In response to the Dave’s post ‘Encroachment’, I can see the conceptual message towards the profession and the extension of roles within physiotherapy, however there are some more points to consider. Now although I have a good breadth across a number of areas within Physiotherapy I have resided in MSK and will therefore relate my experience and thoughts to that particular field of care.

I agree that we need to be mindful in relation to the shift in the Public Health message and whether the physiotherapy degree has the foundations to support this paradigm shift is questionable as to how this manifests itself into clinical practice.

The point raised by Dave in his blog ’It could be argued that you don’t need a three- or four-year degree and experience as a diagnostician of multiple co-morbidities to take on this role, no matter how attractive it might be as a mechanism to secure public health funding…’ is one that requires some more details to expand on its context, as I wonder if the consideration here is that to understand MSK healthcare as a whole and the input on the person and their quality of life takes more than 3-4 years of training and exposure to a multitude of MSK pathologies that enhance pattern recognition and the impact on the patient and Public Health. The value of this expertise allows those in extended roles where they are managing MSK and Orthopaedic case loads instead of the GP in order to allocate to a more appropriate care pathway should be a fusion and synerygy with the public health message being at the forefron where applicable.

The co-existence of an ESP working within MSK healthcare articulating the public health message is key, however we must consider this alongside a number of variables such as socio-economic factors, demographics and local health resources. A number of clinicians in extended roles are signposting to secondary care more appropriately as well as managing the Public Health message. Admittedly this is still work in progress in some areas but there are some fanatics examples being demonstrated within the field of MSK. We know that the most common reason for repeat visits to the GP is for MSK pathology and that 30-40% of a GPs case load is related to MSK presentations.

The details of the physiotherapy degree may need to evolve to meet the paradigm shift and ensure that clinicians are entering the profession with the correct mindset, clinical tool box, competency and development plan to help them achieve the correct approach to an ever changing healthcare population.
We should maybe look to see this as opportunity. Should we look to accommodate the change with caution….. Yes…..Approach with trepidation…. Yes….. Value the change with excitement…. Yes…. Improve ongogin competency…. Yes……Make leaders accountable for poor service delivery…… Yes……. Have more clinical leadership driving forward Public Health …. Yes…….Avoid extended roles…. No..!

Why not prepare to embrace the public health message and apply that to clinical practice to improve the health of our patients.

Apologies for the breif repsonse and thanks to Dave for raisng the discussion and keep up the good work.