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A personal reflection from Sarah Morton, Professional Head of Adult Physiotherapy, Gloucestershire Care Services NHS Trust, on a recent visit from the Chief Allied Health Professionals (AHP) Advisor for Wales:

Last week we had a visit from the Chief Therapies Advisor for Wales to discuss some of our extended practice roles in Rapid Response. A service specifically designed to support acutely unwell patients where clinically appropriate, in their own homes preventing unnecessary and disruptive hospital admissions. Her visit was to find out more about the well-established Rapid Response service in our organisation and to take any learning back to contribute to potential development of models in Wales. It was a welcome visit and came about as a result of discussions with our Professional Body.

The Rapid Response service is comprised of Paramedics, Nurses and Physiotherapists all with their own unique skill set and professional backgrounds. With the solid foundation of medical model training the Physiotherapists in this service have developed new competencies along agreed pathways using competency frameworks to support their learning needs. This has included M level post graduate training at University to underpin areas not addressed through core undergraduate training. One of the Physiotherapists incorporates a Clinical leadership role of a Multi-Disciplinary Team as well as expanded scope functions.Earlier in the year, the Chartered Society of Physiotherapy Chief Executive, Karen Middleton had spent a day with us in Gloucestershire Care Services meeting clinicians and discussing professional issues. During one of those conversations, some of our Physiotherapists in Rapid Response were able to talk about their roles as Practitioners within that service, their extended functions and how they had developed new competencies traditionally within the scope of other professions. Karen’s belief endorsed and supported our commitment to continuing to encourage our clinicians to take opportunities to develop and expand our roles within services across all areas of our profession.

Significant learning has been acquired along this journey, much of which could help other areas to develop their own Multi-Disciplinary models where the roles undertaken by clinicians are about the competencies rather than the perceived demarcations of the professions. The professional background is the starting point for what should be lifelong learning allowing for growth, development and expansion of professional roles.

 The recently published Chartered Society of Physiotherapy Advanced Practice Guidance 2016 has been a very welcome document. This helps define the framework which underpins the requirements for existing and emerging roles such as the Rapid Response Practitioner. As commissioning units and provider organisations move forwards with innovative models it is essential to share learning from these evolving services. A degree of consistency in the requirements and evaluation of work based competencies will be essential for robust, sustainable models.  

 With the short supply of highly skilled clinicians across all professional groups, maximising the contribution of clinical contacts and reducing unnecessary clinical duplication is good for patients and for effective streamlined services. However this all has to be underpinned with strong governance frameworks. Our learning during the development of Rapid Response has been that where this has not been in place it has resulted in clinicians feeling unsupported and the model needing to be more clearly defined. The service is now three years into its evolution and will be more fully described by one of the leading Physiotherapists who has been involved since its inception. 

Rapid Response is a key and essential component of our urgent care community services and offers an example of what our profession can contribute when you start thinking outside the role boundary box. It’s good to challenge the delineation.