JOB DESCRIPTION Physiotherapy Specialist

[Telehealth & Telecare]

Job Title:Physiotherapy Specialist [Telehealth & Telecare]
Reporting To:NHS 24 AHP Clinical Coordinator
Department(s)/Location: NHS 24 Physiotherapy Team based in Cardonald, Clydebank, or South Queensferry
Job Reference number (coded):
  1. JOB PURPOSE
The post holder will form part of NHS 24’s Physiotherapy Service working to provide direct physiotherapy input across a variety of unscheduled and scheduled care and will work as part of a multi-disciplinary team of professional and administrative colleagues, speaking directly to patients and handling, on behalf of the service on calls identified as suitable for physiotherapy triage or assessment. This will involve the utilisation of telehealth and telecare technologies to deliver services in a patient's home or a community based setting.
As part of the NHS 24 Physiotherapy Service, post holders will be expected to scope, develop and provide physiotherapy telehealth and telecare service working closely with territorial and special health boards, the Scottish Centre for Telehealth & Telecare, the Scottish Ambulance Service and partners in social care and the third sector.
The post holder will also give their specialist support, advice and training to nurse practitioner, call handler and health information advisor colleagues who require specialist physiotherapy input during their consultations and interactions with patients. They will maintain high quality standards and work to ensure the most appropriate patient journey.
The post holder will work with NHS inform and national partners to review and develop physiotherapy related self-management resources in a variety of media.
For those post holders who have a musculoskeletal speciality they will be able to support a hands input to the Occupational Health Service for the 1010.5 WTE staff currently employed by NHS 24.
  1. ORGANISATIONAL POSITION

  1. SCOPE & RANGE
Following on a successful pilot of investigating how physiotherapists could make an impact within NHS 24 it has been decided to develop these roles into substantive posts. The post holder would be expected to have specialist clinical expertise in one or more of musculoskeletal, falls or respiratory areas.
Although fully supported in existing NHS 24 governance structure and clinical processes, post holders would be expected to work with significant autonomy managing physiotherapy aspects of their work
This new and developing role will be wide and varied and will include some or all of the following:
The role of NHS 24 Physiotherapy Service is:
  • Provide telephone physiotherapist triage to the current unscheduled care service at NHS 24 Provide telephone physiotherapy input to callers to the National Musculoskeletal Advice and Triage Service.
  • Link with other Out of Hours Partners to provide specialist physiotherapy input and to develop new telehealth and telecare pathways
  • Staff Physiotherapy Support Line, which will offer physiotherapy advice to NHS 24 colleagues working in Scheduled Care and Unscheduled Care Services.
  • Work with the Scottish Centre for Telehealth and Telecare to scope, develop and deliver on new physiotherapy telehealth and telecare activities for NHS 24 and for NHSScotland
  • Work with NHS inform and other partners to develop self-care resources for the people of Scotland.
  • Evaluate, share and spread the physiotherapy work from NHS 24.
  • To provide users with timely, individualised and clinically effective care, including screening, assessment, treatment and advice to alleviate symptoms, maximise function and promote self-management.
  • To provide clinical education and specialist teaching to undergraduate and post-graduate physiotherapists and other health care professionals.
  • To develop and support the infrastructure, capacity and capability required to deliver the Clinical Governance agenda.
  • Support a skilled, accessible and equitable Occupational Health musculoskeletal triage and rehabilitation service for the employees of NHS 24, in a variety of environments.

MAIN DUTIES/RESPONSIBILITIES
  • Works as an autonomous practitioner using e-Health, telehealth and telecare media to assess, diagnose and treat patients based in the community with highly complex presentations and to deliver specialist physiotherapy triage and support to patients or their carer / relative through participation in direct patient / carer contact over the phone or through advice to nurse practitioners, pharmacy advisors and call handlers when required.
  • Works as an autonomous practitioner to assess, diagnose and treat patients with highly complex presentations. Uses expert clinical reasoning skills, knowledge of evidence based practice and expertise to formulate diagnosis and accurate prognosis and determine appropriate treatment plans. This will also include patients presenting with unusual signs and symptoms where expert opinion may be conflicting.
  • To interpret and analyse clinical and non-clinical facts, which may be conflicting, to form accurate diagnoses in the most highly complex types conditions which may include the differential diagnosis of serious pathology e.g. Tumour, infection, deep vein thrombosis, or conditions were immediate medical intervention is required. This will be done in most instances without a face-to-face consultation and require special communication skills.
  • To assess, analyse clinical and non-clinical information, provide highly specialist, and where possible provide a comprehensive clinical diagnosis for patients to determine their need for physiotherapy intervention. This includes patients with highly complex and emotive presentations. Following this is able to identify and then direct callers to other medical specialities following triage or implement or refer onwards specialist physiotherapy programmes of treatment to maximise patient rehabilitation.
  • To provide a specialist and accurate physiotherapy advice and information for the respective contact centre’s frontline staff and senior management.
  • To help deliver the physiotherapy elements of clinical governance & quality for the Contact Centre through participation, when requested, in front line staff performance management review procedures such as call review and partner feedback to ensure safe, efficient and effective calls are being delivered.
  • To deliver through personal involvement and where identified by the AHP Clinical Coordinator physiotherapy related training and Continuing Professional Development for front line staff (Nurse Advisors, Health Information Advisors, Call handlers, Team Leaders) in the respective Contact Centre to ensure these staff members are competent to deliver the service.
  • To deliver the physiotherapy elements of the NHS 24 induction programme to a high standard, ensuring a robust understanding of the physiotherapy based services.
  • To work with the NHS 24 Physiotherapy Service, nurses, pharmacy and NHS 24 core staff to develop programmes of care for callers.
  • To engage with front line staff, creating opportunities for coaching in the live environment and establishing clear mechanisms to ensure staff feedback is effectively utilised for continuous improvement within the NHS 24 Physiotherapy Service and NHS 24.
  • To support & develop a cohesive, effective and progressive physiotherapy interface, which reflects national and local priorities, where Physiotherapy is seen as a key clinical care provider and an appropriate referral route for NHS 24 and as the NHS 24 Physiotherapy Service role at NHS 24 expands; to be able to identify gaps and contribute to new service developments
  • To work with NHS inform Health Information Services team to provide specialist input into the development and evaluation of self care web resources that will add to the existing national library provided by the organisation.
  • The post holder will be proactive in encouraging the use of a range of self-management strategies to patients or their carer/relative and in doing so overcome barriers to understanding. This will frequently require negotiation with patients on the return to activities where cognitive, behavioural and motivational issues may be significant barriers to change.
  • Responsible for producing reporting on the service to AHP Clinical Coordinator including analysis of management information (based upon qualitative and quantitative information) on service performance and highlighting staffing issues.
  • The post holder will be required to deputise for the NHS 24 Physiotherapy Service Lead managing the clinical workload of the specialist clinical area when required.
  • Proactively identify risks and make recommendations on potential service improvements and changes, the post holder will support the NHS 24 Physiotherapy Service Lead work with Clinical Governance group to mitigate.
  • Acts independently and continually reassesses patients making highly skilled evaluations and decisions regarding treatment options within group and individual work in order to progress treatments and pain management strategies effectively.
  • In collaboration with line management, reviews and analyses current practice and service provision in order to plan and develop the NHS 24 Physiotherapy Service.
  • Reflects own and current work practices to develop new and innovative ways of working including extending the scope physiotherapy practices specific to telehealth and telecare.
  • Action increased awareness of evidence-based telehealth and telecare practice from within NHS 24 and the NHS 24 Physiotherapy Service throughout Scotland.
  • In conjunction with the AHP Clinical Coordinator is responsible for developing the role of clinical specialist, including extension of practise and negotiating blurring of professional boundaries to aid more effective patient management.

  1. SYSTEMS & EQUIPMENT
This role requires the post holder to be a proficient user of a range of software tools and have a familiarity with the operation of a range of in house systems:
  • Telephony - Knowledge of telephone triage/rapid triage model . Use complex telephony systems to handle calls and must be able to operate these systems skilfully to ensure the ‘patient journey’ is smooth.
  • In absence of Physiotherapy Lead be able to analyse weekly reports
  • Patient Record Management Software - Maintain accurate computerised consultation records.
  • Microsoft Word - for the provision of committee papers, reports, communication.
  • Microsoft PowerPoint – for the production of presentations.
  • Microsoft Outlook – for effective and efficient communication and diary management.
  • Microsoft Excel – for analysis of management information to identify service performance trends.
  • eExpenses – For inputting expenses online.
  • General Equipment – Use of personal computer, printer, fax machine, telephone, photocopier, scanner and audio visual equipment.
  • They are also required to follow NHS 24’s Clinical & Operational Processes and operate the current clinical software application as defined by the organisation.
Physiotherapy Equipment
Understands, appropriately selects and monitors safe use of physiotherapy related equipment and additional patient care equipment by self and other members of own team.
Responsible for the regular testing, maintenance and repair or physiotherapy related equipment within own speciality.
Equipment may include;
  • Setting up, monitoring and evaluating telehealth and telecare equipment supplied to patients
  • Walking Aids – elbow crutches, sticks
  • Supports – full range of appliances and orthoses.
  • Rehabilitation Equipment – treadmill, exercise bicycles, steppers, multi-gym, weights, plinths, balance boards, gymnastic balls, full range of small exercise equipment.
Patient Records
Keeps detailed patinet records in line with NHS 24 current process and CSP Stanards of Practice. This may involve differnt systems for different parts of the role.
Research & Evaluation
  • In conjunction with the AHP Clinical Coordinator is responsible for continually undertaking more complex audits of service provision, which will include multi-professional components, and collation of results with dissemination of findings to appropriate stakeholders.
  • Critically appraises and synthesises outcomes of research, evaluations and audits. Directs the dissemination of information evaluated to optimise patient care and service development.
Occupational Health specific
  • Is an expert autonomous clinician support the NHS 24 Occupational Health team managing a clinical caseload of musculoskeletal patients and providing expert Physiotherapy assessments and treatment plans for patients attending the NHS 24 Occupational Health Service.
  • Liaises with and refers to other social and health services to provide comprehensive patient management and optimise patient outcomes. This may include work place risk assessment.
  • Develops links with partner boards to develop pathways for secondary referral to improve the patient journey
  • Identifies and implements and evaluated strategies which promote a healthier working environment such as stand desks.

  1. DECISIONS & JUDGEMENTS
  • The post holder will be called upon to analyse and interpret information from a series of varying sources when considering complex medication enquiries and draw safe conclusions to respond to patient symptoms. In addition to face to face interacions there will be a requirement to be able to analyse and interpret inforamtion via telephone triage, video conferencing and other telehealth and telecare media.
  • The post holder will be expected to operate with minimal supervision in meeting these physiotherapy objectives and to prioritise their own workload on a daily basis.
  • The post requires a high level of concentration to be exhibited whilst undertaking direct patient or carer contact and whilst advising NHS 24 colleagues to ensure the most appropriate outcome is reached for the patient. The post holder may be asked to make decisions on limited information available to them at that time. They then have to divorce themselves from that decision to allow an unbiased assessment to be made on the most suitable treatment for the following patient they deal with.
  • Frequenlty make autonomous decisions within their scope of practice on diagnosis, treatment and on going management/discharge analysing information using highly developed analytical skills and available options to ensure an appropriate outcome for callers.
  • Be individually resposnible to decide when to refer to nursing colleagues within NHS 24 core services to ensure patients receive optimal and clinical care for potentially life threatening presentations.
  • Deal with a wide variety of calls, which will range from simple to high complex presentations. These will require the post holder to gather and synthesise information to make sure the caller is directed to the appropriate programmes of careand to decide when to refer to pharmacy colleagues to ensure patients receive optimal clinical care.
  • Identify and communicate to leads, areas of service development and improvement.
  • Prioritise workload taking into account competing clinical priorities to ensure effective use of time to ensure key performance indicators are met.
  • Guide and support non-clinical staff.
  • Deal with staff performance issues and refer onto senior staff as appropriate.
  • In the absence of the NHS 24 Physiotherapy Service Lead manage the clinical workload of the specialist clinical area
  • Objectives will be agreed with the AHP Clinical Coordinator in line with organisational priorities and the Senior Management Team within the respective Contact Centre. The post holder will be expected to operate with minimal supervision in meeting these objectives and to prioritise their own workload on a daily basis.
  • A system of regular informal monthly and formal six monthly appraisals will be conducted by the AHP Clinical Coordinator and a personal development plan produced.
  • The post holder will also receive support and coaching from operational line management within the contact centres on an ongoing basis. These time frames may adjust to meet the needs of the individual / service.

  1. COMMUNICATIONS & RELATIONSHIPS
Internal
Colleagues at all levels and from all disciplines working within NHS 24, including Executive Director of Nursing and Care, Director of Unscheduled Care, Associate Medical Director, Associate Director of Operations & Nursing, Regional Pharmacy Advisors, Clinical Services Managers, Quality Leads, Practice Educators, Team Leaders, Front line staff, Learning & Development team, NHS inform Health Information Services Team and Service Support. Where input to the Occupational Health Service is given this communication will involve on a frequent basis providing specialist physiotherapy input to Human Resources Team to facilitate return to work strategies.
External
Patients, carers and other Healthcare professionals including physiotherapist colleagues in partner boards, Scottish Ambulance Service and the Scottish Centre for Telehealth and Telecare.
This communication must be delivered in an empathetic and caring manner.
All communication, both internally and externally, must be delivered to ensure potentially complex and challenging physiotherapy advice is easily understood and free from clinical jargon. This will include, on a frequent basis, highly complex calls, which will require expertise to effectively deal with callers with complicated presentations who will be in extreme distress and pain which may be related to other medical conditions. Callers will have a range of medical and psychosocial problems and in many cases be in acute pain that will cause high anxiety and distress that require the physiotherapist to utilise motivational and persuasive skills to facilitate rehabilitation in both an individual and group setting.
  1. PHYSICAL DEMANDS OF THE JOB
Physical Demands:
  • The post holder will be restricted in their movements when having to sit at a PC when dealing with calls, national virtual and performance reviews.
  • The post holder requires standard keyboard skills but is required to be multi skilled when dealing with calls, listening to what the caller is saying, and recording the detail.
  • Manual handling of patients for physiotherapy intervention.
  • Manual physiotherapy techniques throughout parts of the day, including facilitation of movement and /or joint mobilisation or manipulation. This requires a highly skilled level of dexterity gained from formal post graduate training, response to sensory feedback and co-ordination of movement.
  • Use of equipment such as walking aids, cardiovascular and resistance exercise equipment,telehealth and telecare equipment which require manipulation, dexterity and strength often manoeuvring within confined spaces
Mental Demands:
  • Frequent requirement for prolonged concentration required when assessing and treating caller to meeting changing patient therapeutic needs.
  • The nature of the role is such that the post holder can expect to be interrupted frequently during their shift.
  • Multi-tasking and effective time management in a busy environment with conflicting priorities.
  • The ability to manage a demanding and complex workload, prioritising workload to meet service requirements.
  • Be able to support and man clinical support lines
Emotional Demands:
  • Frequent requirement to communicate with distressed/anxious/worried callers
  • Frequent need to impart unwelcome news regarding caller’s rehabilitation prospects.
  • Occasionally work with patients with cognitive impairment /disorientation
Working Conditions
  • This post holder will be required to use VDU equipment for the frequently during their shift.

  1. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB
  • Frequently dealing with very emotional distressed callers [and their carers] who are in significant level of severe pain and require guidance and support to calm them and support them to facilitate a safe and effective triage.
  • Develop knowledge, skills and evaluation processes in a wide variety of conditions and patient groups acting as a specialist within particular area of work with involvement in teaching.
Exercise management and specialist clinical skills in the absence of AHP Clinical Coordinator
  • Be able to justify the role, remit and outputs of the NHS 24 Physiotherapy Service both within and out with the organisation.
  • Be able to explain and demonstrate to patients and carer's different telehealth and telecare technologies for use in their home. These are emerging technologies with users both unfamiliar and wary about using them. Significant communication skills will be required to help patients engage with the use of these.
  • Undertake a mentally demanding job, whilst at the same time taking care to safeguard own health and safety as well as that of colleagues and patients.
  • Work with telehealth and telecare technologies as main component of patient management at the expense of more traditional face-to-face interventions. This brings about significant addition challenges to the role.
  • Managing how best to implement change to meet service needs where there may be resistance and challenge to change.
  • The post holder may be exposed to abusive calls and may on occasion have to deliver unwelcome and potentially distressing news to patients and their carers.
  • Utilisation of strict time management skills in order to provide an expert service across sites, incorporating management of individual caseload, advisory and teaching role, research & development activity and supporting service development and to meet key performance indicators of the various work stream.

  1. KNOWLEDGE, TRAINING & EXPERIENCE REQUIRED TO DO THE JOB
Essential
  • Diploma / Degree in Physiotherapy or Chartered Society of Physiotherapy accredited Masters
  • Registration with Health Care and Professions Council
  • Demonstrable knowledge and experience of telehealth and telecare within physiotherapy practice.
  • Wide clinical experience in core clinical settings
  • Previous experience in one or more physiotherapy specialism dependant on role i.e. MSK, FallsRespiratory Medicine
  • Evidence of excellent communication and interpersonal skills
  • Competent IT skills
  • Team worker but also be able to work for longs spells independently
  • Evidence of well developed critical decision making skills
  • The ability to think outside the box about how the physiotherapy role at NHS 24 can develop and grow
  • Excellent listening and communication skills to help direct patients to a safe and effective clinical outcome.
  • The ability to work closely with nursing and pharmacy colleagues, who are experienced in telehealth and to be able to provide specialist support, advice and training to nurse practitioner, call handler and health information advisor colleagues who require specialist physiotherapy input during their consultations and interactions with patients.
Desirable
  • Experience of physiotherapy telephone triage
  • A CSP recognised qualification in MSK Injection Therapy

  1. JOB DESCRIPTION AGREEMENT
A separate job description will need to be signed off by each jobholder to whom the job description applies.
Job Holder’s Signature:
Head of Department Signature: / Date:
Date:

Physiotherapist Specialist – Telehealth & Telecare 1.1 June 2016