MSK – Claire Paling

Advanced Practitioner

Claire is an Advanced Practitioner working within the Orthopaedic Spinal Pathway in Wiltshire. She is a musculoskeletal (MSK) physiotherapist by background. Her role involves seeing people with spinal pain in both community and secondary care services. She has been in her current Advanced Practitioner role for 6 years and completed her Advanced Practice MSc in 2020. Claire has subsequently completed the ePortfolio route to gain recognition via the NHS England digital badge, as an Advanced Practitioner.

Claire works at Level 7 across the
four pillars of advanced practice

Clinical• Advanced understanding of spine-related conditions and management.
• Broad background knowledge of MSK conditions and ability to screen for non-MSK masqueraders.
• Responsibility for ordering and interpreting appropriate investigations.
• Clinical autonomy for listing for injections and surgical interventions.
Leadership• Point of contact regarding management of spine-related conditions across Wiltshire.
• Orthopaedic Spinal Pathway development.
• Service evaluation, development and monitoring.
• Supervision of other staff.
Education• Lecturing pre and post-graduate medical professionals at higher education providers.
• Teaching on professional CPD courses.
• Teaching staff within the Trust.
Research• Qualitative and quantitative research published in peer reviewed journals.
• Presented at conferences.
• Peer review for academic journals.
• Social Media Editor for Musculoskeletal Science and Practice Journal

How would you describe your role as an Advanced Practitioner to a patient who does not know about the role?

I am a physiotherapist by background, and continue to provide physiotherapy-based rehabilitation, but combine this with a focus on complex spinal assessment, diagnostics and triage to provide holistic management for those with spinal conditions.
My role involves working closely with the wider healthcare team, including physiotherapists, spinal surgeons and our local pain management team, so I have a good understanding of potential management options. My training allows me to order and interpret investigations to co-ordinate care and support patients to get to the right place at the right time.

Feedback from a patient: I just wanted to express my thanks for the amazing care you provided to my partner.
You took her case seriously and as a result she had a microdiscectomy 2 weeks after her MRI, just brilliant. She is already much better and has lost all her radicular pain. There are even early signs her power is improving.
Thank you so much for making her a priority, we feel like we’ve had the most amazing care.
We are so grateful.

How does your role change and improve service delivery?

The provision of our Orthopaedic AP service has alleviated pressures on secondary care services and improved access to care for patients.

For example, a patient with acute and severe sciatica who is likely to benefit from an early nerve root injection does not have to wait to see a surgeon at a hospital in a secondary care service. They can be seen in our community-based service, at a venue local to them. They can then go on to have an MRI, receive the results from a spinal specialist and have an injection performed in an outpatient radiology clinic.

I also work in a secondary care clinic, which provides additional capacity for secondary care services with less cost, as patients can have non-surgical consultations and diagnostic work up with an Advanced Practitioner, freeing up the surgeons time.

What advice would you give to aspiring Advanced Practitioners?

The path to advanced practice is full of challenges but highly rewarding. I would recommend it for people who want to constantly expand their knowledge and understanding, face challenges head on, problem solve and manage the nuance and uncertainty involved in healthcare.

Feedback from a colleague: Claire has exceptional clinical knowledge which is founded on evidence-based practice and her love for learning new things and teaching others is contagious.
She creates a positive learning environment through supervision and readily makes herself available to others when they have clinical questions. Claire encourages ideas of others and is keen to find ways of making the service more efficient and effective.
She is a role model for working hard to improve patient care and pathways for safe management of patients. Claire is always very positive and helps to create a good morale amongst the team – a pleasure to work with!

Want to hear more about Claire?

I wanted to become a Spinal AP before there were any formal pathways (nationally or within my Trust) to progress into these roles. While I was working as an outpatient physiotherapist, I changed my working hours to free up one morning a week and dedicate that time to independent learning, observing others and started some postgraduate studying.

In 2017, a temporary opportunity arose to support our Orthopaedic AP service. This helped me gain vital experience and I went on apply for a Spinal trainee AP role. I completed my competencies and was awarded my AP MSc by 2020. In 2022, I was accepted for Cohort 1 of the NHS England supported ePortfolio route and a year later I was excited to be awarded official recognition by NHSE as an Advanced Practitioner!

Alongside this, because of my love for teaching, I offered to lecture at local universities, who continue to invite me to speak on a regular basis as a visiting lecturer. I continue to publish my research and work hard on the non-clinical pillars and CPD, including input on other publications and presentations at international conferences.

In summary, it was a combination of hard work and the huge blessing of supportive colleagues and well-timed opportunities which put me in a position to successfully complete the supported ePortfolio route for advanced practice accreditation.

Read more South West advanced practice case studies here

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