Pillar Talk part two

Where it started ……

In April’s Frontline we introduced the notion that the four pillars of contemporary allied health professional (AHP) practice should be considered at the earliest and every point in a career in physiotherapy. 

CSP professional advisers Sara Conroy and Tamsin Baird encouraged everyone in the profession, in all roles and at all stages of their careers to familiarise themselves with the pillars of clinical, research, education, and leadership. This is in order that we modernise our thinking on professional development and career progression to ensure we evolve as a 21st century profession that is equipped to ‘…influence, lead and work with others, to demonstrate quality and evidence-based practice, to be actively involved in educating and empowering others and to be providing patient-centred and safe care.’

Later in this article our interest was piqued with a ‘watch this space’ mention of emerging CSP plans to firmly embed the pillars into the profession. We were told of the CSP’s ambition to make explicit the knowledge, skills and attributes required of the profession’s workforce in education, research, and leadership as well as clinical practice at every level of practice and in every role. 

Your career, your adventure, your path

Plans of how to accomplish this ambition were finally revealed to members in July as we launched the modernising the physiotherapy career framework project.  

It is through the updating of the original 2011 physiotherapy framework and in situating the core domains of physiotherapy practice in the context of the four pillars that we hope to support the profession and others to view a career in physiotherapy differently. 

So, what difference does and could an awareness of the four pillars at every level of practice (as will be outlined in the new career framework) make? How will the new framework support members of the profession and others think differently about career opportunities and progression? 

Let’s talk pillars 

To explore this, we approached several members at various levels of practice, working in different roles and at various stages of their careers and asked them to reflect on their own career journeys. We asked them to what extent a better understanding of the relevance of the four pillars of practice has either had or might have had in their career.

Laura Bunce is a physiotherapist who graduated in 2021 and is currently working for Oxford University Hospitals NHS Trust in the early supported discharge for stroke service.

‘Understanding the need for development across all four pillars of practice is essential for any graduate entering their first role. 

Pre-registration training often focuses on the clinical practice pillar, with the other three being underappreciated as newly registered practitioners. 

I felt very privileged to have had the opportunity to increase my awareness and understanding of the other three pillars whilst undertaking a leadership placement as a student. It became clear on this placement that the professional growth required to develop into a rounded compassionate practitioner is dependent on more than acquiring clinical knowledge and skills. This is an insight I took with me into my first job as a new graduate, in a community rehabilitation role. The demands of this setting mean I mostly work independently with my patients. Therefore, it is crucial that I continue to develop my skills particularly in the leadership and education pillars of practice. This is something I am being supported to achieve in work, for example through regular supervision and preceptorship sessions, and externally from opportunities such as those acquired through my involvement with the CSP South Central regional network.

I believe it would be helpful for all students and new graduates to have a better understanding of the importance of four pillar development and start to think differently about how and where that development might be gained, right from the start of their careers.’

Lorraine Allchurch is an assistant practitioner and is the lead for AHP support workers at The Dudley Group NHS Trust.   

‘I was always interested in leadership and education in my support worker role, and I quickly developed an appreciation that at every level of practice the development of knowledge and skills in these pillars of practice is both necessary and critical for future professional growth. 

I actively sought opportunities to do this and in 2020 I was lucky that a pilot lead AHP support worker role at band 5 became available at my trust. 

This role would lead AHP support worker education and development. At interview, the development I had undertaken really contributed to me landing the job. 

My role has since been made permanent, demonstrating the commitment in my trust to developing all AHP support workers and I am currently in my second year. A new physiotherapy framework showing the opportunities and requirements to develop across all four pillars for support workers will help others to see what is possible and that a support worker role is more and can be more than clinical support.’

Bilal Sheikh is an advanced practice physiotherapist and co-director of Creative Physiotherapy Ltd, a company based in the Midlands where their interest is in helping people return to recreational sports after brain injury.

‘I’ve always been aware of the relevance and value of leadership, education and research in healthcare roles. This is because prior to becoming a physiotherapist I worked in the education and fitness industries. Skills in these areas were crucial to success with clients and to the business. After graduation as a physio, I took a courageous leap and took up a role in the charity sector with the Birmingham Arthritis resource centre as a research assistant and public information support officer. Not the usual route for a graduate but the opportunities for growth in education, leadership and research stood me in good stead as I progressed in clinical practice, where I had an exciting career in the independent and neuro rehab world. Now as a clinical director in an independent company I’m able to put all that growth and learning to good effect in my business; in how I work with patients; the research opportunities I pursue and, in the education, and support I’m able to provide to other members of the MDT.   

If a four pillar of practice focus on development at every career stage was more widely championed and appreciated earlier in my career, I would have had more confidence in making a decision that was right for me and the career development I wanted to pursue.

I would have been less put off by others saying it couldn’t be done that way. 

I hope the framework will inspire others to forge their own path acknowledging the contribution of all pillars when growing into the professional they want to be.’

Rachel Garfitt works in a dual role in the Belfast Health and Social Care Trust splitting her time between working clinically in MSK outpatients and as a learning and development and governance facilitator.

She credits her career progression into advanced practice to an understanding of the importance of development in all four pillars of practice. 

‘I was very focused on clinical practice and progression early in my career. When the Northern Ireland Advanced Practice framework was published it really highlighted to me that the 4 pillars are relevant at all levels of practice, it was this interest and belief that prompted me to further explore and pursue development in research, leadership and education. That development eventually led me to where I am now.  

In my current role I am passionate about introducing and encouraging growth in all four pillars to new graduate staff, regardless of where they see their career heading. Even if staff are firmly focused on clinical practice, I help them to understand the relevance of the other pillars; leadership, research and education are so integral to how we work as clinicians; how we engage and communicate with patients and colleagues, and how we use the evidence base to inform our practice and deliver the best care. We have recently overhauled our approach to appraisal to include demonstrating development in all 4 pillars. 

I am delighted that the CSP are modernising the profession’s career framework in the context of the four pillars as I do believe they should be embedded at every level of practice.’

Emma Harris is a MSK first contact practitioner working for Pure Physiotherapy in the East of England. She is currently working towards stage two of the FCP roadmap. 

Emma believes an understanding of the four pillars of practice and undertaking development in each is crucial at every stage of a career in physiotherapy. This awareness, she believes, would be helpful to hone learning from various experiences and enable the workforce to fully appreciate how development in each contributes to growth as a fully rounded professional. 

‘I was aware early on in my career that I was developing education and leadership skills as I took on additional responsibilities in my keenness to progress, but I don’t think I would have been able to describe other initiatives I undertook, such as service improvement projects, as activity and development in the research pillar. I hope that the new career framework, set out in the four pillars, will help the profession to appreciate that activities in education, leadership and research need to be part of every role at every level in order that everyone contributes to the development of physiotherapy as a whole, as well as their individual career journey. There are a multitude of opportunities in our brilliant and rewarding profession and it will be great if everyone could see that and understand the development required to get to where they want to be.’ 

Dr. Esther Clift is a consultant practitioner in frailty at Southern Health NHS Trust and a professional adviser for NHS England. 

For Dr. Clift, an awareness that she had been developing in all four pillars of practice didn’t really dawn on her until she became familiar with them during her consultant training. Had she been able to articulate their relevance to a career in physiotherapy earlier she senses she may have been even more confident to strive towards a position that traditionally had been seen as the reserve of doctors or nurses.

‘Discovering the four pillars of practice and the inherent capabilities within them was somewhat of a revelation to me as I started my consultant training. I loved developing as a clinical leader of multi-professional teams in an emergency department context but as I pushed further forward towards very senior clinical leadership, I felt somewhat an outlier as an AHP; this type of leadership development and role was not something others saw as relevant or appropriate for me as a physiotherapist, although my hunger for development, in order that I could influence the wider system was always supported by my colleagues in the MDT.

I hope a new career framework that focusses on developing capabilities across all pillars will support the entire profession to see how they can take the lead in transforming models of care. There must be an understanding that everyone has a responsibility to educate, to engage in service improvement and step towards leading, no matter their level or setting they work in. Its will be by doing this, that AHPs are embedded in system leadership.’ 

Bev Harrison is an assistant practitioner in older peoples’ and palliative care in NHS Fife. She credits a supportive manager to the development of her capabilities in all 4 pillars of practice. 

‘The four pillars of practice are familiar to the physiotherapy workforce in Scotland. They have been articulated in the country’s nursing, midwifery and allied health profession’s career framework here for several years. 

I only became aware of the relevance of them to my scope of practice as an assistant practitioner when I became an assessor for the Scottish Vocational Qualification for support workers and I only really gained support to develop in all four pillars myself, in order to work at the top of my scope of practice, when I moved to NHS Fife and received encouragement from my manager here. 

As a result of recognising how to address developing capability in the education, leadership and research pillars I have gone on to deliver audits; undertake a leadership course and I’m currently leading the development and implementation of a multi-disciplinary falls prevention class. This is as well as my continued development in the clinical pillar by undertaking a postural stability instructor course.   

Currently encouragement to develop and work across all 4 pillars for our support and assistant practitioner workforce seems dependent on who your manager is. Anything that can make this requirement more explicit is bound to help and would ensure everyone can see what members of the support workforce can achieve in their roles and enable them to work at the height of scope in their roles.’     

Leanne Simmons is an associate clinical physiotherapy lecturer at the University of East London. 

Following a string of Covid-19 redeployments from band 6 outpatient MSK rotations to medical ward-based practice, Leanne was unsettled in her clinical role. A nine-month rotation into higher education at the University of East London seemed a timely opportunity to diversify her portfolio. She did not expect the rotation to be as influential on progressing her clinical skills and her knowledge in addressing the ‘Educational Pillar of Practice’.

‘Advancing in my career on this rotation at the university has reignited my passion for the profession. Historically, expectations of professional advancement were limited to management. This opportunity has opened my eyes to more pathways in diverse professional environments. I have extended my scope of practice, led, researched and developed in the context of higher education.

My perspective on clinical practice has changed and I feel fortunate to have built a network of mentors and mentees that challenge my practice. The skills I have developed are reflective of the all pillars and I would encourage everyone to seek opportunities outside of their comfort zone. Over the last nine months, I have grown as a clinician but also as a person – priceless!”

Vishali Patel is a rotational band 6 physiotherapist in an acute hospital trust in London.

Having graduated in 2020 and now progressed into a senior role in which she is expected to teach and lead others and contribute more to service improvement, Vishali says she wishes she had been aware of the importance of developing capabilities in all 4 pillars as a student and a new graduate as this would have enabled her to set annual objectives around the pillars.  

‘As a new graduate my focus was on consolidating clinical skills development. It was only when I was faced with a couple of difficult situations at work did I have any idea how essential it is to develop in other areas. It was as a result of recognising some gaps in my leadership capability that I proactively applied for the CSP leadership development programme and was successful in being awarded a place. I’m looking forward to being a member of the next cohort on this course and seeing where this path takes me.’

Vishali hopes that a new framework with development in all 4-pillars made explicit will help to better prepare students and new graduates to develop the range of capabilities that are required to work successfully in practice. She also hopes that service leads and manager use it to support with appraisals and career conversations.

Adam Poulter is a specialist neuro physiotherapist and director of Foundations Physio, an independent practice specialising in neurological and older peoples’ care in Surrey. 

He focussed mainly on development clinically earlier in his career, latterly he intuitively sought to progress in research, education and leadership due to an inquisitive mind.

‘As I continued to develop as a practitioner, especially after I moved into private practice, I actively sought opportunities to develop myself beyond improving my clinical skills. As members of the profession, no matter in what context or sector we work, research, leadership and education should be a part of everyone’s role; it’s how we can pull together to progress the profession. For example, just like my local NHS colleagues, I have a relationship with Winchester University where I support as a guest lecturer and take their students on placement, I take my responsibility to contribute to the education of the future workforce seriously.

A framework that explicitly describes expectations of education and research capability at different levels of practice including ways to develop this, and how they are enacted in practice, can only be helpful to support others to do the same. Developing and running my own business has stretched my leadership skills and seeking out ways to achieve the level of capability required to do this was a conscious decision. I hope a new career framework can help others to map out how to achieve their career ambitions too, whatever they may be.’

Dr. Joy Gana-Inatimi is an academic, researcher and consultant physiotherapist at Edge Hill University leading the undergraduate medicine programme for leadership and teamwork and is the safeguarding lead for the medical school.  

She also has an honorary consultant physiotherapist contract within the NHS. 

‘I am a strong advocate for the four pillars of contemporary AHP practice and believe that clinical, research, education and leadership are integral for the viability and sustainability of our profession. If we do not evolve with the times, which are constantly changing, we will become irrelevant. I’m passionate about extending the boundaries of practice and pushing for clinicians to consider how best to deliver excellent impactful care by being innovative about the ways we can meet patient needs in a practical and meaningful manner.

The growth I’ve had in all four pillars has enabled me to develop into the professional I am today. These experiences enable me to function more effectively in my current roles due to the transferrable skills I have gained and give me great job satisfaction.’    

Jayanti Rai is an advanced physiotherapy practitioner at Kent Community Health NHSFT. 

‘There is so much focus on in developing clinical skills even at advance practice level. This tunnel vision can lead to under development of equally important other pillars like research, leadership and education. Research and leadership pillars in the NHS need additional emphasis. During my MSc, I led two NIHR portfolio studies. 

This gave me research and team leading opportunities as a senior physiotherapist.  I was awarded a British Elbow and Shoulder Society AHP Fellowship in 2016, which allowed me to travel clinical excellence centres in Sweden, Belgium and the USA. This enabled me to improve patient care pathways by organising multidisciplinary teaching in the region and helped in developing my education and leadership skills. 

This allowed me to develop a one-stop ultrasound shoulder clinic in East Kent Hospitals in 2017 through fund-raising and external research funds. I developed research and development extended scope physiotherapist posts in two hospitals. 

As an executive committee member of the Physiotherapy Research Society, we hosted our annual conference in Kent to enhance awareness of research within the profession and beyond health care. I joined CAHPO BAME SAG in 2021 and have worked with the national EDI team and collaborated on AHP Strategy 2022-2027.  There is a need to emphasise all 4 pillars in the job descriptions and career development pathways.’