Physio Leaders: fast-tracking from physio to clinical matron

A recent report by the trust regulator NHS Improvement concluded that allied health professions (AHPs) are an untapped reservoir of talent and that the NHS should do more to draw leaders from a body of professionals that make up a third of the workforce.

Hampshire Hospitals NHS Trust, is already demonstrating that there are no barriers to AHPs making the speedy ascent to senior leadership. Grace Smith, a respiratory physiotherapist who qualified in September 2013 is a case in point. In April this year, Ms Smith took up the role of clinical matron for the E3 respiratory ward at Basingstoke and North Hampshire Hospital. 

‘After qualifying, I did my rotations at Basingstoke when I was fortunate to hit my core ones back-to-back as a band 6 position within the acute team became available,’ says Ms Smith. ‘Most of my time was spent working as a physio on the respiratory ward where we had a number of very unwell patients.  That’s where I decided to focus my interest on non-invasive ventilation and the care of neck-breathing patients and I went on to work in intensive care for a while. One day, a colleague mentioned a band 7 ward sister role had become available on the respiratory ward and the role was now open to AHPs. I applied and was successful – it all happened quickly. I had been ward sister for around 18-20 months when I learned that my clinical matron was retiring. I saw it as a real opportunity to progress in respiratory.’

In the same week Ms Smith started her new role as clinical matron, she was named as one of eight winners of the Rising Star award at the national Advancing Healthcare Awards 2018 in recognition of her role as ward sister. 

‘It was quite humbling to win the award as I felt I was just doing my job,’ she says. Explaining how the idea of AHPs working in senior leadership posts developed within the trust, she adds. ‘Around six years ago, the trust appointed an occupational therapist to work as ward sister on a year’s secondment. It opened the door to how the trust could use AHPs to bring their skills to what are traditionally nursing posts. From there, they moved towards introducing the clinical matron model.’

Paving the way

What paved the way to Ms Smith’s career progression was the trust’s 2016 clinical matron AHP approach. A cohort of 30 staff including senior nurses and two specialist physiotherapists moved into band 8 matron roles with the aim of enhancing standards in clinical leadership.

Laura Dyer is a neurology physiotherapist with a special interest in stroke and was one of the trailblazing originals. She is clinical matron for the hyper-acute stroke unit at Royal Hampshire County Hospital in Winchester. Ms Dyer has been in her role for just over two years.

‘It was a very different approach for the trust to take,’ says Ms Dyer. ‘They had the confidence and the vision to look wider for those skills rather than just looking to professions. Physiotherapists can provide a different perspective and this adds breadth to organisations and the way teams practice. 

‘It was the perfect career move for me as it offers the best of both worlds,’ she adds. ‘I spend my days clinically on the ward with patients but I also have the opportunity to have that strategic overview of the service. I also do a lot of service quality improvement work and I have embedded a truly open teaching experience where we learn from one another to strengthen our individual skills.’

Both Ms Dyer and Ms Smith encountered surprise from their teams when they were promoted. When Ms Smith took over as clinical matron on the respiratory ward, the outgoing matron had a nursing background and had been in post for many years. ‘It took the team a while to get their heads around it,’ she says. ‘However, once they realised what I would be bringing to the role we got over that and it made settling into the role easier. It has meant a change of relationship with my team but they seem quite happy that I have got the post.’

Driving up quality

In Ms Dyer’s case, as one of the first physiotherapists turned clinical matrons at the trust, she describe her start in the role as challenging as the team assumed it would be a nurse leading the stroke service. ‘I think it was a bit of a shock for them as traditionally they had always had nurses as their clinical matrons. It took a few months really I suppose for me to prove myself and demonstrate what I could bring to the role. Supervision of nurses is very different to supervision of physios and I found that aspect of the role challenging to begin with. However, I have been able to really make a difference to patient care. We have been able to drive up quality on the ward and accountancy within the stroke service. Most importantly, I feel our patients are getting a really good experience of stroke care.’

Ms Smith’s move from sister to matron means she has a larger clinical role now and can share her knowledge and experience with the team. This has included helping to upskill the nurses on positioning and what this can do for patients, and providing education on non-invasive ventilation. Additionally, Ms Smith works with the ward’s healthcare assistants to encourage them to have more of a rehab mind when caring for patients. 

‘I’m still constantly thinking as a physio in terms of discharge planning, positioning, deterioration and progressing patients,’ she says. ‘But I’m getting used to the fact that I’m not the one who always has to provide care. Sometimes I need to take a step back and work with my team to help them think through what they can do such as considering repositioning if a patient starts to deteriorate. I have also learned new skills such as venipuncture and cannulation. I don’t insert catheters or apply dressings but I know how to look after them including what to do if the skin starts to deteriorate because of the pressure area or a moisture lesion. I feel these are skills that physios working on wards should have anyway.’

Repeat admissions to the ward are common due to conditions such as chronic obstructive pulmonary disease and pulmonary fibrosis so the staff often build up a rapport with patients. ‘End of life care is a part of my job I really didn’t expect to enjoy as much as I do,’ says Ms Smith. ‘Being there for patients at the end of their life is such a privilege. We can make a real difference.’

Moving on up

As a clinical matron trailblazer for the trust, Ms Dyer advises physios not to be afraid to step outside of your comfort zone. ‘It’s been the best move I’ve ever made, ‘she says. ‘The role of physiotherapists within multidisciplinary teams is so important but I feel we need to keep building on that so more of us have greater responsibility within healthcare settings going forward.

‘By allowing me to move into roles often restricted to nurses, the trust has really thought outside the box,’ adds Ms Smith. ‘As a whole, the NHS has to think more cleverly about job roles and not just focus on professions. Recruitment needs to also consider what individuals can bring to posts. I feel as physios there is so much more we could be doing that we just don’t get exposed to in our training or when we’re working on the wards. Making the move is so worth it. It is a challenging role at times but I absolutely love what I do. Every time a physio moves into a leadership role, the message gets out there that AHPs such as physios and occupational therapists can do so much more.’ 

More information

NHS Improvement. Leadership of allied health professions in trusts: what exists and what matters.