MSK – Claire Paling

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.

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.

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.

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.

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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