The Importance of Leadership in Community Physiotherapy

Purpose

Supporting Community Rehabilitation is a core priority for the Chartered Society of Physiotherapy. With increasing national pressures to move care into the community and out of hospital, we know there is a significant challenge ahead. We hear anecdotally that community physiotherapy services are under resourced, carry long waiting lists and are considered unattractive roles by many working in other specialities. Many services are blighted by issues of recruitment and retention. We know we have an ageing population and rising numbers of people have multiple long term conditions. The rehabilitation needs associated with those conditions is often provided by physiotherapists working in the community. We wanted to understand the realities of working community physiotherapy, the models of care that have been used to support service improvements and to design a package to support members in practice.

Approach

We visited 8 community rehabilitation services in various locations around the UK, with a mix of urban and rural work patterns. We spoke with physiotherapists working in those services about the realities of working in the community, the challenges they face and what they have done to overcome them. We wrote a report of our visits and asked the services to feedback the accuracy of what we captured on the site visit. We analysed our findings to inform the ongoing development of resources to support community physiotherapy teams in practice.

Outcomes

The most important factor we found during the site visits was: Leadership. The importance of strong system wide leadership must not be underestimated. Community rehabilitation services are complex to navigate and even more complex to change. Leaders who are strong influencers and demonstrate strong resilience are needed to effect change across the sector. Leadership allows clinicians the space to think and improve their services. Some services describe challenges were senior leaders were not visible and when encouraged to lead, services delivered meaningful improvements. Where there is a lack of leadership, services suffer from a lack of strategic direction, poor understanding of their offer and unmanageable waiting times.  

We need to ensure community physiotherapists have the skills to lead and influence local decision making in order to improve community services. We hope the resources that we develop (including a model of community rehabilitation) will enhance the ability for physiotherapists to lead and influence for service improvement in the Community.

Implications

The CSP is developing a model of practice and a suite of resources to support services to understand how to define and describe their service. This will enable services to target their service improvement activity and develop their capacity to lead and influence.

Fund acknowledgements

This work forms part of the CSP´s priority on Community Rehabilitation.

Additional notes

This work was presented at Physiotherapy UK 2019