I enjoy positive experiences with patients by empowering them to manage their condition and return to valued activities
A brief profile of where you work and the position you hold and then the following questions.
My name is Daniel McCarthy, I am an Osteopath working as an Advanced Musculoskeletal Practitioner and First Contact Practitioner supervisor in the musculoskeletal department, and spinal outpatient department at Epsom & St Helier University NHS Trust.
What are the key responsibilities and duties of an advanced practitioner in your field?
To be an expert clinical resource regarding musculoskeletal (MSK) conditions and to undertake a clinical caseload to provide autonomous clinical practice in the assessment, diagnosis, and treatment of complex patients with MSK conditions. To provide leadership within my specific clinic speciality. To assist with education and training to a wide range of staff from different disciplines, working across primary and secondary care. To assist with research, lead audit and evaluation of relevant clinical practice.
How does your role as an advanced practitioner differ from other healthcare professionals or practitioners?
Advanced practice roles have a higher level of responsibility and autonomy regarding their clinical caseload load but additionally work in areas of leadership and management, education, and research. These constitute the four pillars of practice and as per the advanced practice framework, they will be working at level 7 capability.
What additional training or education did you undergo to become an advanced practitioner?
I completed a Masters of Science in Sport, Exercise and Health Medicine, in addition to various additional training focused on clinical knowledge and leadership. Furthermore, I have published two research projects on rehabilitation.
How does your role as an advanced practitioner meet the other 3 pillars – Research, Education and Leadership/Management.?
In addition to my clinical duties, I also work across the other three pillars of advanced practice in leadership and management, education, and research.
For example, in leadership, I am running an internship for osteopaths at two NHS trusts. This allows osteopaths with the intention of working for the NHS to get valued experience and exposes NHS departments to a more multidisciplinary working environment to encourage broadening the recruitment pool to aid with workforce supply. Additionally, I am also working with secondary care colleagues to create a degenerative cervical myelopathy pathway. Lastly, I am a line manager for two first-contact practitioner colleagues.
From a research perspective, I have published two papers and I am currently working on a third. Lastly, my education pillar is evidenced by regular in-service training for the musculoskeletal department, regular supervision of first-contact practitioners and physiotherapy colleagues, hosting students from higher education institutes, and sharing evidence-based medicine research in online communities.
How do you collaborate and work with other members of the healthcare team in your role as an advanced practitioner?
Owing to the level of patient complexity, it is imperative that patient care is coordinated with other healthcare professionals. As such, I attend numerous multidisciplinary team meetings. This includes spinal consultants, pain management team and consultants, consultant radiologists, and rheumatology consultants.
What types of patients or conditions do you typically encounter in your practice as an advanced practitioner?
I see a variety of patients with pain and or disability related to suspected musculoskeletal conditions, starting from 16 years of age upwards, ranging from acute injuries such as fractures, dislocations, sports-related injuries, or trauma that may need further diagnostics or rehabilitation guidance. Common MSK conditions like low back and neck pain, sciatica, nerve pain, carpal tunnel, and joint pains like shoulder and knee pain. To more persistent problems such as primary persistent pain conditions or osteoarthritis. Typically, I will only see patients with the most complexity, who do not improve with rehabilitation, or who may require further investigations.
Can you provide examples of specific interventions or procedures that you perform as an advanced practitioner?
The main intervention I provide is focused on working with patients to make sense of their pain, providing a plan of management in collaboration with them towards returning to work or engaging them back to valued activities, and encouraging positive health and lifestyle behaviour changes which are linked to musculoskeletal conditions.
As a diagnostic clinician, I am responsible for ordering and interpreting further investigations such as x-rays, MRI, ultrasound, or nerve conduction studies to aid diagnosis and or referral to secondary care consultants.
Furthermore, I am responsible for referring or directly listing patients for interventions, such as spinal and peripheral joint injections.
How do you stay updated with the latest advancements and research in your field as an advanced practitioner?
There are various ways I keep up to date with research in my field. Firstly, I ensure that I fill knowledge gaps with multiple CPD events per year. Additionally, I contribute to the monthly in-service training and act as supervisor to multiple clinicians, which motivates me to keep my clinical knowledge up to date. Lastly, I use social media as a medium to keep a finger on the pulse of the professional environment and updates on the latest research.
What challenges or complexities do you face in your role as an advanced practitioner?
The challenge I face in my Advanced Practice role is managing complexity and risk in clinically ambiguous situations with added time constraints. What’s more, when dealing with people who are suffering or in significant pain there are times when you have to manage conflict and have difficult conversations. In some situations, I have the responsibility of breaking bad news to patients following the results of investigations, which can be emotionally taxing.
Can you describe a particularly rewarding or memorable experience you had in your role as an advanced practitioner?
There is no one experience I can recall that was rewarding, rather I have a collection of positive experiences from working with other healthcare clinicians, which has greatly improved my professional capability, particularly with working with other professions.
Moreover, I enjoy positive experiences with patients by empowering them to manage their condition and return to valued activities.
Collaborate with other Advanced Practitioners
