July 2021: The British Society of Rheumatology have recently released a “Workforce Report”, it includes exciting potential developments for all of the multidisciplinary team. This BSR document talks about “enhancing roles” for the AHP workforce in rheumatology and clearly these “enhanced roles” speak to the advancing practice agenda coming from other areas of the National Health Service. There have been developments elsewhere with regards to advancing practice, for instance, the Centre for Advanced Practice that Health Education England have just launched; and hopefully similar advanced practise support will very soon follow across the other three nations that make up the UK.
When we think of advanced practice historically, perhaps we think of band 8 roles, but now we’re seeing advanced practice roles advertised at band 7 level, maybe to better match the banding amongst nursing staff. We do also have to be aware of independent providers of rheumatology services who will also offer advanced practice rheumatology physiotherapy roles, but outside of the NHS agenda for change banding structure.
The BSR document suggests that bands 6,7 and 8 should be looked at and, in their phraseology, “enhanced” to allow allied health professionals to meet the increasing demands across healthcare services in rheumatology. This report, taking information from GIRFT, NEIAA and member engagement, does accept that there are quite wide variations in the application of AHP roles across rheumatology. These findings are in keeping with the national rheumatology physiotherapy survey undertaken October 2019 and quite recently published: we described 40 different roles a physiotherapist might undertake in rheumatology, and there were varying scores of applications of those roles across different banding levels, as well as across different parts of the country. We do hope with the very imminent release of the Rheumatology Physiotherapy Capabilities Framework there will be a chance to better balance the way rheumatology physiotherapy roles are provided. In balancing these roles, there is also a fantastic opportunity to enhance and advance what is undertaken by us as rheumatology physiotherapists and what we can offer to the rheumatology team in these times of increased demand and other challenges related to the peri-COVID and, hopefully soon to come, post-COVID environment.
Data presented in the BSR report, picked from the NEIAA, shows that 50% of UK departments do not have a physiotherapist embedded in their MDT. More concerningly, 7% of Trusts reported that they didn’t have access to physiotherapy services.
The BSR report shares some information from the yet-to-be-released GIRFT report on rheumatology, it states that GIRFT “found that departments in England were not making best use of the multidisciplinary skills mix of the team, and that this could be harnessed to address capacity challenges, optimise services and increase their resilience and sustainability”.
Whilst accepting there is no such thing as a typical MDT; the BSR report does present data for an “average UK rheumatology department”. This shows the current average of 1 whole-time equivalent rheumatology physiotherapist for every 5 and a quarter rheumatology consultants. Or for every full-time rheumatologist, you would require about 1 day per week (7.5 hours) of rheumatology physiotherapy to match the current national average. Finally, in considering service demands, waiting times and health outcome improvement, the report gives a suggestion/recommendation of one rheumatologist per 60-80k population. It can be extrapolated from these numbers that recommendation could be one rheumatology physiotherapist per 315-420k population.
The penultimate paragraph of this blog and really our call to action as members of the rheumatology MDT, must come verbatim from the BSR report…
“BSR is calling for Trusts and Health Boards to establish more enhanced roles for AHPs, pharmacists and nurses within rheumatology departments. Departments should be open to reviewing who does what within their team and whether there are better ways to make use of the multidisciplinary skill mix of the MDT. Staff should be encouraged to develop their specialist skills and extend their scope of practice with departments providing the opportunities to do so. These roles must be recognised with appropriate Agenda for Change (AfC) banding in line with the specialist skills required and to ensure that they attract qualified candidates”
So, whether you still use the term “extend their scope” or if you would rather be “advancing“, now is the time to take this BSR workforce report (and perhaps some of your local data) to your managers, your rheumatology colleagues and whoever needs to hear this message. Physiotherapists can and will adapt and progress to meet the challenges in the rheumatology workforce.
References
BSR (2021) Rheumatology Workforce: a crisis in numbers
https://www.rheumatology.org.uk/Portals/0/Documents/Policy/Reports/BSR-workforce-report-crisis-numbers.pdf?ver=2021-06-16-165001-470
Gregory WJ, Burchett S, McCrum C (2021) National Survey of the Current Clinical Practices of UK Rheumatology Physiotherapists. Musculoskeletal Care 19:136–141.
https://onlinelibrary.wiley.com/doi/epdf/10.1002/msc.1516
Gregory WJ, McCall GJ, Shaw K, Martindale J, (2017) BENCHMARKING THE NORTH-WEST SPONDYLOARTHRITIS PHYSIOTHERAPY SERVICES, Rheumatology, Volume 56, Issue suppl_2, April 2017, kex063.002https://doi.org/10.1093/rheumatology/kex063.002
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