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P. Sarigiovannis1,2, N.E. Foster3, S. Jowett4, B. Saunders1
1Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, Staffordshire, United Kingdom, 2Midlands Partnership NHS Foundation Trust, North Integrated Musculoskeletal Service, Stoke-on-Trent, United Kingdom, 3The University of Queensland and Metro North Health, STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), Brisbane, Australia, 4University of Birmingham, Health Economics Unit, Institute of Applied Health Research, Birmingham, United Kingdom
Background: There are approximately 9000 physiotherapy support workers in the UK forming 15% of the total physiotherapy workforce. Many of them work in physiotherapy outpatient services treating patients with musculoskeletal conditions. In many services they take responsibility, under professional supervision, for types of clinical work traditionally undertaken by physiotherapists. Nevertheless, their role(s) are relatively undefined and as such there is considerable variation in the duties and tasks they undertake. In some physiotherapy services they have a predominantly clinical role whereas in others they fulfil primarily an administrative role. This latter situation leads to support workers not being able to utilise their clinical skills, job dissatisfaction as well as unjustified variation in care and clinical services provided to patients.
Purpose: This study aimed to reach consensus amongst physiotherapists, support workers and managers about what constitutes “best practice” and what components should be included in a best practice framework of delegation in England’s National Health Service (NHS) musculoskeletal outpatient physiotherapy services.
Methods: A consensus study was carried out, using Nominal Group Technique (NGT). A convenience sample of physiotherapists, support workers and managers who work in NHS musculoskeletal physiotherapy services were recruited through the Chartered Society of Physiotherapy’s (CSP) professional networks and social media. Three separate role-specific NGT working groups were convened with: 1) physiotherapists (7 participants); 2) managers (10 participants); and 3) support workers (10 participants) from 13 NHS Trusts.
Prior to the study, participants were sent a summary of existing evidence on clinical delegation and guidance from the CSP. During the meeting participants were given the time to individually and silently generate ideas for items to include within a ‘best practice’ framework, which then were shared with the group one by one. Each shared item was then individually rated for importance by all participants. Following this, the results of these ratings were discussed within the group, and then re-rated individually by participants, who were given the opportunity to amend their scores in light of group discussions. Each item was rated on a 7-point Likert scale and a mean rating calculated across each group. The threshold for consensus was set at ≥70% (i.e. an average of >4.9/7 for each item).
Prior to the study, participants were sent a summary of existing evidence on clinical delegation and guidance from the CSP. During the meeting participants were given the time to individually and silently generate ideas for items to include within a ‘best practice’ framework, which then were shared with the group one by one. Each shared item was then individually rated for importance by all participants. Following this, the results of these ratings were discussed within the group, and then re-rated individually by participants, who were given the opportunity to amend their scores in light of group discussions. Each item was rated on a 7-point Likert scale and a mean rating calculated across each group. The threshold for consensus was set at ≥70% (i.e. an average of >4.9/7 for each item).
Results: 32 out of 38 generated items reached consensus in the 3 groups, with consensus scores ranging from 70% to 98%. Although these items differed slightly across groups, they were categorised under 5 main areas: 1) clear delegation process; 2) defining the role of support workers; 3) training/Continuous Professional Development (CPD) for physiotherapists and support workers; 4) competencies and 5) safety net. Having clear core skills and competencies defining the scope of the role and having a clear delegation process allowing for open communication channels from start to finish were the highest rated items.
Conclusions: Key stakeholder groups were able to reach a strong level of consensus on the priority areas for inclusion in a ‘best practice’ delegation framework.
Implications: The findings from this study will contribute to producing a best practice framework of delegation in NHS musculoskeletal outpatient physiotherapy services.
Funding acknowledgements: Panos Sarigiovannis, Clinical Doctoral Research Fellow (NIHR301550) is funded by HEE/NIHR (UK) for this research project.
Keywords:
Support workers
Skill mix
Delegation
Support workers
Skill mix
Delegation
Topics:
Musculoskeletal
Service delivery/emerging roles
Professional issues
Musculoskeletal
Service delivery/emerging roles
Professional issues
Did this work require ethics approval? Yes
Institution: Health Research Authority, England (HRA)/ Health and Care Research Wales (HCRW)
Committee: South West – Frenchay Research Ethics Committee
Ethics number: 21/SW/0158
All authors, affiliations and abstracts have been published as submitted.
