Natalie Beswetherick retires as CSP director of practice and development. She speaks candidly to Gary Henson about initiating change, making a difference championing the physiotherapy profession
It is said that Natalie Beswetherick embodies the phrase ‘championing the physiotherapy profession’ in that she’s “all-in” and open to change in terms of clinical ways of working.
I think that’s been true my entire career. If I spotted an opportunity for change then I took it.
‘I’ve always relished a change if it was purposeful and you were doing it because there was a problem that was crying out, “The way we’re doing things is not the best way of doing it for that particular patient population.”
‘It’s about looking at the whole picture – I always go back to looking at the population that you are needing to assess, treat or manage and then at which service delivery model will actually meet their needs and give better outcomes for the patients.’
She certainly practised what she preached. In the 1980s working in a remote Cornish coastal location, she created a forerunner of today’s First Contact Practitioner (FCP) service to make physio accessible for a mostly elderly population with little access to private or public transport.
When she started work there, the only access to physiotherapy for many patients was in the local hospital’s outpatient department. An infrequent bus service and the fact many patients did not have their own cars meant many missed out on vital rehab.
‘People used to retire there and many couldn’t drive, so I provided physiotherapy in primary care.
‘Rather than having clinics at the town, I took some of the clinics out to where the population lived.
‘The positive was that I could see people who lived and worked in that area in their local health centre. I went twice a week and they could just self-refer, come in and they would be seen and advised by me and that saved them travelling all the way into the town, which was 13 miles away.
‘It was about having a physiotherapist in the practice to see people with musculoskeletal conditions promptly, which is the same principle as FCP’s.’
A decade later, in Gloucestershire, she helped set up physio direct telephone triage and a complete self-referral scheme for the whole area, which also saw physios sited in GP practices.
‘We were shifting what we did to what actually met that local population’s needs rather than, perhaps, your preference as to where you want to work.’
She shows signs of frustration that more than 20 years on, some in the profession are still resisting the change. ‘There are still swathes of the physio population who carry on doing what they’ve always done, and those are the people who need to really shift and change now.
Natalie is direct about who in the profession she means: ‘Non-acute physiotherapy services that are provided from very large acute hospitals, rather than being sited in the community. They’re nowhere near where people live.
‘And if you have areas of social deprivation it can be a real nightmare, as patients may have to get three buses to reach the outpatient department at the hospital.
‘The physiotherapy profession needs to wake up to and start thinking seriously, “Am I giving access to services to people who have the greatest need? Or am I just doing the things that I’ve always done, because it is easy and I don’t have to change?”’
Apart from innovating in models of primary care in her clinical practice Natalie has led at the CSP the development of the vision for UK physiotherapy and on revising the four pillars of physiotherapy practice.
But the pace of innovation in the past 18 months has been unlike any she has seen in her career. She speaks of ‘really transformative’ advances coming out of the Covid-19 pandemic.
‘It pushed large swathes of the profession to adopt digital platforms, enabling us to shift almost overnight to a new way of working. The profession really grasped the opportunities to continue to provide the best quality services they could – with online classes, online initial consultations and then follow-up consultations with patients.
‘Yes, there were still some people who believed the only way you could carry on being a physiotherapist was to see people in person. But what we saw from the pandemic is that was not the case.
‘It was a fantastic example of how a positive transformational shift in the way we practice the profession can come out of a deadly pandemic.’
Equity and diversity
The question of diversity in the profession, in education and research is a critical piece of work for the CSP. Our new EDB strategy seeks to ensure that the future workforce aligns itself in terms of diversity within society, explains Natalie.
There needs to be a significant shift. ‘We’ve already seen a significant change in the student physio population in terms of diversity which is increasing year on year. But of course there is a long way to go.
‘A lot of people who are from ethnic minority communities don’t even think about going into physiotherapy because they don’t see anybody on the programme or in the profession who looks like them.
‘In turn, many patients will not see many people in this profession look like them, which we know would be strongly enabling.
‘If we don’t attend to that we will never break through and understand the different needs of different population groups.’
Though she believes improving the diversity of the profession is key, advancing the understanding of the needs and lived experiences of different patient populations is a duty for all physiotherapists, whatever their background.
‘There’s an awful lot of physiotherapists that may not understand and may not have been exposed to treating people from diverse communities. It’s important for everybody to start thinking about how we are a multicultural society and we do need to understand the difference and understand other people’s experiences.’
Natalie said she was optimistic about change.
Natalie said that her realisation of her own unearned privileges was a wake-up call and a start of her journey to understanding what she could do to be an ally for those without her privileges. She believes many in the profession are on the same journey and many more were woken up and have made a pledge following the inspirational Founders lecture at Physio UK in November.
Natalie urges the profession to understand the richness afforded by having a diverse profession embracing the protected characteristics of ethnicity, sexuality and disability, remembering that many disabilities can be hidden.
Disparities and inequities
Natalie called on the profession to be ‘much, much more aware’ of socio-economic disparities and health inequities.
‘They are really inherent in not just inner cities but in remote geographical locations, coastal towns where high unemployment pervades and where there’s little access to services.
‘I feel that there’s building pressure across multiple communities and professionals to understand that every professional – not just in health – has a part to play in that, to actually make a change.
‘Because disparities and health inequalities have been there for centuries, it’s not going to change overnight, but the more we recognise it, the more we can do something to make the changes needed.’
Natalie became a CSP steward in Plymouth at the start of her career. She says it helped to develop her ‘political astuteness’ – not to mention her ability to be ‘absolutely straight’ with people.
‘Because you were exposed to some really bad behaviours by some employers - and equally some really good examples - so you did have to listen to people and explore those issues with those individuals.
‘Being politically aware helps you understand the bigger picture, and I think that was one of the critical pieces of learning and development of skills, that I got as a steward.’
That built on lessons she learned from her father, when she was a teen.
Her dad was an agricultural labourer and ‘a strong’ trade unionist and shop steward in the Union of Allied Agricultural Workers.
She recalls a fatal incident when a workmate drunk a highly toxic odourless and colourless poison thinking it was lemonade.
‘As a trade union rep dad took his case to a board meeting of the manufacturer of the weed killer and they agreed to change it so it had a pungent smell and was bright purple.
‘My father made an impression on me that you could get change because that clearly was unacceptable practice, health and safety wise, on every level.
‘There is no doubt that because I was a steward I was so much more knowledgeable across the whole of health and social care policy than anybody else – it enabled me to get a senior management position at a very young age.’
Reflecting on her leadership of the CSP’s vision for physiotherapy – to transform lives, maximise independence and empower populations – Natalie said:
They still hold good today because that’s exactly what physiotherapists do.
Natalie believes that the CSP punches way above its weight. The profession continues to develop its scope of practice, innovates and changes to transform patient’s lives. The profession is world-leading and held in high regard by physiotherapy organisations across the globe. She knows all too well that for the positive disruptors and innovators progress feels too slow and for others who don’t want to change, it is too fast. The profession is being held back by some laggards who Natalie urges to wake up, change and be part of a profession that constantly seeks to transform even more people’s lives.
CSP chief executive Karen Middleton:
'Under Natalie’s leadership over the last 11 years, the profession has gone from strength to strength with standards and its profile never higher. I have seen for myself how that leadership is viewed on the international stage with physiotherapists and organisations turning to Natalie for her expertise, experience and wisdom. But Natalie’s leadership goes back a long way: she was the first chair of the Allied Health Professions Federation as she could see what the collaboration with AHP colleagues could achieve in terms of influencing. She also led the work on first contact and telephone triage – I can remember as a physiotherapy manager myself being told to go and see what she was doing in Gloucestershire! And, of course, her whole professional life is one of service to the profession from CSP steward through to chair of council.'
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