Liz Hoskinson
Physiotherapist
Dorset HealthCare/Dorset Primary Care Training Hub
I am an advanced musculoskeletal (MSK) physiotherapist working in a portfolio model that gives mutual benefit to each role.
For Dorset musculoskeletal (DMSK) services I use my 20 years of clinical experience to deliver high quality care and advice to patients on the pathway between GPs and secondary care. I work on service development and have created a clinical training program to support physiotherapists transition from Band 6 to Band 7, including preparation for work as an FCP (first contact practitioner). I also represent DMSK at county-wide and regional levels.
The Clinical Fellowship with the Primary Care Training Hub is a fixed term secondment to develop FCP provision across Dorset no matter which provider model is used. It involves collaborating with another Fellow to develop a robust strategy for Dorset, informed from national updates and frameworks. We also represent Dorset at a SW Faculty FCP/MSK group and some of our local innovations have now been rolled out nationally. We have been privileged to collaborate with the AECC University College to help create an innovative postgraduate FCP/MSK advanced practice course.
The combination of roles has enhanced my contact network gained from working in Dorset for 20+ years and allowed sharing of ideas with others (both locally and nationally) going through the same challenges.
The Clinical Fellowship was out of my comfort zone, but it has been an amazingly supported experience with access to project management and quality improvement courses. As a clinician we do not prioritise these aspects of our job and it was so useful to find that what I had been doing to create the training program, could have been made much easier using techniques from these courses.
I started as a rotational physiotherapist in Bournemouth in 2020 (having qualified in 1998 but sailed around the world for 2 years). I continued my growth in Dorchester and Weymouth (the equivalent of Band 6 now) and worked part time in private practice.
After 6 years I started working as an extended scope practitioner (ESP) for the lead knee orthopaedic consultant, who supported me to become an independent prescriber and injection therapist. In 2006 I was one of the first clinicians to be recruited when the Dorset Intermediate Orthopaedic Service was created to bridge the gap between GPs and secondary care. I have worked for intermediate care (now DMSK) ever since and been involved in its growth from 4 clinicians to 30+.
At one point I had 3 official job roles: outpatient physio; ESP for the orthopaedic surgeon; intermediate orthopaedics service clinician (and two unofficial: wife and mother of twins).
When the opportunity arose for a clinical fellowship with the Primary Care Training Hub, my manager suggested that I apply as it mirrored the work that I was already doing for Dorset MSK and my experience could have a positive impact across Dorset. It has really opened my eyes to the opportunities out there and I look forward to new challenging roles in the future, while still keeping my grounding as a physiotherapist.
Monday – Non-working day
Tuesday – 4 hours FCP Clinical Fellow. Working from home, attending meetings, scoping and problem solving
Wednesday – 4 hours Dorset MSK Services: training, support and mentoring other clinicians across Dorset. Service development
Thursday – 4 Hours FCP clinical fellow
Friday – Non-working day
Saturday – Non-working day
Sunday – Non-working day
- A portfolio job role helps to keep you stimulated with variety and offers insight benefits to both jobs.
- Crucially, it helps prevent ‘burnout’ if you find one of the job roles particularly demanding. This is becoming increasingly relevant with the risk management aspect inherent in advanced practice, performed under tight time constraints.
- Combined, they have boosted my own confidence in the value of my opinions – which is easy to downplay when you are mostly clinical.
- My clinical experience informs the practicalities of the more management decisions (I can hand on heart say I never wanted to be a manager, and still don’t identify as one). It is only now having worked in a portfolio model that I can see that part of what I was doing within my clinical role can be considered ‘leadership’ if not management.
- Don’t be scared to push yourself
- It is easy to get comfortable in a job role with which you are familiar
- Don’t underestimate your value
- You may not recognise how many other skills you have learned along the way and how they can be used to great effect more widely than you can imagine
- A little goes a long way
- Part of the portfolio may only be for a few hours, but the impact can be great
- Talk to a coach or mentor
- Someone who is not so familiar with your job can stimulate you to think in different ways
Project management and quality improvement strategies! For years I had been suggesting and making service improvements on the hoof – now I have a framework to work within to help me keep on track and evaluate impact of the changes made, no matter the job role.
Chris Brookes
Physiotherapist
Dorset County Hospital/Dorset Primary Care Training Hub
Things evolved slowly. I first undertook an ACP role in 2006 in a large emergency department in the Midlands, although ACP had yet to be properly defined. Following this I relocated to Dorset in 2007 and became the team lead physiotherapist for the MSK outpatient service at Dorset County Hospital.
By 2014 I was looking for new challenges. I therefore trained in non-medical prescribing, which led to my interest to develop further advanced practice competencies. I became aware of a newly developing role called ‘MSK first contact practitioner’ from some publicity within the national physiotherapy magazine, and some local colleagues in the east of Dorset who were embarking on these roles. Shortly afterwards a chance meeting with an influential local GP led to a productive conversation. Physiotherapy department access times had been traditionally very high in her locality, and she was keen to explore new ways of working which could improve patient access to physiotherapy assessment and advice. These conversations led to a 6-month FCP pilot funded by the GP surgery. The service was extremely well received by patients and GP staff, and so the arrangements became permanent at the end of the pilot. These hours were part time and so I also continued with my team lead role.
By 2018/19 the NHS and UK Gov had realised the potential benefits of FCP roles, and FCP was one of the first roles to be funded under the additional role reimbursement scheme to PCNs. This opened further opportunities locally which I maximised by engaging local PCNs, and by the beginning of 2021 I was doing 3.5 days per week of advanced practice FCP and helping set up new FCP clinic sites for experienced MSK physio colleagues to develop their own FCP practice.
In the meantime, Health Education England published its first Advanced Practice ‘Roadmap’ which provided and supported FCP educational standards and structure. The Dorset Primary Care Training Hub advertised a fellowship to support the implementation of this document in Dorset and I applied and was successful. A role I now share with a colleague from Dorset HealthCare each of us doing 8 hours per week.
The Clinical Fellowship was out of my comfort zone, but it has been an amazingly supported experience with access to project management and quality improvement courses. As a clinician we do not prioritise these aspects of our job and it was so useful to find that what I had been doing to create the training program, could have been made much easier using techniques from these courses.
I am primarily a lead advanced practice first contact physiotherapist. This means I work in GP surgeries seeing patients with suspected or confirmed MSK conditions instead of a GP. Clinically this role allows me to work at the top of my clinical competency and skills, as I manage patients independently, order medical tests and prescribe medicines, refer on to secondary care services, as well as explore and encourage self-management options. Part of this role is to provide strategic leadership function for the service as it grows and develops, inducting and training new FCPs to the role, liaising with service managers and clinical directors in the PCNs regarding contracts and service level agreements, and exploring and facilitating future aspirations for service expansion.
I also work one day per week as a clinical fellow for the Dorset Primary Care Training Hub. This is a one-year secondment specifically to provide guidance and advice both to the hub and the pan-Dorset FCP workforce regarding the HEE roadmap to practice for FCP and its many implications for FCP service development. This has involved engaging a network of contacts throughout the South West of practitioners in similar roles, liaising with local universities to help facilitate the development of ‘roadmap compliant’ educational course, developing and advising workforce strategy for FCP in Dorset, and leading a group of senior FCPs from across Dorset aiming to agree a common data set for Dorset FCP activity.
Monday – Am – FCP clinic GP surgery in Dorchester/PM- team lead for physio OPD department – working remotely
Tuesday – clinical fellowship for Primary Care Training Hub – working remotely.
Wednesday – FCP clinic in GP surgery in Weymouth
Thursday – FCP clinic GP surgery in Weymouth
Friday – All day – FCP clinic GP surgery in Mid Dorset PCN (rural site)
Saturday – Non-working day
Sunday – Non-working day
- I really enjoy the variety of working in different roles and at different sites
- I also do not wish to lose the clinical skills I have developed and want to keep challenging myself and developing clinically. At the same time, I also want to use my leadership and managerial skillset
- My portfolio role allows me to maintain and develop in both areas
- Keep your ear to the ground for opportunities (horizon scan) as you never know when one might arise.
- When you get an opportunity, enthusiastically explore it as you also never know where it might take you.
- The career journey is part of the adventure.
- I couldn’t have planned to be an FCP when I graduated in 1996 as nothing like it existed. Likewise, any new and recent graduates working today will inevitably be working very differently in 20 years’ time compared to how they work now, because healthcare is constantly evolving.
Anna McHillier
Physiotherapist
University Hospitals Dorset
I am a clinical lead physiotherapist. I work clinically on the wards, while also supporting a small team of physio and OTs. I am part of a wider management team that looks after all of acute therapies at UHD covering the medical, surgical, ITU and acute admission wards.
The Dorset AHP faculty had a series of HEE funded roles and invited applications. I put my application in and was lucky to be offered the 6 month secondment opportunity.
Monday – Clinical lead physiotherapist for acute therapy team UHD – working clinically within cardiology and haematology, supporting my team, and performing supervisions/team development
Tuesday – Non-working day
Wednesday – Clinical lead physiotherapist for acute therapy team UHD. On Tuesday, I am also duty lead for the day so I will work on any issues that arise that impact the wider acute therapy team and pick up other elements of non-clinical work such as recruitment. We also have a weekly team leads meeting with our 8a to review operational issues and direction of travel
Thursday – Secondment to HEE funded post within the Dorset AHP Faculty developing DORN (Dorset Opportunities in Research Network)
Friday – Non-working day
Saturday – Non-working day
Sunday – Non-working day
- It has been refreshing to use my brain in a different way and to network with wider AHPs/HEIs
- It has given me the opportunity to develop new skills and unearth new opportunities for myself
- The secondment work will hopefully also directly benefit my ‘home’ team as I aim to promote all opportunities that DORN will present to them so they can develop their skills and integrate research into their practice/career development
- Ensure you have agreement and support from your team
- Try to exercise good time management skills and draw clear lines between your different days of work so the two don’t bleed together
Alannah Pasokhy-Holmes
Paediatric Occupational Therapist
University Hospitals Dorset
I have always been interested in broadening my learning and scope of practice. In order to do this, I have sought opportunities both within and external to my clinical speciality to develop my skills both clinically and within project management.
For FCP this was a pilot that begun with expressed interest from PCN in MSK paeds physiotherapy but has initially expanded to also offer paediatric OT within the pilot. I expressed an interest on my colleague going on maternity leave to continue this.
The HEE funded secondment was initially emailed out with expressions of interest sought, I expressed an interest in 2 projects and was successful in one. This was determined by the faculty.
I work as a band 6 Paediatric Occupational Therapist for majority of the week. This involves outpatient clinics and school visits for patients aged 0-19 referred with a range of diagnosis and needs, including long-term conditions (cerebral palsy, genetic diagnosis, neurological diagnosis, ASD), developmental needs (babies, pre-school) and difficulties with coordination, ADL’s, and handwriting.
The role involves understanding of a child’s motor-based needs, cognition, sensory and developmental factors which impacts their ability to functionally engage in their daily occupation. For children this encompasses play, facilitation of positions of play, equipment, dressing, handwriting, eating, bi-manual skills, fine & gross motor coordination etc.
The occupational therapist will need to adapt and have a comprehensive understanding of a range of clinical areas in order to facilitate this effectively for the range of ages, diagnosis, and child’s specific functional needs.
I am also on a rota to support consultant paediatricians in diagnostic clinics for both ASD and neurological conditions.
I participate in a Paediatric Fist Contact Practitioner pilot role at the Adams Practice for ½ a day a week alongside my paediatric physiotherapy colleague. From an OT perspective this can involve patients with developmental concerns, sensory difficulties and signposting to relevant services parents can access.
I am also currently engaged in a HEE funded secondment one day a week; this is focused on advanced practice across Dorset for AHP’s, in particular opportunities and barriers. This has enabled broader opportunity to develop more project management and QI based skills within a project external to clinical area of speciality.
Monday – HEE project role – working from home for secondment role
Tuesday – Clinical role – meetings/clinics
Wednesday – Clinical role – paediatric FCP pilot clinic/school visits/7 meetings
Thursday – Clinical role – support OT apprentice (clinic/supervision)/school visits and admin
Friday – Clinical role – OT clinics/admin (notes/reports)
Saturday – Non-working day
Sunday – Non-working day
- Currently I am a band 6 OT, there are no opportunities within paediatrics to progress to a band 7 role.
- I have sought opportunities where I can gain a range of relevant experiences at a range of bandings to broaden both my clinical and non-clinical skills. The secondments I have undertaken have significantly broadened my non-clinical skills and within a project where I am entirely responsible, this has excellent opportunity for more autonomous project management outside of comfort zone.
- This is also more stimulating for me on a personal level, as I often seek to develop and learn where possible.
- It can be difficult to balance responsibilities and time, clinical work often will take priority as more urgent. It is easier to be able to separate days entirely to dedicate to other role to prevent crossing into more demanding role
- For project management-based work, working from home has been a real benefit and easier not to be pulled into clinical or team support responsibilities typical of your other role
- Link with others completing projects, share experiences, gain QI training to develop project skills, ask if you’re not sure or stuck where possible
Time commitment for meetings impacting project time, potentially sought additional day or half day to complete secondment.
Caroline Morris
Clinical Specialist Paediatric Physiotherapist
University Hospitals Dorset
As the paediatric therapy service has developed, we have been fortunate to have had many opportunities as physio’s to work in a portfolio role. The orthopaedic clinic I work in is a long-standing clinic which has always had a physiotherapy practitioner working alongside our UHS consultant who covers a clinic once a week at Poole. This is a role I took over when my colleague went off on maternity leave. She also had the role of the Acute Physio Team Lead which is again a role I took on to cover over her maternity leave period.
FCP clinics are well established within an adult MSK environment, and it was therefore agreed to pilot of Paediatric FCP clinic through the Adam’s Practice. This is now 7 months into its pilot study phase and was again a role I took over for maternity leave cover. When I am non-clinical my time is spent completing managerial work for the team including e-roster, supervisions, appraisals, training, meetings etc.
The HEE funded secondment was initially emailed out with expressions of interest sought, I expressed an interest in 2 projects and was successful in one. This was determined by the faculty.
I am the Acting Team Lead and clinical specialist physiotherapist within the Acute Paediatric Physiotherapy Team at Poole Hospital. In our team we treat 0–16-year-olds with MSK conditions requiring, assessment, treatment, and rehabilitation along with inpatient work on the children’s ward covering ortho, neuro, respiratory etc patients. I also work as the Team Lead involved with managing the team of paediatric physio’s and assistants. I part of my role I work in an extended scope role within paediatric orthopaedics once a week seeing children for orthopaedic assessment and follow up which includes x-ray interpretation along with thorough assessment and treatment planning. I am also working as an FCP within paediatrics in a pilot clinic at a GP practice once a week seeing children with a variety of MSK complaints who will be assessed and managed more often than not by me initially negating the need to see a GP.
Monday – Based at Poole Hospital. In the morning I run a baby hip dysplasia (DDH) assessment clinic in the ultrasound department all morning with a small team of Pphysio’s. These are babies with risk factors of DDH or babies who have been diagnosed already and having treatment in harness for this condition. I am responsible for the physical assessment of babies, application and adjustment of the harness along with working closely with the sonographers to ensure timely diagnosis and treatment for these babies. In the afternoon I run a paediatric MSK outpatient clinics in the child development centre seeing 0-16 year with a wide variety of MSK issues for assessment and treatment
Tuesday – Admin day based at the CDC at Poole Hospital. I use this time for team lead admin, supervisions, meetings etc. In the afternoon I hold a team meeting and have weekly in-service training time. Following this I attend a weekly team leads meeting with my therapy manager and the OT and PT Team leads in the Children’s Therapy Team.
Wednesday – I am based at the Adam’s Practice in Hamworthy for the morning running the paediatric FCP clinic assessing 0-16 year olds with MSK conditions. I am able to organise referral on for x-rays, bloods etc as needed and can refer into necessary specialist services as needed. (1/2 day so off Wednesday PM)
Thursday – I work in the paediatric orthopaedic clinic in the main outpatient department at Poole Hospital alongside the paediatric orthopaedic consultant/registrar as an ESP/APP. This clinic is a specialist service for children with orthopaedic issues. Many children will need x-ray’s taken and interpreted by me for diagnostics or bony monitoring for certain conditions. I am able to list some children for certain orthopaedic surgical intervention. I refer children into more relevant specialist services if ortho is not the most appropriate following assessment along with giving extensive physiotherapy advice and making formal physio referrals as needed.
Friday – Admin day/slots available for urgent assessments in the morning, based at Poole Hospital in CDC. If slots are not needed then I use this time to complete any remaining admin from the orthopaedic clinic the following day. I also attend the medic’s x-ray meeting every Friday morning where complex radiological case studies are discussed from that week of which I am able to input if I have any myself. Once every 4 weeks I attend the Child Heath Directorate Meeting on Friday afternoon as the acute paediatric physio representation. Otherwise this is a day for administrative tasks.
Saturday – I work one in approx. 7 weekends (Saturday or Sunday only) covering the children’s ward seeing any children who need physio intervention for any MSK/ortho, post op, respiratory or neurological needs.
Sunday – As for Saturday.
I find that a portfolio career gives me great challenge as every day is different. It has allowed me to feel incredibly specialised within a paediatric setting and given me some fantastic opportunities for learning and career progression.
My role gives me a mix of both clinical and leadership/managerial roles which I really enjoy giving me a great deal of job satisfaction due to the variety my roles offer. I am constantly challenged within these roles to further my knowledge and development which I am very passionate about.
Julie Dowdney
Orthoptist
University Hospitals Dorset
I felt I wanted to be an influencer, and although being a head of service allowed me to do this, I wanted to improve the provision of my profession at a national level – I now get to meet regularly with people like Suzanne Rastrick, and Bev Harden – true movers and shakers representing AHP’s.
Four days per week I am Head Orthoptist and Optometry Service Manager – this is split 25:75 clinical V management duties. I am also the Ophthalmology Safeguarding Children Lead and represent Ophthalmology AHP’s.
One day per week I am seconded into my role as Vice Chair of the British and Irish Orthoptic Society, the professional body, and trade union for orthoptists, which involves national representation of orthoptists, professional opinion, financial responsibility for the society and responding to any national (5 country) queries.
Monday – Management day – daily huddle, AHP Council/faculty meetings, clinical governance meetings. Responding to complaints/secretarial/appointment queries. Approving invoices
Tuesday – See Monday (plus cover for sickness/AL/student supervision)
Wednesday – See Monday (plus cover for sickness/AL /student supervision)
Thursday – Designated clinical morning, plus all of the above
Friday – Usually my BIOS Day, but this can be split into odd hours across other days!
Saturday – Day off.
Sunday – Day off.
You’ll never get bored! If you want something done, ask a busy person – this is generally true, and you will be busy.
Do you have the time? Do you have the energy? Can you meet tight deadlines? Can you flex other duties to allow this? All whilst maintaining a work/life balance (i.e. are you superhuman?)
How to protect my time – all roles tend to merge into one another, and ringfencing time for each role can prove difficult – a large degree of individual flexibility is required, and the support of your team, and managers.