Billy Consultant Physiotherapist "Physiotherapy is a dynamic profession. As a consultant I see patients nearly every day, lead a team of physiotherapists and sit on research committees. I'm continuing to develop my career and am studying for my PhD."

Billy works in a large hospital in the south of England. A consultant is a senior member of a team and is highly experienced in his or her area of work. Most consultants have special areas of their clinical work which they study to a high level, they also work with and give advice to other clinicians as well.

What does it mean, being a Consultant Physiotherapist?

We're a relatively new breed. It's a senior position without going into the sort of management job that takes me away from patients. It's the clinical work I enjoy. I'm essentially a clinical lead for other therapists, and part of my responsibilities is to act as a bridge between the clinicians and the management, and direct clinical services from the top. As a clinical lead I see patients almost every day and my specialist area is musculo-skeletal problems. This is to do with any problems affecting the muscles and bones from the head down to the toes.

You lead a team?

Yes, in conjunction with my fellow consultant in the same department, we lead a team of about thirty therapists in outpatients. Although, I concentrate mainly on backs, necks, knees, shoulders, elbows, and feet pain, I also give clinical leadership in the areas of research and audit to other physiotherapy colleagues in different specialities; areas such as neurological, respiratory, paediatrics conditions, as well as occupational therapists. All together we number over 100 therapists. As clinical lead I work in an extended role in clinics with doctors and surgeons, in GP practices, rheumatology, and orthopaedics. I am therefore involved very early in how a decision is made about whether a patient should be referred for more physiotherapy, needs injections, or acupuncture which I can also do.

At the moment I'm researching chronic musculo-skeletal problems and waiting list management.

Chronic?

Chronic means the illness or problem continues over a long period sometimes due to injury, but other times it is not possible to associate a cause. These type of patients usually need good management of their problems rather than a cure. So, for instance, suppose someone fell down some months ago and hurt themselves but comes back three or four months later because they're still having problems. Say it was their ankle, they will have developed more problems because they have been walking badly... I'm looking at how we manage them so that they get better by doing the right exercises. They should not just be sitting on a hospital waiting list because their problem has been classified as chronic. If we can see patients, assess them accurately, reassure them and treat them if we have to – (and quickly) it's much better for the patient and saves a lot of money for the NHS. That's why patient waiting list management is important.

But physiotherapy isn't only about 'curing'; I often talk to patients about adapting life styles to manage their problems.

Can you give an example?

I see quite a lot of students who are having problems with back pain, neck pain, and pains in their hands and wrists. It can be frightening for them. More often than not it is nothing serious… It might be that they have a bad posture when working (like at their PC) or are spending too long keying in material or using their mouse

You mean Repetitive Strain Injury (RSI)?

I can't diagnose it as RSI because RSI is not officially recognised as a condition. What I do with the student is first of all reassure them to allay their fears (that's very important), and then discuss working patterns, working posture and so on. Usually, they get better if they follow simple advice.

So you're seeing patients and researching; that's quite a lot – anything else?

Yes. We audit what we are doing to patients in our department across the specialities – musculo-skeletal, outpatients, respiratory, neurology, paediatrics, obstetrics and gynaecology, and community regularly. 'Audit' means we regularly meet to look at what we're doing – are we working effectively? Are patients getting the best deal or coming back too quickly? We ask ourselves these sorts of questions, with the aim of improving our service.

I represent the department on hospital committees too. I sit on the Research and Development Committee and on the Clinical Governance Committee.

Clinical Governance?

This is very important for patient care. In clinical governance we look to our treatment procedures to make sure that there are treatment 'pathways' that are agreed and standardised to 'best practice'; we must be able to check any patient's treatment against this pathway for quality assurance – it's about patient protection.

Are there changes happening in the way patients are treated?

There are. One of the big changes is in the way we run clinics. We're trying to move away from the emphasis on clinics in hospitals. We're trying to move some of our clinics nearer to patients – outreach clinics should be as near to GPs' practices or the patients’ homes as possible.

Anything you don't like about your job?

I don't think so. Not really... in the past I might have said "going to meetings" but I've got used to it and learning to get the best out of each meeting.

And the best bits?

A lot. Physiotherapy is a dynamic profession – I like that. And watching people get better is always good. Talking with patients, explaining things to them, reassuring them, that's very rewarding. Perhaps the best bit of all is being able to lead and guide other clinicians; as a team we're trying to find the best way to manage patients who are in pain so they don't have to wait or suffer for too long.

And that's the bit you can do because you're a consultant?

Yes. This new level of consultant is the best thing that's happened in the profession in the last five years; it's based on government directives to improve patient management. It also means that someone like me can stay in clinical practice within the NHS where my experience can be used to support new physiotherapists to run an efficient NHS for the future.