Jonathan Hearsey

Jonathan Hearsey

Do you feel valued?

A father said to his daughter “You have graduated with a first class honours degree, and my gift to you is a car I bought many years ago. It is pretty old now but before I give it to you, take it to the local used car dealer and tell them I want to sell it and see how much they offer you for it.”

The daughter did as her father asked but returned and said, “They only offered me £1,000 because the said it looks pretty worn out.”

The father then requested that she take the car to the nearest pawn shop. The daughter returned to her father and said, ”The pawn shop offered only £100 because it is an old car.”

The father asked his daughter to finally go to a car club and show them the car. The daughter then took the car to the club, returned and told her father that the club offered £100,000 for the car because, in their opinion, the car is iconic and sought by many collectors.

The father explained the following to his daughter, “The right place values you the right way. If you are not valued, do not be angry, it means you are simply in the wrong place. Those who know your value are those who appreciate you……Never stay in a place where no one sees your value.”

Integrated Musculoskeletal Teams

Musculoskeletal medicine has undergone a considerable change since the Department of Health released the musculoskeletal services framework in 2006.  Clinical musculoskeletal teams in the UK have moved away from the familiar physician-led model and the use of extended scope practitioners is now widely accepted as best practice. Musculoskeletal teams mostly consist of extended scope practitioner physiotherapists although, in some NHS trusts and MSK partnerships, other allied health professionals such as podiatrists, osteopaths and occupational therapists work alongside physiotherapists in multidisciplinary musculoskeletal teams.

I am currently writing an initial scoping document aimed at assessing the current makeup of musculoskeletal teams and looking at any quality, efficiency and productivity improvements that can be made by making musculoskeletal teams truly multidisciplinary.  I am very interested in hearing the opinions of musculoskeletal physicians, nurses, clinicians, and allied health professionals working in musculoskeletal multidisciplinary teams or those that are interested in doing so.  I also welcome comments from patients, professional bodies and healthcare regulators.

It could be argued that the clinical role of an extended scope practitioner is predetermined by the position in the care pathway that the extended scope practitioner is working in (usually between the patient’s general practitioner/physiotherapist and secondary care consultants).  My question and interest relates to whether non-physiotherapist clinicians can work as extended scope practitioners rather than should we be integrating osteopathy, podiatry or occupational therapy (as examples) within musculoskeletal NHS teams – the efficacy of which is a different topic entirely.

As a guide, I’m interested in comments from potential and existing extended scope practitioners or from physicians that work alongside non-medical clinicians in this field.  I am interested in what training issues there might be, what governance arrangements might be necessary and particularly any potential conflicts that you might foresee.

Having worked in multidisciplinary teams for the vast majority of my 20 year NHS career I can only see advantages but I have benefited from supportive, forward-thinking employers and colleagues that have patient management as a core value.  I appreciate, however, that working in a multidisciplinary team might pose a number of questions and it is this that I am trying to explore in this scoping exercise.

Please feel free to comment below or use the contact page should you wish to discuss this privately.  I am happy for comments to be anonymous but will moderate out abusive comments et cetera.


10 tips for NHS clinical redesign teams

1. Tailor the clinical redesign to answer the question – why are the commissioners redesigning this particular clinical service?

2. Patient-centre every single stage of the care pathway.

3. Acknowledge the vital importance of the GP in each stage of the care pathway.

4. Ensure both secondary care and primary care clinical teams are part of the redesign process from the very start.

5. A redesigned community service is useless if secondary care provision is compromised in any way. Ensure the secondary care provision is adequate.

6. Use of Extended Scope Practitioners should be limited to their specific knowledge base.

7. Remember that not all clinical roles can be delegated to allied health professionals.

8. Medical consultant leadership is not a luxury, it is a necessity.

9. Use storyboarding techniques for clinical incidents as well as plaudits.

10. Ensure the winning service provider sets regular contractually compliant governance points – evaluate every fifth of the contract.