Specialist Physiotherapist

Job overview

Highly specialised clinical reasoning skills will be used to provide specialist assessment and treatment of complex chronic pain patients as a practitioner within Optimise Pain Rehabilitation Unit. You will provide high quality clinical input and psychologically-informed physiotherapy for persisting pain patients.

The post holder will provide bio-psychosocial assessments, group pain rehabilitation programmes . Other duties include assisting and supporting the team leader and senior staff in the management of the department and ensuring high standards of care are maintained and developed. The successful applicant will be supported with in-house training to increase skills in working with patients with chronic pain. There are also in-service training sessions for both out-patient musculoskeletal services and pain.

Main duties of the job

• To demonstrate highly advanced theoretical knowledge of anatomy, physiology, and pathology and utilise highly developed clinical reasoning skills to accurately determine clinical diagnosis and prognosis in a wide range of mixed and complicated conditions requiring rehabilitation, often in situations where conflicting evidence is present (e.g. medical masqueraders), resulting in realistic, patient centred goals and treatment plans in line with evidence-based practice.

To undertake as a specialist autonomous practitioner, comprehensive assessments of highly complex patients presenting with multiple pathologies, using advanced bio psychosocial clinical reasoning skills, expert knowledge of evidence based practice, and advanced rehabilitation expertise to interpret and analyse clinical and non-clinical facts, which may include very personal, emotive or contentious information. Demonstrate critical awareness of knowledge in the field and at the interface between different specialities. Develop new skills in response to emerging knowledge and techniques

Detailed job description and main responsibilities

The programmes:            Out-patient programmes and one to one treatments which are psychologically informed or that are based on principles of Cognitive behavioural therapy, Acceptance and Commitment therapy and mindfulness.

Job Summary:                   To use highly specialised clinical reasoning skills to provide specialist assessment and treatment of complex patients as an autonomous practitioner within Optimise Pain Rehabilitation Service.

To provide high quality clinical input for persisting pain patients.

To be able to unravel the complexity of the impact of pain and identify which ‘blending of  therapies’ are required to address both the psychological and physical effects of pain.

Principle Duties and Responsibilities

Clinical

• To be professionally and legally accountable and responsible for all aspects of own work including the management of individual caseload, working within accepted codes of professional conduct and clinical guidelines to minimise clinical risk.
• To demonstrate highly advanced theoretical knowledge of anatomy, physiology, and pathology and utilise highly developed clinical reasoning skills to accurately determine clinical diagnosis and prognosis in a wide range of mixed and complicated conditions requiring rehabilitation, often in situations where conflicting evidence is present (e.g. medical masqueraders), resulting in realistic, patient centred goals and treatment plans in line with evidence-based practice.
• To undertake as a specialist autonomous practitioner, comprehensive assessments of highly complex patients presenting with multiple pathologies, using advanced bio psychosocial clinical reasoning skills, expert knowledge of evidence based practice, and advanced rehabilitation expertise to interpret and analyse clinical and non-clinical facts, which may include very personal, emotive or contentious information. Demonstrate critical awareness of knowledge in the field and at the interface between different specialities. Create a research-based diagnosis to problems by integrating knowledge from new or interdisciplinary fields and make judgements with incomplete or limited information. Develop new skills in response to emerging knowledge and techniques.
• To monitor and reassess therapeutic input and patient status in order to progress and adjust treatments effectively and develop comprehensive discharge plans referring to specialist services as indicated.
• To take a lead professional role in a highly specialist area by providing expert advice and support to physiotherapists and other healthcare professionals.
• To be responsible for producing and developing guidelines, protocols and policies pertinent to specialist area from government directives (e.g. NHS plan / NICE Guidelines etc)
• To plan and organise own time including patient care, training, supervision and meetings.
• To be responsible for the competent use of exercise and gym equipment, and patient      appliances as indicated, and to report any defects or malfunctions to the Team Leader.
• To participate in the service Clinical Governance and Clinical Supervision programmes.
• To develop comprehensive discharge plans.
• To be responsible for writing clinical letters, reports and discharge letters issued to patients and outside agencies.
• To advise patients, employers and occupational health departments on the appropriate time to return to work, sports and other activities. To issue AHP fit notes.
• To manage clinical risk within own caseload and within the pain rehabilitation service. To be able to undertake a suicide risk assessment and follow the pathway for suspected cauda equina. To report safeguarding issues and refer to appropriate teams.
• To assess patients attending Optimise Pain Rehabilitation Unit and refer to the most appropriate programme, including assessment for hydrotherapy, physiotherapy, one to one sessions. To participate in the running of the Balanced Life and Get Back Active programmes including hydrotherapy and manage complex patients on a one to one basis.
• To decide (in consultation with colleagues if necessary) whether to treat, co-manage or refer.   e.g. reason referral requirements to crisis team, community mental health or pain clinical psychology; be able to unravel the complexity of the impact of pain and identify which ‘blending of  therapies’ are required to address both the psychological and physical effects of pain.
• To provide post programme reviews for participants.
• Demonstrate academic and theoretical knowledge of pain neurophysiology (e.g. pain gate, neuroplasticity, peripheral and central sensitisation, centrally generated and maintained pain; role of sympathetic, parasympathetic, immune systems and genetics, pathology of peripheral neuropathies, CRPS, phantom pain, etc)
• Demonstrate understanding of core concepts of Acceptance and enhancing psychological flexibility; cognitive defusion (how our thoughts / language becomes fact); contact with the present moment; the observing self (Mindfulness); reconnecting with values; encouraging sustained committed action. Differentiate between struggling and acceptance.
• To be familiar with a range of psychological approaches used in pain management such as mindfulness, motivational interviewing, ACT, CBT etc and to be competent in the delivery of treatment in groups using principles from such approaches.
• Demonstrate ability to use activity/exercise sessions as an opportunity for patients to be exposed to difficult thoughts, emotions, and bodily sensations. Ability to facilitate patients in managing these when they arise, in keeping with values and workability.
• To participate in the evening and on call rota.

Communication

• To communicate in simple terms complicated concepts about pain mechanisms  and scientific information to patients, carers and other staff (within and outside own profession), both on an individual and group basis, who may find such ideas difficult to understand due to differences in educational or language background, and who may not want to accept information provided. Information needs to be clearly conveyed without causing offence or distress.

• To communicate with all other healthcare professionals, voluntary agencies and professional networks concerning patient care or professional issues and ensure good working relationships for the effective provision of musculoskeletal rehabilitation.
• To impart unwelcome or disappointing news to patients with poor prognoses and their relatives/carers in an appropriate and empathetic manner ensuring their understanding of the implications of such information.
• To demonstrate negotiating and persuasive skills where required in relation to specialist caseload and service development.
• To deal with verbal complaints and to follow the Trust’s formal complaints procedure.
• Demonstrate theoretical and clinical application of communication skills (empathy, validation, active listening, rapport building, reflecting, paraphrasing, summarising, use of silence etc). Able to elicit, identify and act on patients understanding / concerns.
• In groups and individual interactions it is necessary to provide information using an ACT approach that may be contrary to previously received medical advice. The needs of the individual versus the needs to the group need to be managed in a sensitive manner such as coping with interruptions by distressed patients or dealing with anger when it is aimed at oneself or other patients.
• To provide appropriate feedback to the referring staff during and at completion of physiotherapy intervention.

Education

• To develop and deliver teaching programmes within specialist area of practice to senior and junior staff.

• To attend clinical governance meetings.

• To assist the Team Leader in organising the Clinical Governance programme within the service. To participate in the IST programme.
• To deliver specialist lectures to a wider audience e.g. conferences, clinical interest groups.
• To be responsible for maintaining a detailed personal portfolio showing reflective practice, and provide CPD and clinical supervision and mentoring to all staff.
• To act as clinical educator for undergraduate students as required.