Your comments: 21 June 2017

Green fingers

Gardening can be a very rewarding way of keeping active in order to maintain and improve fitness and wellbeing. The Association of Chartered Physiotherapists in Cardiac Rehabilitation (ACPICR) professional network has added a new leaflet on gardening to an existing range on activities for patients with heart problems. These look at topics such as golf, swimming, resistance training and racquet sports.

The ACPICR is committed to promoting best practice in cardiac rehabilitation for the benefit of patients. As one of our objectives, we produce a new leaflet each year. All the leaflets are available to download from the ACPICR website. Visit www.acpicr.com

Melanie Reardon, co-chair, ACPICR

Room for discussion

Starting to talk about death is like recognising there is an elephant in the room. As a physio with a post-graduate certificate in healthcare chaplaincy, I felt we needed a more open dialogue with patients of the pulmonary rehabilitation team at Midlothian Community Hospital, Dalkeith, near Edinburgh.

In Dying Matters Week, which ran from 8 to 14 May, we held three events during pulmonary rehabilitation classes that focused on death and dying. For more information on the week, visit www.dyingmatters.org

As well as offering a range of Dying Matters leaflets, we displayed a Hope Tree poster that offered a quiet space for staff and patients to remember those they had lost. We also used 'fink cards' to encourage discussions relating to anticipatory care planning. For more information, visit finkcards.co.uk

Patients told us the sessions were helpful or very helpful. Comments included: 'It's good to talk', 'Useful to talk', 'Life is too short', 'It's not too bad to talk' and 'I need to get a will sorted.'

Dying Matters Week was a springboard for the pulmonary rehabilitation team to embed such conversations in our programmes all year round.

Susan Begg, specialist physio in pulmonary rehabilitation, NHS Lothian

The time is right

The NHS Five Year Forward View has given the green light to transformation when it comes to providing a more resilient, robust NHS. Numerous models of practice have been piloted, highlighting that having a diverse workforce outside the standard medical models is needed if the NHS is to meet the growing needs of the population.

One such model is the role of the musculoskeletal physiotherapist as a first-contact clinician in primary care. Early implementation schemes showed that having physiotherapists at the 'front door' helps to manage patients effectively, economically and safely.

There is a compelling need for our profession to show strategic leadership. If we do not, other professions will occupy the role and use the early work completed, leaving physiotherapy outside the clinical offer to primary care.

So, what needs to be done? First, a national database providing outcomes that have robust numbers supporting the narrative. Second, clear workforce models to help our health leaders see how re-design can be implemented. Third, economic models that demonstrate the value on the wider system so that health commissioners can visualise the proposals. Last, a transparent, agreed national model of advanced practice, with clear frameworks, competencies and standards that are recognisable both within and across professions.

The time for saying we are useful is over, the time to prove it is now.

Dr Neil Langridge, consultant physiotherapist, Southern Health NHS Trust

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