Who dares wins

When Michael Dare landed the role as head of rheumatology for one of the UK’s largest independent providers of NHS services at the age of 33, it was all part of the plan. He oversees four community rheumatology services with 21 rheumatology health professionals covering five Clinical Commissioning Groups. An emerging area, Dare has big plans for the future of rheumatology physio, which he’d like to see rolled out as a nationwide community-based service, similar to musculoskeletal provision.

‘I’ve always had a plan of how I wanted to develop clinically and professionally and I’ve tried to stick to it and in most instances it’s been beneficial for myself, and for rheumatology,’ he says. And he is keen to see opportunities in his specialism taken up – with AHPs assuming key roles in rheumatology to support and improve outcomes and waiting times for patients while ensuring the patient sees the correct practitioner the first time.

‘With the current challenges on access to NHS healthcare, we can see the breakdown of barriers in all professions, particularly AHPs,’ he says. ‘Physiotherapists in particular have the skills, knowledge and training to step up – particularly now they can prescribe – and there are great opportunities to do so. It’s our duty to continuously push the barriers within a safe environment and support our medical colleagues.’ 

Born in Kimberley, South Africa to an accountant father and a photographer mother, Dare admits to growing up with a false perception of his future career. ‘As a junior athlete with a love of rugby, hockey and squash I thought physiotherapy only dealt with sports people and injuries.’ 

He got a ‘reality check’ from his bachelor’s degree at the University of Western Cape where he saw patients ranging from premature babies to poly-traumas in ITU – ‘sports injuries were only a very small part of what we did,’ he says. ‘One of the beautiful things about being a physio is the diversity of the role – there’s very little restriction on the type of people you see, treat and help, which is awesome.’

Several times in my career people have said physios can’t work in rheumatology, and it’s a practice only for medics, so to pass that was a basis for me to say these roles should be based on competency and to break down those professional barriers was very important.

Thinking outside of the box

Another surprise may have ended his career prematurely, if Dare hadn’t been so tenacious in his ambitions. ‘When I started, I didn’t do well with blood or drips or machines. I had lot of anxiety and several fainting spells in hospital and had to get myself conditioned to working in those environments. But I don’t think it ever crossed my mind to change my decision to be a physio.’

His determination was further tested during the mandatory internship year all South African physiotherapists undertake on graduation. Dare spent his in a state hospital in the isolated, rural village of Madwaleni, 10 miles from where Nelson Mandela was born on the Eastern Cape. ‘It was very far away from my comfort zone back then,’ Dare admits. 

‘People spoke very little English and the area was quite deprived, so it was a real eye opener on the realities of healthcare in rural South Africa.’ Efforts were focused on treating communicable diseases and giving rehabilitation to patients with quite severe disabilities arising from HIV, traumas, or injuries from road traffic accidents. ‘There wasn’t much back, knee or neck pain,’ Dare deadpans. ‘But it was a pleasant surprise to be able to make a difference in the lives of people who were quite poorly. It allowed me to gain more confidence in dealing with things out of the ordinary, and to be able to think out of the box when managing patients clinically.’

He went on to complete a Master’s in MSK medicine at Stellenbosch University. A transitional doctorate in physiotherapy was followed by a stint in the Middle East for a few years alongside an orthopaedic surgeon. This sparked his interest in rheumatology. ‘The surgeon had a special interest in ankylosing spondylitis, so I was rehabbing patients with severe pain and instability, and that really started my interest in rheumatic disease as a whole.’

A passion for improvement

Dare moved to rheumatology as an advanced physiotherapy practitioner in 2017, explaining the appeal of his specialism as ‘a good fit’ for his skill set. He was quick to adjust to the UK landscape – ‘in the UK, most of the money is spent on lifestyle diseases like hypertension, cancer, diabetes, and MSK. It’s a healthy, ageing population, so the focus is completely different.’

It’s clear Dare is a relentless self-improver, with his five years at Connect Health being populated with continuous studies – ‘Every year I try to do something in terms of CPD or something formal in terms of training or study.  That way I’ve always been able to update my knowledge or skills and keep up to date.’

Prescribing training at the University of Essex was followed by ultrasound training, injection therapy training and a two-year European League Against Rheumatism diploma. Passing this last was his proudest moment, second to becoming a father, because it proved his doubters wrong. ‘Several times in my career people have said physios can’t work in rheumatology, and it’s a practice only for medics, so to pass that was a basis for me to say these roles should be based on competency and to break down those professional barriers was very important.’

He admits to being ‘quite a workaholic’ in his first couple of years in the UK, expending all his energy running a full-pelt launch of Connect Health’s rheumatology offer to the NHS, then working weekends as a sonographer to help with the Covid backlog. 

In addition, he’s still currently enrolled on the CSP’s six-month, master’s level Leadership Development Programme at the University of Central Lancashire, which he highly praises. ‘I struggle with leadership, I have neglected it in my career but I’m finding the course really beneficial.’ 

Finding your own leadership style

The CSP funds about 48 places for physiotherapists each year using funding from the CSP Charitable Trust.  ‘It’s a really good initiative to support and fund university-accredited leadership programme for physios,’ says Dare. ‘It personality types you in terms of your leadership profile, which gives you a good insight into your personality and what aspects affect your leadership style and how other people’s leadership styles might respond positively or negatively to certain aspects. 

‘There is a lot of case discussion and situational challenges faced in the workplace, with a very strong bias on breaking down barriers for AHPs so they can move into higher levels of leadership in the NHS. This really has to happen in the future. The medically top-heavy model for the NHS is not sustainable, as we can see with the challenges facing it at the moment.’

Though Dare is the kind of professional who may find it difficult to power down, he is quick to credit others with helping him – whether colleagues or course mates – to his various successes. ‘I’ve been very lucky that we have close consultant support in our learning and discussions that happen every day, which help me grow clinically. 

‘My career has reflected that I’ve never underestimated the importance of networking, being a good person and having integrity and a good worth ethic. I’ve been surprised several times, where having a good professional relationship with colleagues can bring up opportunities for you.’

And his advice for others who may have ambitions to top the leadership league table? ‘Just be honest with yourself about your strength and weaknesses. Be very specific about what you want to achieve in terms of your development and career pathway and put down measurable and realistic steps to achieve those goals. If you stick to the plan anything is possible.’