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This month’s focus on our eLearning platform is axial spondyloarthritis (AxSpA). Will Gregory, a consultant physiotherapist at Salford Royal Hospital, who runs a weekly AxSpA clinic and is a member of AStretch, a national group of physios driving excellence in AxSpA management, tells us more below.


Also, this month we’re offering access to eLearning materials free of charge to all non-member AHPs. To take advantage of this offer, email Daisy Southam, Head of Education, on dsoutham@rheumatology.org.uk.


How has your career progressed in rheumatology?

When I first started in rheumatology in 2004, I was entirely employed by physiotherapy. As time went on, we identified more areas for development which allowed me to pick up extra roles traditionally done by rheumatologists.


The first advanced practice role was in the injection clinic. It was a steep learning curve, but very rewarding. In a 20-minute injection appointment slot, you can make a real difference to patients. You might have someone who's hobbled in to see you; once you’ve aspirated and injected their knee, they're able to walk out a lot better than they walked in. It’s nice as a physio, as you can provide the post-injection rehab at the same time.


How has your role in working with people with AS changed over time?

I've always run a gym class and only recently handed over the hydrotherapy AxSpA class. We launched our physio AxSpA clinic in 2013 which replaced the nurses and then the doctor’s appointments in our AxSpA pathway. I currently see people with AxSpA for measurements, exercise and medications advice and general review, with a medical consultant review every two years or as and when required. This has freed up doctor slots and improved the holistic care of our AxSpA cohort.


How did you achieve a consultant role?

Over time I was supporting consultants in clinics and gradually being given more responsibility. I was successful in a business case demonstrating the capability of an AHP to run the non-inflammatory pain service in rheumatology. It offers a full package of care including initial referral, management, treatment and discharge. This then became a consultant post, as I was doing it independently as an AHP.


What are the advantages to physios of joining a rheumatology team?

In physiotherapy there isn’t a recommended ratio between direct clinical care (DCC) and supporting professional activities (SPA). We know that there are wide variations in physiotherapy of 60-95% for DCC.


When you work in rheumatology, the ratios are often better balanced. When you have more SPA time, it allows you some headspace and means you can deliver a more efficient service. Although you’re spending less time directly with patients, you’ve got more effective pathways which means you’re getting through the same caseload.


Can you tell us about the physio capabilities framework?

In 2017 we did a survey of North West physios. Dr Carol McCrum from East Sussex encouraged me to expand it to the whole of the UK to give us a better understanding of the national picture. We then did a UK-wide survey in 2019 which showed wide variations in time spent with patients and activities undertaken. This data allowed us to consider 40 job roles a rheumatology physio might do.


It made us realise that a framework would be useful because of how varied the role is applied. We were concerned about losing colleagues to other specialties, especially those at advanced practice and highly specialist levels. The capabilities framework will provide a stronger structure to allow rheumatology physios to progress and develop within the specialty.


What work are you doing to improve the voice of physiotherapists?

The capabilities framework also identified that we were at a disadvantage not having appropriate representation at the Chartered Society of Physiotherapy. There had been a rheumatology group, but it hasn’t been active for a few years, so we recognised we needed to set up a formal group.


Now that everyone is used to online conferencing, we’ve had a fantastic response from all four nations and have started a scoping project to see what people want. Having a national voice is useful for benchmarking, education and career development. Our BSR physiotherapy working group is also incredibility important. We’ve had two meetings so far and are working on how we support and progress our colleagues.


What can people look forward to in June’s eLearning?

We’ve got some fantastic learning this month relevant to all AHPs. We have a talk from Prof Karl Gaffney which covers tips for diagnosing and management of AS. We have a journal article from Becky Adshead at Barts illustrating an excellent example of how to run an inflammatory backpain service.


There’s a webinar on interpreting investigations and how to include blood tests and imagining in your thinking. In the podcast you’ll be able to hear about the NICE guidance on AxSpA and how to apply it in practice. We’ve got an interactive eLearning case on back pain and the pathway to diagnosis and management.


Plus, we have Claire Jeffries from Solent NHS Trust presenting a case study on non-pharmacological management of AxSpA. While we know that drugs have revolutionised the care of AxSpA, it’s a nice way to reflect on how important exercise is as an additional treatment option.


Many thanks to Will Gregory for sharing his expertise. Improve your knowledge on the condition by visiting our eLearning platform.