3 minutes with Nathan Humphries

I work as an advanced physiotherapist practitioner with the advanced clinical practitioner (ACP) team in the hospital’s emergency department. I spend most of my time in minors and paediatrics, where I autonomously manage patients who present with anything from minor to major life-threatening conditions, through to admission or discharge.

 

I believe the patients I see receive competent medical assessment and management. The benefit of having a physiotherapy background, besides providing musculoskeletal (MSK) expertise, is my knowledge of rehabilitation and being able to provide a different insight to care from medical and nursing colleagues, which enhances the team as a whole. 

 

ACPs were introduced to this trust in 2006 because of a shortfall in medical staffing. They now make a significant contribution to the emergency department workforce, with 53 per cent of the attending patients being seen and treated by non-medically trained staff. 

 

ACPs are capable of working as senior decision-makers and make fewer clinical mistakes and prescribe more safely than a transient workforce or middle-grade equivalents. A recent study, comparing permanent emergency department ACPs and emergency department middle-grades, showed that the emergency department ACPs saw approximately 1,000 more patients a year than the average medical emergency department middle-grade counterpart. 

I qualified as a physio in 1999, specialising in MSK outpatients from 2003. Three years later I began a split role, working 40 per cent of my time in physiotherapy MSK outpatients and the rest in the emergency department, initially exclusively seeing MSK presentations with the emergency nurse practitioner team.

 

I qualified in the management of minor injuries in 2007 and minor illness in 2011 and these new skills led to my joining the ACP emergency department team in 2013. As part of the ACP team I see the full range of emergency department presentations. I have gained skills in venepuncture and cannulation, for example, and in advanced paediatric and adult life support and am an independent prescriber. I am in the final year of an MSc in advanced clinical practice at the University of Warwick.

With the skills I have developed, I regularly teach MSK, neuro and minor injury management up to masters level to doctors of all grades, GPs, physios, nurses, paramedics, pharmacists and others. 

From medical, surgical, cardiac and orthopaedic teams to paramedics, pharmacists, social workers and mental health professionals, we all need to work together to provide the best care to patients. 

This is already happening in our trust. Physiotherapist ACPs have recently been introduced into intensive care, critical care outreach, trauma and orthopaedics, acute medicine and elderly care. Being an ACP allows true, independent, autonomous patient management. However, developing ACPs is more than a process of just teaching more ‘medicine’ to nurses and AHPs. For an ACP to grow and become effective, they need to be coached in decision-making processes. They also need networks, supervision and support from medical clinicians and from fellow ACPs who have completed the process.

Nothing. After a typically hectic shift in the emergency department staying awake is the problem!

 

Nathan Humphries is an advanced physiotherapist practitioner at the emergency department at Heart of England NHS Trust