Preparing students for 21st century practice

Jennifer Trueland reports: when Eve Scarle considers the roles open to physiotherapists now compared to when she qualified, she marvels at the level of transformation.

It’s not as if Scarle is ancient – she trained around the turn of the millennium – but a lot has changed in two decades. As well as specific new posts such as first contact physiotherapy the health and care environment more broadly is very different, meaning that there is increasing demand for more physiotherapists across primary and community services, performing ever-wider roles.

All this means that there’s a growing necessity to train more physiotherapists to meet current and future need – and a corresponding requirement to ensure these graduates are fit and prepared for all that modern practice will demand of them.

‘When I graduated 19 years ago there weren’t the same jobs as we have now in health promotion, in long-term condition management and so on,’ says Scarle, who is academic course leader for physiotherapy at the University of Gloucestershire. ‘These roles just didn’t really exist in primary care. While the physio role is growing, we’re going to see a need for a lot more of them. Plus, we’ve got a lot of physios sitting close to retirement, so we have to consider that too.’

Gloucestershire is one of several universities that started offering physiotherapy degrees last year. These new programmes are vital to ensure the supply of high quality graduates ready to take on not just the exciting new roles, but also to address current vacancies and future workforce needs.

The CSP, which has been closely involved in the development of the new courses, which it accredits, forecasts that the NHS needs to recruit 500 extra physiotherapists a year to meet growing demand. ‘People are living for longer, and physiotherapy has a great opportunity to really maximise quality of life as people age,’ says Gill Rawlinson, CSP assistant director, practice and development. ‘Internationally and within the UK we need sustained growth in the physiotherapy workforce in order to meet the increasing demands of the population, and the complexity of their health needs.’

A greater number of higher education institutes (HEIs) offering pre-registration degrees in physiotherapy brings a number of benefits, says Rawlinson. It’s an opportunity to encourage innovation – underpinned by quality – but it is also a chance to help improve the supply of physiotherapists to areas that have traditionally found it hard to recruit.

‘One of the areas we are focusing on as new programmes come on line is thinking about the needs of the local stakeholders. What is the workforce planning in that area? What are the needs of the population? What are their main challenges and how is the new course going to meet these challenges?’ says Rawlinson.

This is certainly the case in Gloucestershire. ‘We’ve been working really closely with local trusts, who were heavily involved in the writing of the programme,’ says Scarle, who is also the university’s academic subject lead for allied health professions. ‘We know there are big struggles with local recruitment into physiotherapy posts, both in NHS and private practice. This was our chance to think about developing a new course locally that hopefully supports development of the local workforce.’

Modern curricula

Starting with a blank canvas, they had the opportunity to think hard about what future physiotherapists would look like, and the skills and education they would need. As a result, they decided to focus on long-term conditions, health and wellbeing, and leadership and innovation. ‘We’re really lucky that business and computing are on our campus as well, so I’m hoping we can generate a really modern, forward-thinking cohort of physiotherapists who will be thinking about how physiotherapy will look different, and how we can use technology more,’ says Scarle. ‘Things are moving to be much more digitally-based, much more app-based, so the plan is to try to use some of the expertise that we have in and around the campus to help us think about how we can take some of these ideas forward.’

We’re promoting innovation in models of practice and really thinking about, for example, how we prepare students for working in primary care and the community

Support from the CSP in developing and implementing the programme has been crucial, she says. ‘We worked closely with the CSP and they’ve been really keen to be involved in helping us with the structure of the programme and much else too. They have worked with us to make sure we had a really modern curriculum.’

North Wales is another area that has traditionally struggled to recruit physiotherapists, says Julie Wilkins, professional lead in physiotherapy at Wrexham Glyndr University. Its new BSc degree in physiotherapy, which also started last year, is trying to reverse that, and encourage people to stay and work in the area. ‘Twenty of my 21 students are North Wales or Powys-based, so they are all people who have grown up and lived in the local area and who, on graduation, want to put their services back there,’ she says.

‘We can take local people, and grow local physios, to take local posts to contribute to the health economy and the health and wellbeing of people who live in North Wales.’

Importantly too, as a university with a strong emphasis on widening participation, the students aren’t necessarily following the traditional route of coming straight from school with a clutch of biological science-based qualifications. ‘We’ve got one chap who has an engineering degree,’ she adds. ‘We’ve got somebody who worked in the local council. We have people with a broad range of skills that they can now apply in a new setting.’

Support to develop programmes

Support from the CSP has been key, says Wilkins. ‘They’ve been the best critical friends that anyone can ever have – that partnership with the CSP has been invaluable. We couldn’t have done it at the pace we have without them.’

This support included providing a solid framework and encouraging her to ‘hold a mirror up’ and consider every element of the programme.

She continues: ‘We’ve thrown away that route-map of “you’ve got to do neurology placement, an MSK and a cardio-respiratory placement”. What we’ve said is that actually, citizens are living in rural communities – North Wales has 17 community hospitals – so two placements need to be in primary, community or rural care, only one needs to be in secondary care provision, and, through a learning contract, you will build your placement profile to make sure that across those settings you gain the skills of respiratory, neuro, and MSK. We’ve turned it on its head, if you like.’

According to Chris Carter, senior lecturer in physiotherapy at the University of Sunderland, which also took on its first BSc physiotherapy students last year, being part of something new and innovative has been a great opportunity, as has working with local stakeholders.

‘We spent a lot of time with practice partners in developing the programme – really, they helped us write it,’ he says. ‘They were telling us what they thought should go in. Service users were involved with that as well.’

While developing the programme, he was initially worried about the availability of placements, particularly with larger physiotherapy courses already operating at neighbouring institutions including the universities of Northumbria and Teesside. In the event, a good variety of placements has been found across the North East, offering experience in a range of settings. Employers were keen to be involved, he stresses.

‘For me it’s been great to involve everybody from the off – we’ve got a sort of shared ownership of the programme: it’s not the university’s programme, it’s everybody’s programme.’

Preparing students for work

The university’s Patient Carer and Public Involvement (PCPI) initiative is also threaded through the programme. This, says Carter, is part of Sunderland’s aim to put the patient at the centre, and develop physiotherapists who truly practise holistic care.

The CSP was crucial to the programme’s development, both in providing direct support, but also in linking Carter up with a senior physiotherapy educationalist from another university. ‘They advised me to come up with a vision of what I wanted – what was a Sunderland physiotherapy student going to look like, and how we were going to get there. The support was invaluable.’

The CSP has guiding principles for the delivery and development of programmes it accredits. Broadly, themes include how people learn and are assessed, widening participation and increasing the diversity of the profession, and supporting those from non-traditional backgrounds. The principles also promote inter-professional working and putting the patient at the centre of care that is truly joined up.

‘We’re promoting innovation in models of practice and really thinking about, for example, how we prepare students for working in primary care or in the community,’ says Rawlinson. ‘How do we embed research and critical evaluation skills right throughout the programme so it’s not just seen as a final year project? And how do we innovate in practice-based learning so that students are really getting the breadth of experience that is going to prepare them for 21st century practice?’

Although the CSP will support providers who might struggle to fulfil all these requirements, ensuring that programmes are high quality and fit for purpose is vital, she stresses. ‘If programmes aren’t up to scratch, and they’re not able to demonstrate those learning and development principles, we will give them support, but they will have conditions to meet, and unless they meet these conditions they won’t be able to establish the programmes,’ she adds. 

Workforce growth

Many physiotherapists will, of course, recall the situation in the mid-2000s where there were more graduates than there were jobs available – leading to many struggling to find work or leaving the profession altogether. Rawlinson is confident that this situation won’t be repeated.

‘There has been a clear mandate from government at a strategic level that we need a growth in healthcare professions including physiotherapy. We’ve had a clear commitment to first contact practitioners in the four countries of the UK so we need the workforce to deliver that, and we’re working on getting the same commitment for community rehab.

We’re in a different place [to 2007-8] in that physiotherapy is really positioned to answer a lot of the challenges and provide solutions to the healthcare crises that we’re seeing. The difference, in a nutshell, is that we might have seen increases in the workforce before, but we didn’t have the increased roles and the service transformation to take them up.

This time we’re playing catch-up because we’ve got a deficit in the workforce that we need to backfill but we’ve also got a predicted increase in physiotherapy roles that we need to provide a workforce supply for.’

Community rehabilitation and first contact practice bring tremendous opportunities for physiotherapy, she says, ‘We’re delivering more physiotherapy in primary care and we need an increase in the workforce to roll that out. In rehabilitation, for example, we’ve got really strong evidence that physiotherapy works, but people aren’t able to access the amount they need and deserve. We need to grow our workforce so that we can deliver that.’