Vision of a modern workforce

The role of physiotherapists in the surgical team is changing – and growing, says Amanda Trees.

I was invited this year to the Royal College of Surgeons of Edinburgh (RCSEd) to discuss the role of the advanced practice physiotherapist (APP) in surgical services. 
The occasion was the college’s triennial conference, the Modern Surgical Team: the Future of Surgery. The RCSEd is not only looking at developing and advancing its own surgical practices, but embracing changes proposed by the joint committee of the royal colleges and allied health professional bodies in the document Multi-professional Framework for Advanced Clinical Practice in England.  
The topic I was asked to discuss describes in part my 17-year journey to the job I love. My role is similar to that of other APPs in the field of paediatric orthopaedics. I lead our talipes service, providing ongoing training to the team, and making clinical decisions on the timing of surgery and follow-up care, with minimal surgeon involvement. 
I run my own choose-and-book paediatric orthopaedic clinics, refer patients for investigations and interpret results, list for surgery, co-ordinate inpatient admissions, organise post-operative care of elective surgical patients. I am also involved in specialist registrar teaching within the Northern Deanery, and have been heavily involved with the regional sustainability and transformation partnership for children’s surgical services.
I found it so encouraging that the RCSEd wants to work collaboratively with both nursing and allied health professionals to develop roles that will move medicine – surgery, in particular – away from the traditional boundaries and develop a new, modern workforce. 
The college wants to get involved with our training and nurturing, and fellows and members are excited by the prospect of having expert practitioners with a range of advanced skills and knowledge on their teams. They understand that practitioners in development roles will require mentorship and supervision, and protected time for CPD. They also need to set competencies and pathways, as well as the open communication and trust required for success. 
So if we have the support of (most) surgeons, our physio managers and peers to take these roles forward, why are there so few posts in practice? 
The consensus in Edinburgh was that higher up the hierarchical chain there is a lack of understanding and acknowledgement of our roles. The stakeholders and ‘investors’ don’t understand what they get for their money. The purse-holders see a business case for an APP 8a costing their trust £58,000 (with on costs), but a registrar will cost the same and can perform surgery. They fail to acknowledge that in 12 months’ time, the registrar will move on and a replacement will need to be trained.  
So where do we go from here? I challenge those of you who want to develop your posts to talk to the surgeons and your managers. Read the linked document for an insight into the skills and commitment required, then write a case for it. It’s worth it. 
  • Dr Amanda Trees is an advanced practice physiotherapist at James Cook University Hospital, Middlesbrough
Dr Amanda Trees Advanced practice physiotherapist at James Cook University Hospital, Middlesbrough

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