The MS Consultant role

1. The MS Consultant role Linda Miller consultant physiotherapist in MS 7/10/2010

2. Content • Personal & professional journey • The Job Description • Challenges, opportunities & expectations • Adding value & measuring impact • How can we secure MS services in the future

3. The Journey

4. Professional Journey • 1986 - BSc physio • 1995 - 2006 Senior 1 neuro out- patients, stroke project co-ordinator • 1999, 2000 - MSc modules • Developed interest in MS, FES, spasticity & neuro rehab • 2001 - 2005 p/t M Phil (TENS for spasticity in MS) • 2003 - regional & national involvement in MS • 2006 - ESP in MS ( 3 yr part funded by MS soc) • Pilot MS in MCN, other specialist posts funded • 2005 - 09 – Building on skills base (presentation, academic writing, further research, led service redesign) • 2007/8 – non medical prescribing • 2009 – consultant in MS

5. WORKING TOGETHER • Well established MS service. • Strong MD team • Supportive head of service & consultant • MCN invaluable for service development

6. Personal Journey • MPhil & further research • Taking risks & gaining confidence • Systematic approach • Focused and lateral thinking • Collaborative working with HEI • Tenacity & maintaining momentum • ESP post • Demonstrate impact • Beginning to think strategically • Gaining clarity on expectations • Non medical prescribing • Increased awareness of NMAHP roles • Holistic package of care • Releasing/supporting consultant time • Improving patient pathways • Consultant post • Working in NHS & HEI • Focusing on high impact areas • Switching between levels • Position of influence • Breadth of involvement • Revalidation of values Pushing out of the comfort zone

7. Consultant physiotherapist in MS: Job Domains Expert clinical practice Professional leadership Educational & professional development Research, service development & evaluation

8. Extracts from job description: Expert clinical practice • To be responsible for a complex caseloadincluding the prescribing of medications in accordance with delegated prescribing rights • To create and develop protocols of care and design patient care pathways with the aim of providing examples of best practice across the regions and/or nationally. • Practice as an autonomous professional without direct supervision including independent and freestanding clinics which run parallel to rehabilitation consultant clinics.

9. Expert clinical practice • Defined clinical caseload including complex presentations (FES, spasticity, pain, vestibular) • Provide advice to MDT (GP’s prescribing) • Physiotherapy patient pathway • National advisory group for implementation of QIS neurological standards • Integrate non medical prescribing & symptomatic management • All MS review clinics now NAHP led

10. Professional leadership • To provide effective leadership, motivating and inspiringothers to deliver the best care for patients within the neurological field, including Primary Care. • To take a proactive role in cycles of service/business planning, developing action strategies and evaluating changes within and across the rehabilitation services. • To explore and exploit opportunities for change, facilitate staff ownership of change, and ensure robust systems of evaluation are in operation.

11. Professional Leadership • Led & evaluated • MS review clinic, MD domiciliary review service, FES service • BC for FES service • Joint led • West of Scotland MS Physio Network • MS Physiotherapy Assessment Pack • Evaluation of practice (spasticity) • MS MCN • steering group and sub groups • A&A Physiotherapy • clinical improvement groups • Represent • Board and National level • Standards, education, clinical services, NM prescribing • Development need – clinical leadership

12. Educational & professional development • To promote and facilitate the development of a learning environment, particularly by encouraging reflective practice, such that multiple sclerosis services continuously improve and develop. • To maintain and foster genuine partnerships with higher education institutions and other professional bodies relating to neurological/physiotherapy care.

13. Educational & professional development • MCN education sub group • Newly diagnosed, living with MS, carer programmes, GP training, CHP staff training, leisure centre staff • Regional/national events • MS patient pathway • I day a week with Glasgow Caledonian University • Joint project with MS Society(Scotland) re accredited education for NAHP & SW professionals • Influence delivery of programme (under & post graduate level) • Research to be targeted strategically & link with clinical practice. • Facilitator/co-ordinator for AHP practice placements in Ayrshire • Sit on NHS Education for Scotland physiotherapy advisory group • Regular contact, joint assessments and advice for MD staff

14. Research, service development and evaluation • To collaborate with academic institutions through clinical teaching and research activity to enhance the evidence base impacting on developments within local, national and international arenas. • To promote and demonstrate high quality evidence based practice by implementing the findings of research evidence into practice, and by encouraging and supporting staff to be actively involved in research. • To lead service evaluation through selection and design of complex clinical audit, and through the dissemination and implementation of the findings.

15. Research, service development and & evaluation • MCN Research & Development, audit & monitoring subgroups • Link with GCU • Link with Glasgow University • TENS study (MPhil) • FES study & further study planned 2010/11 • Clinical supervisor 2 PhD students • Pain in MS, leisure based exercise • RCT - home based physiotherapy for patients severely affected by MS (2009). Provisional acceptance for publication & CSO application for multicentre trial • CSO proposal for tele-rehab • Audit • FES database & ongoing evaluation. Detailed review planned Jan 2011 • QIS standards • Education events • Support physiotherapy staff in audit, evaluation & research • Development requirement – Prof Doc/ PhD?

16. Challenges/Opportunities • Clarity of role & direction - line management/mentorship • Working between 2 departments • Leadership is strategic not operational • Balancing clinical priorities with research, education and clinical development • Linking work streams & thinking strategically • Keeping abreast of policy, guidelines, standards & research • Breadth of involvement -knowing what to get involved in & what not • Maintaining fitness for practice • New skills – influencing, marketing, developing BC • Learning to say no & to delegate • Isolation • A new set of values • Managing expectations • Demonstrating impact & added value

17. Expectations of the consultant role • Colleagues • Consultant • Managers • Health Board • Patients ?????

18. Colleagues • Because you review patients for the consultant I know that you ask about nutritional issues. This has improved care, made the review process more patient centred and holistic and resulted in closer team working. I'm not sure what the other aspects of your post are and would be interested to find out (D) • I don't think your role has had any particular impact on our service (SLT) at the moment. An AHP consultant post may impact more significantly. There could be an opportunity for collaborative research within the team which you could lead on.

19. Colleagues • I see your key strengths in research and in prescribing which enhances the service that patients receive. You are a strong link in the team and always full of ideas & willing to look at service redesign. You are a point of contact for staff & patients but not sure if this differs from specialist role (OT) • It makes a difference that you know the patients from diagnosis and know their problems. This gives continuity. It is a real benefit to me that you are able to see the more severely disabled patients at home ( MS Nurse)

20. Colleagues • Because you are the first to see new patients to the service I am now noticing that patients coming for physiotherapy are better informed, have clearer expectations and are more engaged with their rehab. The patients we see in physio are more appropriate and we are generally seeing more positive results. • Your ability to see the more disabled pts at home for assessment is invaluable. • We value your specialist input to FES and spasticity management and your knowledge/experience in managing MS in the wider context. Not having to go to the consultant all the time especially with things like prescribing is a bonus(PT)

21. Consultant • There is increased autonomy with your role as you are independently reviewing and making decisions regarding patients care. This has been enhanced by non-medical prescribing. This is impacting on my clinic as I now see the patients that are more appropriate for me to see. • You are involved strategically in a leadership and advisory role which should ultimately enhance the quality of the MS service • You have a responsibility to engage in teaching and research as part of your role and to integrate this within the rest of the team

22. Manager • I really value your role. I see consultant roles as key in driving, supporting and evidencing clinical excellence. I expect your role to provide a key link between education, research & practice enriching all sides • Provide support & overview of clinical based research using links to HEI to maximize wider impact • Support clinical improvement groups to drive strategically aligned clinical improvement • Take a lead in setting strategic direction of R&D within AHP’s • Clinical expert in MS & provide support to staff locally & nationally delivering excellence in your field • Identify & harness opportunities for service improvement within your field • Represent A&A nationally & internationally within your field & be an ambassador for the wider service

23. Health Boards/PCT • NMAHP consultants can bring • Position of influence, • Clinical vision & strategy • Awareness of cultural shifts • Challenging the status quo • Make knowledge organisational • Demonstrating added value

24. Moving MS services onwards & upwards?

25. Strengthening our MS services for the future • Not just about consultant posts but gaining high profile is important • Demonstrate added value & measure impact • Define your key questions & drivers • Know & manage your stakeholders • Plan activities towards key impacts

26. Added Value • ‘Added Value’ aspires to enhance how we view, use and understand mundane everyday objects. It questions the importance the mundane carries in our everyday lives. http://www.by-louise.co.uk

27. Added Value • “the act of giving the customer more than they think they are getting” • “increasing the worth of a product or service as a result of a particular activity” • How do we know that we have added value? • What kind of value can we add? • How can we measure this?

28. Measuring Impact – Key Questions • what are you trying to achieve? • VISION • IMPACT (targets, efficiency) • what is the desired outcome? • Are there other options • what indicators will demonstrate you have achieved your outcome? • OUTCOME INDICATORS

29. Where does it fit? • National policy & strategy • Better health, Better care, Quality Strategy, Rehabilitation framework • Focus on long term conditions • NICE, SIGN, QIS • Improving quality is a top priority • Local targets (HB/PCT) • Local delivery plan • HEAT targets • Cost • Evidence Base

30. Know your stakeholders • Identify the boss, expert, sponsor, team, user • ‘WIFM’ – benefits, risks & costs • What makes them tick • visual, auditory, tactile, big/small picture, status, safety, profit • Attach importance & manage appropriately • Involve early & give opportunity to gain ownership

31. Influencing others • Know what you want • Well defined smart objectives • Use positive language • How will it look, here, feel? • Is it within your control? • Who will be affected? • Pitch the sale • Pacing & leading • Ask assertively • Close the deal

32. What next? PLAN ACTIVITIES • Baseline measure • Gather evidence • Identify indicators • Monitor • Evaluate IMPACTS • ?affecting patient needs/outcomes • Resource efficient • Contributing to HB targets Challenge assumptions & identify risks

33. Kotters 8 Steps • Increase Urgency • Build a guiding team • GET THE VISION RIGHT • Communicate for buy in • Empower action • Create short term wins • Don’t let up • Make changes stick

34. What about data? • Know your question (and the answer your stakeholders are looking for!) • Know your strategic fit • Know your evidence base • Define your indicators • Is it meaningful? ( make it!) • Know how to present your data clinical outcome patient centeredness cost benefit

35. What will it take? • Agreeing the right targets • Focusing on outcomes • Developing meaningful measures • Bold & thoughtful leadership • Challenge current practice/re-think how we work • Thinking outside our professional box • Can we do jobs others might currently do? • Impact of our work on others? • DNA rates • Winning hearts and minds • Embedding quality in day to day work • Working together

36. Blue Skye Thinking?

37. Thank you for listening