voluntary sector. A handful are even setting up in private practice on their own. Claire Formby, class of June 2006, Salford University, turned to the voluntary sector when she found herself unemployed last summer, securing a part-time job running a gym for BASIC (Brain and Spinal Injuries Charity). 'It is orthopaedic-assisted exercise,' she says. 'It's for people who cannot access a normal gym because they have Parkinson's disease or multiple sclerosis - mainly people with neurological conditions.' It is good experience, she says, although much narrower than she would gain in a traditional new graduate post in the NHS. And the pay is low, at just £12,000 for a four-day week. It's not without difficulties, either. She has had to organise her own continuing professional development, helping to set up a workshop for unemployed graduates in Manchester, and her own supervision. 'I have two hours a week supervision from someone at Hope Hospital,' she says. 'Otherwise I am in charge. That's the biggest problem.' Ms Formby is now heading back into the traditional route. In March this year she got a full-time rotational band 5 post at St Thomas' Hospital in London. 'It's going to be fantastic,' she says, noting she is looking forward to full-time support. Lottie Bell is another new graduate who turned to the independent sector. She's in a research and development role for Neural Pathways, an independent provider based in Gateshead. She takes research into practice and it's been 'fantastic'. She has had access to supervision and a chance to use her skills to the full. 'I really didn't expect this sort of role at this point in my career,' she says. Recently she went for a weekend away with other newly qualified physiotherapists and students and her boss. 'We discussed different business ideas of how we can develop junior positions,' she says. She'd recommend a job in the private sector to new graduates. 'At university you only learn about the NHS, and it isn't until after graduating that you find out about all the opportunities in the independent sector. For me it's been great.' What Graduates Need There are more. Frontline has been contacted by new graduates in a wide range of roles and settings, from a children's hospice to charities to a private pain clinic. Physio First, the CSP's occupational group for private practitioners, now has new graduates in its membership. It's a controversial area and the CSP is exploring the implications. Jamie Mackler, student adviser, says: 'Private practice is generally not something that the CSP has previously encouraged for newly qualified physiotherapists due to, among other things, their lack of clinical experience, the potential lack of senior support or access to a structured CPD programme, and a potentially limited career development pathway.' The reality is that the current job climate leaves some new graduates no choice. With this in mind, Mr Mackler suggests some criteria for graduates working outside the NHS (see: Going it alone?) He says: 'With the appropriate support it is possible that newly qualified physios can practise safely within the private sector. With the backing of senior colleagues willing to mentor and share their knowledge, regular meetings with peers and structured CPD training, there is a possibility of newly qualified physios developing in the same way that they would in a junior role within the NHS.' Carol Owen is not convinced this can be achieved in private practice, however. Her view is that setting up in private practice as a new graduate is potentially dangerous. 'I think it's a really difficult area,' she says. 'We understand the sensitivities and we recognise that graduates when they qualify are autonomous practitioners. But this is only within their scope of practice, and their scope of practice is limited. In private practice you have to be prepared for whatever your patients present with.' There are other issues too. How many new graduates are familiar with laws on planning, national insurance and tax, health and safety, and disability discrimination? How many are prepared for the isolation of working alone and bearing the full cost of education? 'I wish there was a magic wand we could wave to solve this,' says Ms Owen. 'I think there is scope in other areas such as working within a GP practice. But new graduates need to be working alongside more experienced practitioners.' Caroline Southgate, who runs a private practice in Essex, is more optimistic. She believes some newly qualified graduates may be capable of setting up by themselves. 'It's not for everyone; I reckon one in 100 new graduates might do it. There is nothing to stop them, but they do need mentoring, supporting and supervising.' Many graduates are not the typical 22-year-olds of yesteryear but more mature people with existing businesses, she points out. She has now put together a 'comprehensive programme' to support new graduates setting up their own private practices. Called the professional development and support programme, it costs £5,000 over two years. Currently there are six newly qualified graduates signed up. They receive weekly mentoring, courses in cardiopulmonary resuscitation and manual handling, business skills and the like. Concerns over Career Development The other side of the coin is the value that new graduates bring to the new environments in which they are working. Liz Mather, national head of physiotherapy for BUPA Hospitals, is very clear it's a two-way street. Two years ago BUPA began to employ new graduates to work with inpatients, financed out of its extended choice contract to treat NHS patients. It was a big departure for BUPA, which has traditionally employed only those with five years' experience. Leaving to one side the irony of NHS money being used to pay staff that the NHS can't afford to employ, it's been very successful. The new graduates have brought in the best of current practice, she says, and given her more qualified physiotherapists a much-needed chance to develop their person-management skills. The new graduates have proved to be very flexible too, working unusual shift patterns that fit around the work. She has been very careful to provide the mentoring and in-house training that new staff need, and has had nothing but positive feedback from new graduates and from existing staff. Even so, she does not believe that new graduates should remain at BUPA too long. They can't work in outpatients where the five-year rule still applies, for example. Ms Mather says: 'We are not able to offer rotations, although we are talking with NHS colleagues about a spell at a BUPA hospital being a rotation. A year here is probably the longest they should remain for their own career development.' Career development is a sore point for some new graduates who have worked in the private and voluntary sector for a year or so and are now wondering about their careers. Melanie Turner works for a children's hospice and loves it. She knows she wants a career in paediatrics and says she is developing skills that would allow her to work in a number of areas. Yet she fears she would not be considered for a senior job because she lacks rotational experience or she may have to take a pay cut and do a rotational role later on. She says: 'Managers need to realise that for those juniors who have had to take specialist roles early on and are happy to do so, there needs to be a route for progression. I have been lucky that I haven't had to work at Tesco and I don't see why I should be discounted further career progression for this.' Going it alone? If considering working outside the NHS, newly qualified phyiotherapists need to ensure the following:     * appropriate mentorship     * access to immediate help and advice when required     * a structured training programme, including business and clinical training days     * peer support     * a clear understanding about working within their scope of practice   Frontline would like to hear from you What do you think? Is it possible, with appropriate support, for newly qualified physios working outside the NHS to develop in the same way NHS juniors would? Or are there too many hurdles for graduates working outside the NHS to overcome? Email your views to features editor Catherine Blackledge at Please state whether you are happy for your comments to be published.

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