Celebrate the autonomy

e started out as community Advanced Physiotherapy Practitioners (APP) in January 2016, at an Edinburgh surgery where the lead GP believed physiotherapists could step into this autonomous role with a rehabilitative approach. Catching the patient in primary care is key to keeping them out of a cycle of onward referrals with no one managing their care.  

 

Initially, we knew little about the job, but understood the focus was on holistic, person-centred care, following a case management approach within a multi-disciplinary team.  We enjoyed the challenge and started to develop the role as case managers in the community and at a nursing home. 

 

Our community remit is to help people with complex needs to self-manage their health and well-being.  We see people who are frequent users of primary and secondary services, along with vulnerable people after discharge from hospital and those with a new diagnosis who need more support. Key responsibilities include accurate management based on advanced decision-making, use of improvement methodology to develop care pathways and facilitation of team learning, while leading on the development of the role. High levels of clinical reasoning are required within the boundaries of knowledge and practice.  We needed to complete a Acute Minor Illness module, so we could assess areas not traditionally seen by a physiotherapist. 

 

Now we case manage all residents of a 120-bed nursing home covered by the practice.  We visit the home once weekly to address acute needs, with a GP if necessary.  We also address planned needs and ensure that every resident has an up-to-date Anticipatory Care Plan.  This often involves difficult conversations with relatives regarding end of life care and Do Not Apply CardioPulmonary Resuscitation orders. Other regular areas of work include chest, ear and abdominal examinations, delirium, urinary tract infection, neurology, musculoskeletal and dementia.  

 

We are not independent prescribers and have decided not to pursue this route at present, due to our working closely with prescribers in the team.  We make electronic referrals independently and can refer urgently to secondary care.  

 

We have had amazing opportunities in this challenging, worthwhile and continually developing role.  Here in Lothian, many APP roles have been developed in recent years, including community respiratory care, orthopaedics, paediatrics, women’s health and, of course, MSK. The feedback from patients and clinicians has been overwhelmingly positive and, in current times, with a shortage of GPs and a primary care contract with a focus on AHPs, now is the time to shout about this special role.