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The Rheumatology Physiotherapy Capabilities Framework is now live, supporting role development, service delivery and commissioning throughout the UK. We speak to project leads Hannah Chambers, Will Gregory and Dr Carol McCrum, all leading rheumatology physiotherapists, about how the framework can help, the process they went through, and how they're driving change in rheumatology physiotherapy.


Read the framework


How did the framework come about?

Will: In 2016 we undertook a survey of rheumatology physiotherapists in the North West to better understand the disparity in roles. After publishing this, Carol encouraged me to expand it to the whole of the UK so we could get a national picture of roles and scope clinical activity, skills and settings.


Our UK-wide survey in 2019 showed the breadth of specialty skills and expertise, but also wide variations in time spent with patients and activities undertaken. It made us realise a framework was needed to support practice, standardise care and act as a key resource for the rheumatology and MSK community.


What does the framework do?

Carol: It’s a go-to document for anyone working in rheumatology and MSK. It supports service delivery, role development and commissioning. We'd contacted colleagues in Canada, Australia and New Zealand and there were no descriptors of specialist rheumatology physiotherapy. This framework does that and sets the standard for patient care, ensuring equity of treatment. It also provides guidance on essential and increasingly specialist capabilities that support safe, effective care.


Will: We often get contacted by colleagues around the UK to support on business cases for protection and development of physiotherapy resource. The framework helps with this, building national standards and validation.


What are some of the problems you're hoping to solve?

Hannah: There’s a lack of awareness about what rheumatology is, which goes right back to undergraduate level. This lack of training, progression and support is resulting in retention and recruitment difficulties for the rheumatology workforce. Our framework gives people the guidance they need for best practice and shows the value of upskilling existing physiotherapists.


Will: At the other end of the scale, many specialist physiotherapists are reaching retirement age or moving to First Contact Practitioner roles. Our aim is to provide a stronger career pathway and structure, ultimately improving patient care. It allows rheumatology physiotherapists to progress and develop within the specialty.


What development process did you go through?

Hannah: There were other physiotherapists like me trying to do this locally, but we realised it was much better to develop a national standard and to do this we needed to bring all the expertise together.


Carol: We did an initial literature review as well as identifying other frameworks to give us a starting point, such as the rheumatology nurse framework which the team behind it kindly shared with us.


Will: We used the survey data to guide the development of the capability statements and did an open call for an expert working group. This collaboration totalled around 30 people, who all supported the initial drafting and extensive review process. Their input was essential.


Who else are you collaborating with?

Carol: Both the Chartered Society of Physiotherapy and BSR have endorsed the framework. They’ve been a great support, sharing their learnings and helping this come to fruition.


How does it align with BSR’s work?

Will: BSR's workforce report chimes very closely with our aims and goals. It gives remit to advance and enhance allied health professional (AHP) roles within rheumatology teams. This is vital for the future of rheumatology.


What place does it have with supporting the GIRFT recommendations?

Carol: The GIRFT report highlights the value and service benefits of utilising physiotherapists within the AHP skill-mix opportunity. The framework includes advanced level capabilities that reflect the skills that can be used. This includes the expanding number of specialist physiotherapists undertaking triage and review clinic roles, use of prescribing capabilities, injection skills, ultrasound training, extensive disease knowledge and monitoring experience that form valuable roles as part of their MDT services.


What do you hope to achieve?

Carol: There wasn’t anything out there to support musculoskeletal (MSK) physios with how to screen for rheumatology conditions. This will support them and sets the standard for patient care.


Will: We hope this framework will help build the next generation by increasing awareness of physiotherapy roles within rheumatology from bands 3-8. It’ll help boost career progression and upskill the current workforce.


Hannah: We want inflammation screening to be a core part of MSK practice. It shouldn’t be seen as something specialist; it must happen at every level of physiotherapy.


What are your key messages to members?

Carol: The rheumatology community should demand that this level of skill is incorporated into every service delivery. This specialist knowledge is essential for safe and quality care.


Hannah: Upskilling physiotherapists is vital, so I’d like the whole multidisciplinary team to be supportive of education and training at all levels.


Will: Use this document in tandem with BSR's workforce report to show the importance of enhanced and advanced roles for AHPs in rheumatology care. We also hope to inspire other AHPs to write their own rheumatology frameworks and encourage better networking beyond the individual professions.


Carol: We’d also like to thank everyone that contributed and helped us along the way, their involvement really made a huge difference.


What are the next steps?

Will: The broad distribution is our core focus at the moment. We’re looking at a 12-month implementation strategy to see how it's adopted and used across the country. We’d love feedback from people who use it so we can revise and develop; please do get in touch with us to chat further.


If you’d like to contact the team and give feedback, please email RheumPhysioUK@gmail.com, find them on Twitter https://twitter.com/RheumPT_MACP, or visit the website.