The design, development and implementation of a Musculoskeletal Trainee programme in a large MSK Interface Service (MIS)


A large MIS in North Staffordshire assesses 21,000 patients per year with musculoskeletal disease, providing over 100 clinics per week. Advanced Physiotherapy Practitioners (Band 8a) manage 85% of the case load. Interviews for Band 8a roles have identified that candidates often do not have the required skill set to operate at this level immediately. Therefore a twelve month Musculoskeletal Trainee programme was developed in order to provide the knowledge,skills and attributes to support a Band 7 Physiotherapists transitioning to a band 8a within an MIS setting. Prior to this programme there was no formal mechanism to support this process.


The bespoke programme was developed by a Consultant Physiotherapist (KS), Consultant Rheumatologist (AM) and Hospital Manager (EH), all of whom had been involved in delivering and managing the service for at least 10 years. It was iteratively developed through a process of design and reflection over a 2 month period. Content was informed by the need for active learning, mentorship and support, a planned increase in workload, reflection, evidence-based practice, clinical skills and audit. It was designed to sit alongside and complement the existing organisational development reviews. A stepped approach was planned to expose Trainees to an increasing level of clinical commitment and responsibility over the twelve month period. Trainees would be required to collect evidence to support each element of the Programme and regular progress reviews were timetabled.


A success Musculoskeletal Trainee programme has been developed and has subsequently supported three Band 7 Physiotherapist to progress to Band 8a within the MIS. Key competencies included;

• undertaking triage and awareness of treatment pathways

• subjective and objective examination skills

• diagnoses and evidence-based management

• communication skills (verbal, non verbal and written)

• managing expectations

• ordering and interpreting investigations

• awareness of inflammatory and non inflammatory pathologies

• awareness of red and yellow flag principles

• current medication used to manage MSK pain

• awareness of comorbidities

• development of audit skill

• develop Injection therapy skills

The Trainees commenced the programme having come from different clinical background (Rheumatology, Inpatients and Outpatients) but reflected on the value and the opportunity to undertake a bespoke programme. They highlighted the importance of mentorship, developing clinical and communication skills with support at a pace that suited their learning needs. One trainee reflected, 'I have thoroughly enjoyed my development post, mainly down to working within such a supportive, diverse and knowledgeable team of Extended Scope Practitioners and Medics. Their experience and knowledge has been invaluable whilst developing my own skills and knowledge for the role.'


A bespoke Trainee programme has been designed, developed and implemented and has resulted in three physiotherapists transitioning from a band 7 role to a Band 8a within a busy MIS.

This programme can support the ongoing development of staff wishing to work within a MIS and thereby allow succession planning. The wider team 'buy in' to provide mentorship and organisation support to transition pay from 7 to 8a on completion are vital.

Funding acknowledgements

This work was unfunded.

Additional notes

This work was presented at Physiotherapy UK 2019.