Advanced Practice Physiotherapist - Spasticity Service

Job overview

Are you dynamic, motivated, forward thinking and have a passion for driving changes to permanently improve the quality of life of patients with focal spasticity, getting actively involved in the patient’s journey?

An exciting opportunity has arisen to join our newly evolving and rapidly growing service for interventional treatment of spasticity of the upper and lower limb. You will use evidence-based principles, current best practices of non-operative treatment to help optimise preoperative assessment and guide postoperative rehabilitation.

You will be optimising pathways for patients and supporting communication between healthcare professional that are involved in the assessment, treatment and rehabilitation of patients with upper motor neuron lesions.

This role also requires the ability to review the current service provision, explore options and make recommendations for the future service including business case development with support as required.

Main duties of the job

To act as the therapy clinical lead in the Spasticity Service and to promote and actively develop the service in conjunction with the Multidisciplinary Team and Head of Therapy Services.

• To be responsible for providing autonomous advanced assessment, diagnosis, and treatment of patients with complex neurological disorders and focal spasticity, working in an Advanced Practice role with the skills to inject and prescribe and authority to order further investigations such as imaging.
• To act as a source of expertise and provide specialist clinical knowledge and guidance on the management of spasticity to Primary Health Care professionals, Consultants, Senior Therapists, and other Health Care Professionals.
• To act as a clinical lead in co-ordinating, delivering, and evaluating the Spasticity service together with the Head of Therapy Services, Lead Consultant for Spasticity and multidisciplinary team in line with the Trust Business Plan and the needs of service users.
• Working for our organisation

The Royal Orthopaedic Hospital NHS Foundation Trust is one of the largest specialist orthopaedic units in Europe. We offer planned orthopaedic surgery to people locally, nationally and internationally.

Our Trust is a very special hospital; big enough to deliver world class services and small enough to offer exceptional patient and staff experience. We offer a working experience unique in the West Midlands and we're always on the lookout for passionate people to join our award-winning team.

The ROH is an equal opportunities employer. We employ people of difference and are committed to growing an inclusive culture, where difference is celebrated, and people feel able to bring their whole and authentic self to work.

We are a Disability Confident Leader and offer a range of inclusive, family friendly and flexible working arrangements and policies, to support our people in the workplace. Flexible working requests will be considered.

The Trust is committed to the Disability Confident Interview Scheme and will offer an interview to disabled applicants who meet the minimum criteria for a vacancy and consider them on their abilities.

If you have a disability and need any support with your application or require any reasonable adjustments to be implemented please do get in touch with the Recruiting Manager for this position so that the team can support you.

Detailed job description and main responsibilities

• To undertake the measurement and evaluation of work and current practices within the Spasticity Service, involving the use of Evidence Based Practice, audit, research, and outcome measures.
• To maintain own continued professional development (CPD) and portfolio, by keeping abreast of any new trends and developments, incorporating them into current clinical practice as necessary. To be responsible for progression and maintenance of CPD for other members of the physiotherapy department within specialist areas.
• To ensure that the agreed quality standards of service, based on professional guidelines and standards from a range of professional bodies (seeking guidance from others as appropriate) are maintained. To abide by Health Professions Council (HCPC) professional standards and code of conduct.
• To be responsible for Clinical Governance within the service, reporting to the Head of Therapy Services.
• To demonstrate a sound understanding of risk management and apply to work situation, following department and Trust policies.
• To be an active member of the in-service training programme where appropriate by organising, attending and teaching at tutorials, training sessions and external courses.
• To provide clinical experience and supervision for postgraduate and undergraduate students as required.

• To be professionally and legally responsible and accountable for all aspects of own work including the management of patient care within the clinics. To ensure a high standard of holistic and timely clinical care for the patients under your management and support more junior staff and other Health Care Professionals to do likewise.
• To act as a Physiotherapy Lead within the multidisciplinary team of specialists involved in the management of patients within the spasticity service.
• To communicate with and provide highly specialist advice and training to Physiotherapy staff, Lead Consultant for Spasticity, Consultants, GP’s, and other Health Care Professionals on the management of patients with spasticity to ensure a co-ordinated and seamless service within clinics.
• To undertake a comprehensive advanced assessment and triage of highly complex patients referred to the service using advanced clinical decision making, analytical skills and manual assessment techniques to determine a clinical diagnosis, within best practice guidelines and the evidence base where it exists, as an autonomous practitioner.
• To formulate individual management and treatment plans for patients with spasticity, including pre- and post-op surgical plans, and may encompass timely referral to areas outside physiotherapy. Working in partnership and liaising with external services (e.g. rehabilitation services, community teams, care homes, wheelchair services, hand therapy and orthotics) to effectively manage patients with complex needs.
• To deliver treatment programmes within clinic using clinical reasoning and a wide range of skills including highly developed manual physiotherapy techniques to facilitate movement and function in patients with spasticity and resultant movement impairments. This requires the integration of research theory into clinical practice and patient treatment techniques.
• To evaluate and modify treatment plans according to patient needs, discharging them when appropriate. Seek advice from others when necessary and work without direct supervision.
• To develop and maintain skills required to practice at an advanced level including manual physiotherapy techniques, and to use an extended scope of practice beyond physiotherapy including ultrasound guided Botulinum toxin injection, serial casting and splinting, manipulation/manual therapy.
• To triage referrals to the Spasticity Service and participate in multi-disciplinary team clinics, referring onwards when required.
• To offer expert advice in spasticity management, including advice on physical
• management strategies and focal physical interventions such as serial casting, systemic spasticity medications and focal spasticity intervention such as Botulinum Toxin injections.
• To undertake the role of Physiotherapy Independent Prescriber within the Spasticity Service in line with Trust policy, professional regulatory and national guidance, if required by the service.
• To maintain competence in prescribing according to level of prescribing qualification and participate in regular continuing professional development in relation to the role.
• To prescribe in accordance with the Trust’s Medicine Policy, The Non-medical Prescribing Policy, local and national prescribing guidance.
• To prescribe within the limits of individual competence.
• To develop and update clear Patient Specific Directive and Patient Group Directives as required for the treatment of patients in the Spasticity Service.
• To provide spontaneous and planned advice, teaching and instruction to patients, relatives, carers and other professionals from the multidisciplinary team to ensure a consistent approach to patient care, by promoting the understanding of physiotherapy aims.
• To communicate effectively and gain informed consent from patients, carers and other professionals to ensure understanding of condition within the Spasticity service, and to maximise rehabilitation potential. This will include using a range of verbal and non-verbal communication tools where there may be barriers to communication e.g. acquired communication and cognitive impairments, non-English speaking patients (use of interpreters), excess noise, lack of privacy, deafness, learning difficulties or mental health problems. This will also include complex and sensitive information requiring skills of explanation, motivation and persuasion to overcome physical, emotional, mental and cultural barriers.
• To accept clinical responsibility for a designated caseload, and to organise this effectively and efficiently with regard to clinical priorities and use of time.
• To maintain accurate, comprehensive and up-to-date documentation in line with departmental and CSP standards, including communication of assessment and treatment results to appropriate disciplines in the form of reports and letters.
• To work evening and weekends as required by the service.
• To work in off-site venues as required by the service.
• ORGANISATIONAL & PEOPLE MANAGEMENT
• To be responsible for the co-ordination and development of services within the Spasticity service, liaising with other areas as needed.
• To ensure appropriate prioritisation, organisation and delegation of tasks on a daily basis within the service, balancing patient related and professional demands.
• To monitor, audit and objectively assess the performance and workload of the

• To make recommendations for future changes in working practice to the Head of Therapy Services, implement change required to improve service provision.
• To develop evidence based clinical guidelines, protocols and policies liaising with Head of Therapy Services and relevant clinical teams as needed.
• To be aware of the Health and Safety at Work Act and its implementation for

• To understand and work within legal frameworks including consent and mental capacity.
• To remain up to date with, and attend mandatory training provided, in line with Trust policies.
• To develop and maintain an ability to cope with and prioritise many unexpected work demands and deadlines and to maintain intense concentration for prolonged periods, when dealing with complex patients.
• Carry out highly specialist assessments and treatments of patients with varying degrees of disability on a daily basis, using moderate physical effort. This may involve moving and handling patients and equipment.
• Frequent exposure to highly unpleasant working conditions on a regular/daily basis, e.g. bodily fluids, urine, faeces, blood and vomit and occasional exposure to verbal and physical aggression.
• Personal responsibility of care with regard to equipment utilised during work.

Person specification

Qualifications / Training

• BSc Degree / Diploma in Physiotherapy
• Current HCPC registration
• MSc level post-grad courses including US guided injections and independent prescribing

• MSc in relevant subject
• Member of relevant special interest group

Other

• Able to develop and clinically lead a service
• Able to work independently and as part of an MDT in the management of complex patients

Experience and skill

• Significant experience at senior level as a chartered Physiotherapist within neurology, neurorehabilitation services and with patients with spasticity
• Highly developed skills including US guided injection of Botulinum toxin and splinting
• Advanced knowledge of adjunctive interventions for spasticity management
• Experience of MDT working
• Experience of teaching and mentoring

• Experience of service improvement including options appraisal and development of business cases
• Experience of autonomous clinic work at advanced practice level