Re-thinking Rehab

Continuing our series, Robert Millett speaks to an advanced clinical practitioner who works within a community response team

Community Rehab
L/R:AHP Louise Bailey, Abbie-Louise Frake and Abigail Barkham [Photos: Neil Turner]

Private practices, charitable enterprises and pioneering NHS services are all innovating to provide high quality community rehab services. In our continuing series of article, we hear from physios who are leading the way in different sectors, this time focusing on the role of an advanced clinical practitioner within an urgent community response team.

An exciting time

With the NHS investing in out-of-hospital care, now is an exciting time for the profession as the physiotherapy workforce has a key role in shaping what new services look like. This brings new career opportunities at all levels.   

The recent introduction of urgent community response standards by NHSE/I mandates that all systems in England must implement the minimum two-hour response standards by March 2022. Whilst some systems offer this service already, many have had to adapt to meet these standards and others have established new community teams with AHPs at the forefront.

Many of these teams work closely with general community therapy services to ensure a seamless transition for patients who may require longer term rehabilitation. 

The CSP believes that all patients should have access to high quality, person-centred community rehabilitation in the right place at the right time – and we know that physiotherapists working across all sectors are well placed to make this happen.  

Many members have come forward to tell us about how they are using innovation to develop their community rehabilitation services, while also driving up standards of practice, meeting government guidance and providing essential support to adults who live with long-term conditions.    

In this article we explore the role of an advanced clinical practitioner (ACP), working within a newly established urgent response service, and also speak to a band 7 physiotherapist about her career as a generalist community physiotherapist.  

Trainee ACP Louise Bailey works for Mid Hampshire’s urgent community response (URC) team, part of Southern Health NHS Trust.

The trust’s UCR service, which started as a pilot in 2019 and is modelled on recommendations set out in the NHS Long Term Plan, is made up of a multidisciplinary team of healthcare professionals, which looks after patients in their own homes and focuses on admission avoidance.

The service aims to meet the needs of patients who experience a sudden deterioration in their health or those with long-term conditions who experience a crisis phase.

Earlier this year, it was shortlisted in the Health Service Journal Awards “Community of Primary Care Provider of the Year” category. 

What is your role in the team?

First and foremost, it is about assessing, diagnosing and developing treatment plans. My role is varied and includes training and supporting the team, research and leadership, whilst also maintaining my identity as a physiotherapist.

And what does your ACP role involve?

As a trainee ACP physiotherapist, I complete autonomous and comprehensive initial assessments, and diagnose and devise care plans to provide short-term and intensive input to patients in their own homes. 

What other professions are part of the team? 

The UCR team has 30 whole time equivalents, including support workers, physiotherapists, occupational therapists and trainee advanced clinical practitioners. 

Our team lead Kelly oversees the day-to-day running of the team with admin support, and Dr Abigail Barkham is the consultant nurse providing clinical support. The trainee ACP backgrounds are wide ranging, including speech and language, paramedic, OTs, physios and nurses. 

What type of patients do you typically work with?

Predominantly we support older people to remain at home and to avoid unnecessary hospital admissions. 

Patients often present with frailty and frailty decompensation – such as confusion, falls or infections – and require regular monitoring. 

We also treat acute exacerbations of long-term conditions, manage complex discharges from outside the acute setting, and receive referrals from the Covid-19 virtual ward. 

How does the service differ from what was previously provided?

This team was previously called ‘Enhanced Recovery’ with the main aim of supporting patients out of hospital and providing rehabilitation. The new admission avoidance model has changed the focus towards those acute needs that can prevent hospital admission. The development of ACP roles has also provided the opportunity to progress towards working at an advanced level, whilst using the therapeutic assessment and treatment skills of a physiotherapist. 

How has your service aligned with the UCR two-hour and two-day standard, as set out in the NHS Long Term Plan?

Our team was modelled to be able to adapt to the standard. A pilot study was completed to enable us to comprehensively understand patient need, and demand and capacity. 

How do you find patients benefit from this approach?

Our service provides a joined up approach with GP and adult services to ensure that patients’ needs are met in a timely manner.

We have the time to address patient’s urgent needs, from a holistic standpoint, and involve other community providers to further support patient outside of hospital.

The feedback from GPs has been excellent. They’ve told us that ‘[UCR] is an excellent improvement to the clinical care of our frail patients’ and that we have longer than a GP to spend with the patient, so more time can be spent exploring the options for keeping the patient at home.

What does your ACP training involve?

I am in my first year of an MSc in advanced clinical practice. I have recently completed advanced physical examination module. I look forward to completing a non-medical prescribing module next year. Competencies developed within the team are broad and include venepuncture, 12 lead ECG and wound care. 

How do you work with ACPs from other professions in the team?

The breadth of experience among the ACPs and the rest of the team enables a truly multidisciplinary approach, allowing us to address the multiple needs of complex patients in their own home.

Have you any advice for physios who might be interested in becoming an ACP?

Becoming an ACP is a wonderful opportunity to develop and expand your therapeutic skills in new areas. It’s a challenging role, and alongside the study it requires hard work and dedication. However, the rewards are huge. It really is a thrill to assess and treat our patients holistically, and first and foremost to prevent hospital admissions. 

Providing holistic care

Vicky Farrell is a band 7 physiotherapist who works for Cornwall Partnership NHS Trust’s community rehab service

What made you choose a career in community rehabilitation?

As a generalist community physiotherapist the breadth of conditions that I see is fascinating. I never know what I’m going to see and no two days are the same. I’m continually seeing new things and it’s always an adventure!

What skills has working in the community enabled you to develop?

Community physios are well-rounded clinicians who develop a broad range of skills, meaning we can effectively work in challenging conditions while managing complex presentations. It requires open and adaptable communication skills to work with the variety of people we engage with daily.

What opportunities are available for physios looking to develop their careers in community rehabilitation?

We have support workers, band 6s and band 7s in our service and we work in clinics and domiciliary settings. For me, seeing how people function in their own homes really brings physiotherapy to life and helps you establish the real root cause of their presentation. We work with many other HCPs and agencies to provide holistic care. These include GPs, social prescribers, housing associations and even the police. You just wouldn’t get that opportunity in any other setting. 

There is no clear-cut career pathway in community rehabilitation but for me this is a bonus; I can pave my own way using knowledge of what my service needs alongside my beliefs and passions to create opportunities that are extremely rewarding.

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