AHP 2 case studies

Daniel Broadley: Extended scope podiatrist

After qualifying, Daniel worked as a locum before securing a band 6 position providing a breadth of services including MSK, Diabetes, nail surgeries and routine care. Daniel always had a special interest in MSK and sought after MSK aspects – such as providing simple insoles and offering exercises – in his general cases to develop his knowledge and skills in this area.

Daniel began working in a specific MSK role where he continued to build his skillset and eventually led to him leading in biomechanical clinics. This leading role supported Daniel’s transition into a hybrid role: part-time Podiatric Staff Podiatrist, part-time MSK Podiatrist.

Staff podiatrist roles	MSK podiatrist roles
Initial assessment of new patients considered for surgical intervention and presenting these cases to the podiatric surgeon  Post operative management, including off-loading and wound care Scrub role in theatre assisting surgeon Advanced anaesthesia (ankle and popliteal blocks)	Assessing pre- and post-operative surgical cases Utilising techniques: mobilisation, acupuncture, exercises, orthoses , steroid injections, ganglion aspirations, C arm guided injections, ultrasound guided injections, diagnostic ultrasound

Daniel reports the benefits of working in the NHS, mentioning, “the NHS gives me the support and peer review, as well as team working".

Alongside his NHS hybrid-role, Daniel also works privately, seeing both MSK and ‘general’ clients. Initially, Daniel was reluctant to see routine clients again after specialising in MSK;  however, he soon realised he was able to apply the new extent of his MSK knowledge and skills to these clients, picking up on biomechanical aspects that were influencing foot health. Daniel mentions the benefits of working in private include, “allowing use of all my skills, including things which may not be NHS funded.”

To support career development, Daniel undertook these additional learning courses: 

• MSc in Clinical Podiatric Biomechanics
• MSc modules in Podiatric Surgery: including blood work, diagnostic ultrasound course
• POMs

Daniel has extended his capabilities across the four pillars of practice and demonstrated development in research and evidence by undertaking an audit on: Developing an MSK arm of the podiatric surgical unit to improve patient reported outcomes. This audit was designed to increase service user experience of care delivery after Daniel noticed not having a dedicated MSK clinician in the surgery unit resulted in service users being referred back and forth to community services for management, where the clinicians in the community did not have dedicated knowledge of the service user’s condition, and therefore affected outcomes and delayed treatment. Through Daniel’s audit, the service incorporated an in-house MSK lead, and the audit results demonstrated improved outcomes for pre- and post-operative service users.

Daniel recommends for those wanting to excel in an MSK career, to:

"spend time in MSK units or podiatric surgical units to gain experience. Try and use your knowledge in general clinics to make insoles and give advice or exercises to improve knowledge and skill".

 

Angela Barry: Associate clinical lead for diabetes

Angela has dedicated her clinical career to diabetes care, leveraging her extensive practical skills and in-depth knowledge of diabetic foot pathology and multidisciplinary team working in the NHS. In her role, Angela has created, managed, and evaluated a clear, practical, and effective diabetic foot pathway in Northeast Essex, and has represented the diabetes team at local and regional meetings.

Beyond her clinical work, Angela has expanded her leadership and facilitation of learning pillars by educating healthcare professionals of all levels on diabetic foot disease. She has done so through various channels, from one-to-one mentoring to local and regional training events, and even university-level professional post-graduate courses.

Despite her increased responsibilities, Angela continues to maintain a clinical caseload of complex patients. She provides highly specialised, evidence-based podiatric interventions, including delivery of advanced care to patients with a high risk of limb loss. Angela has strengthened her research and evidence pillar through auditing service delivery and outcomes within Northeast Essex for diabetes care and strategising on quality improvement methods.

Furthermore, Angela has successfully extended her reach beyond the NHS by demonstrating a fruitful NHS Portfolio Career. She has expanded her skill set into the private sector, delivering regional education programs on diabetic foot screening and management, as well as peripheral vascular disease to GPs and healthcare professionals. Angela's dedication and expertise make her an invaluable asset to the healthcare community.

Education and training	Key achievements and roles
Bsc(Hons) Podiatry Theory	Ensuring the service had clear evidence to support the ongoing funding inpatient podiatry services
MSc Podiatry	Acting as a resource for expert advice and opinion in the field of diabetic foot pathology and management across Northeast Essex, in primary, community and secondary care settings
Pharmacologial Management of Diabetes	Speaking for the East of England Diabetic footcare network on diabetic foot care pathway development
Diabetes Foot Module	Implementing improvements to the diabetic foot pathway, successfully leading to a reduction in local major amputation rates and hospital admissions for diabetic foot disease below the national average
Mentor and Clinical Educatory Preparation	Supporting non-medical prescribers to provide evidenced based practice and mentoring new non-medical prescribers within the team, ensuring we stay within budget, whilst providing safe and effective care
Independent Prescribing

 

Alexia: Preceptorship. Story of a newly-qualified podiatrist

Alexia joined the Oxleas AHP Preceptorship Programme in her first month of practice saying she ‘felt reassured as there was a support system in place right from the start’. She went on to say ‘It has been really nice to meet monthly with other clinicians who are from different scopes and who are in a similar stage of their career as me. I have felt really supported, especially during this difficult time with COVID-19.’

As well as peer support, Alexia went onto say the portfolio provided her with clear structure ‘I enjoyed the portfolio as it provided me with structure and direction. I had to actively think about competencies when doing my clinical work, for example, barriers with communication.’ Alexia also appreciated how the portfolio gave her ‘allocated time to reflect, as at times the work environment can feel fast-paced with clinical pressures’.

As part of the programme, she also completed a Masters module to gain 20 masters credit for the completion of her portfolio. ‘I have always wanted to go on to do a Masters, so this was a great opportunity for me. It gave me a more in-depth understanding of my clinical reasoning’. Alexia went onto describe how she felt the portfolio and accreditation assisted in helping heal a chronic ulceration. ‘My patient had a chronic ulceration for 10+ years, I felt like I had tried everything with this patient. By completing post and profession competencies in the portfolio I used an evidence-based approach to my critical thinking for their care plan. I made a few adaptations tailored to the patient which made a huge impact. The patient went onto heal and remains healed to this day.’


Hear from Alexia in her own words in this video testimonial:

<< INSERT VIDEO >>

Preceptorship aims to consolidate learning from university by applying competencies to real life settings as an accountable clinician. Furthermore, building professional identity, improving confidence and resilience to make for better-quality patient care and job satisfaction.