Bold thinking and standardised assessment can drive services forward, finds latest webinar
‘Quality assuring the multidisciplinary MSK workforce’ was the subject of Connect Health‘s latest Change webinar on Wednesday 4th May, focusing on the potential of multidisciplinary working, and the strategies needed to innovate current systems.
Chaired by Connect Health Chief Medical Officer, Graeme Wilkes, the event brought together speakers from four areas of MSK support provision: GPwER (GP with Extended Roles) MSK medicine, physiotherapy, sports rehabilitation and osteopathy. The mix was representative of the ‘variety and spice’ of multidisciplinary team (MDT) working required to boost outcomes, according to Wilkes.
Opening the session, the former GP and elite sports consultant asked:
The variety in all the teams I’ve worked in has been the real ‘spice’ for me – so how we can bring different professional groups together to get the outcomes we need, particularly in the current environment in the NHS?
In elite sport, you might see a physiotherapist handing over rehab to a strength and conditioning coach towards the final stages of recovery…in professional rugby we used chiropractors and osteopaths alongside our physios.
As we say at Connect, it’s not about what professional group you’re from, but it’s about your training, your competencies, your adherence to professional guidelines and your clinical supervision audit and appraisal – if you tick those boxes, then you’re doing a good job for patients, and should be welcomed.
Dr Giles Hazan, GPwER MSK Medicine, Sussex Partnership Foundation Trust discussed GPwER accreditation and training. He spoke of his own professional journey as a GPwSI (previous terminology – GP with a Specialist Interest) in MSK medicine.
Describing himself as a ‘jobbing GP at heart’, Giles said:
One of the big problems I faced when starting out [in wanting to develop a specialism], was the seesaw of balancing my existing role. When it tipped in favour of a change in direction, I had lots of questions – how do I develop, where do I get the supervision and the support? That was lacking.
There was immense variation across the country, of GPs calling themselves GPwSIs, all with a range of different qualifications and a huge range in experience, which meant it was often quite challenging to move into it. It was very much dependent on forging relationships and friendships, getting somebody to be your supervisor – and whilst that is still the case, great strides have been made to address that.
He joked:
I did the fatal thing of asking why a framework didn’t already exist – and was tasked with taking on the job.
It has all been developed from the NHS long term plan; the role of GPwSIs was supported and encouraged, as part of a move to expand the multidisciplinary team and recognise the need for people, including doctors, to broaden the scope of their practice.
Outlining the development of the GPwSI role to GPwER, Giles said:
The RCGP has produced a framework outlining the move from an area of interest to an extended role – by definition this is outside of your normal practice and it requires it to have a supported level of training and accreditation as a result.
Giles explained how a new accreditation framework is being developed, specifically for GPs specialising in musculoskeletal care, guided by a similar scheme of GPwERs in dermatology.
That pilot proved very successful – as a result, it provided a template for other groups – GPs with a specialist interest in musculoskeletal care but others as well, whether that’s obstetrics and gynaecology, or mental health – there are a range of other clinical fields in which GPs might work in extended roles.
Uzo Ehiogu, Associate Director of Clinical Excellence, MSKR, discussed the topic of ‘MSK rehabilitation standards for physios – where are they and why do we need them?’. Explaining how standards can ensure quality assurance for patients, reduce unwanted variation and increase cost effectiveness, Uzo pointed to a lack of a formalised framework for the education of physiotherapists.
Education, education, education, education…at this moment in time, I don’t believe we have the formalised structure we need in MSK – our colleagues in sports rehabilitation, sports therapists, osteopaths, and such like, they have a very formalised education in MSK. In physiotherapy, we need to get to grips with our education in musculoskeletal practice.
We don’t have a standardised approach [to training and development] across the board – how do we get there? It needs to be linked – all the way from undergrad education to post grad education, to banding and career progression. Once we have a standardised pathway, that is the point at which we can show the impact of what we do.
Outlining how promotion from NHS band 5 through to band 7 is currently achieved via an interview, not practical assessment, he added:
[Accreditation] shouldn’t just be based in higher education – it can be through time served, work-based, portfolio-based – then we can be in a really good place; this is how we’ll start to improve MSK care within physiotherapy.
This is a great opportunity for us. We all want excellence – no-one joins a profession to be mediocre.
Oliver Coburn, Operations Manager & Registrar, British Association of Sport Rehabilitators and Trainers (BASRaT) covered BASRaT’s journey to quality assurance.
A sport rehabilitator is a graduate registered healthcare practitioner, who can work independently in MSK across a variety of environments. And you may be surprised that the majority are currently working outside of sport – it is increasingly more common to find them working as a MSK clinician or in MSK practitioner-type roles. This is in response to workplace challenges, but also in recognition that where the right competencies and governance processes are in place, people can work in MSK clinician roles regardless of their professional background.
He outlined how BASRaT accreditation is achieved – three years of solely MSK education and practice, including 400 hours of MSK care. “Our registration exam is the biggest piece of work, and the biggest development in our profession for a long time. As far as we’re aware, we’re the only MSK professional register or regulator that has this additional quality assurance layer, post-degree.
The exam aims to identify the minimally safe and competent MSK practitioner – we’re not looking for world-beaters, necessarily, but we are putting these people in front of the public, so we need to know first and foremost that they’re safe, and we want to know that they will be effective and competent in treating the MSK patients they find themselves in front of.
He added:
We have to earn our spot on the [MSK] team, we’re the new kids on the block and we do have a point to prove in MSK. Hopefully the exam will go some way to do it.
By choosing someone on our register, employers, policymakers and commissioners know they are appointing a professional with good MSK knowledge who is safe and competent with patients.
Panellist Matthew Rogers, Head of Professional Development at the Institute of Osteopathy discussed ‘providing the highest standards: ongoing workforce development’, looking at how osteopathy can be successfully integrated as a primary care solution.
Osteopaths like myself have been working in the NHS for well over 25 years now, but – as outlined in a 2020 report – awareness of that amongst NHS commissioners and providers is still limited, particularly with respect to service models and the fact that osteopaths can provide workforce supply solutions for NHS providers.
Osteopaths are very cost-effective. In primary care, in first contact practitioner roles in the NHS for example, the return on investment is in the region of £2.30 for every pound we invest in the service – so what we have is a safe, effective intervention, with positive patient experience and good cost-effectiveness.
In a pilot scheme, where osteopaths worked in a primary care, first contact practitioner role across London, 94% of patients said they would recommend the service to friends and family, and almost 80% were successfully discharged with advice and self-management.
97% were managed independently by the osteopaths without the need for GP intervention, and only 1% required secondary care referral, so that hugely reduced strain on primary and secondary care colleagues. The pilot was so successful that all osteopaths involved were employed by the trust to continue afterwards.
Drawing the session to a close, Graeme asked what needs to happen to make MDT working a reality. Oliver said:
It requires bravery and innovation, underpinned by lots of things – an agreed standard, an agreed competency framework for different levels – but if there is a time to do it, that time is now. People just need to be bold in their thinking in taking it on.
Matthew added:
We need to raise awareness of MDT working as a real possibility – having the sports therapist, the osteopath, the chiropractor, the physio all working together and measuring the impact of that. When I was employed in the NHS 15 years ago, there was one advert for an osteopath every two years. There are now 30 or 40 new roles advertised for osteopaths in the NHS each month – that’s a sign that things are greatly improving.
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