Bank Orthopaedic Physiotherapy Practitioner - Kingston upon Thames

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Extended Scope Practitioner- Orthopaedics

An exciting opportunity has arisen for a position as an Orthopaedic Physiotherapy Practitioner (ESP) at Kingston Hospital. This role will enable you to join an established team of five ESPs based over a number of sites in the local vicinity. This role would suit either an experienced ESP looking for a new challenge, or an experienced MSK therapist looking to advance skills and develop into the ESP role.

Our service is involved in the triage of patients referred with musculoskeletal conditions in the surrounding areas and aims to assess, diagnose and arrange onward referral, if appropriate, to secondary and tertiary care services, as well as providing an expert resource within the MSK team. The team is underpinned by care pathways and works closely with Orthopaedics, Rheumatology and Pain services.

The role also carries a physiotherapy caseload and involvement with the friendly and established Continued Professional Development programme of the department, as well as being a clinical resource for more Junior staff.

You must be able to travel between sites in a timely manner as the role provides clinics at several sites.

For an informal discussion about the role or to arrange a visit, please contact Sarah Morrison, ESP Team Lead on 020 8934 2510 or email on 


Extended Scope Practitioner
Job Title: Musculoskeletal Orthopaedic Physiotherapy Practitioner (Extended Scope Practitioner)

Department:       Physiotherapy Department Kingston NHS Trust
Clinically Accountable to:      Clinical Lead (Consultant Orthopaedic 

Professionally Accountable to: Physiotherapy Manager

Extended Scope Practitioners (ESPs) are by definition clinical specialists, but additionally they practice outside the usual scope of physiotherapy and undergo further specialist training in order to practice at this level.


To participate in the development, setting up and implementation of the Musculoskeletal Team (MUST) for KCCG and RTCCG, working in cross trust/multidisciplinary teams.

To develop, update and gain consensus for orthopaedic clinical pathways/ protocols that will have local area and trust wide application.

To be responsible for triaging and assessing patient referrals to the orthopaedic department, along with the Orthopaedic Consultants; providing a highly specialised, cost effective, evidence based service, thereby reducing waiting list times.

To provide expert physiotherapeutic assessment, treatment, prognosis and advice, to a highly complex and diverse range of patients within the musculoskeletal/orthopaedic specialism. 

To act as a highly skilled and expert resource to all other staff with in the physiotherapy department, directorate and Trust with regard to musculoskeletal/orthopaedic issues.


• To works as an autonomous ESP and provide expert orthopaedic assessment, clinical diagnosis, and management in an extended scope role in both the Orthopaedic and Physiotherapy departments.

• To triage orthopaedic referrals and make a decision whether the patient should have an appointment with an orthopaedic surgeon or ESP.

• To refer patients from primary and secondary care services onto appropriate specialities according to agreed pathways, e.g. physiotherapy, rheumatology, neurosurgery and pain clinic.

• Be the physiotherapy lead within a multi-disciplinary team, providing specialist advice to other specialist health professionals, such as GPs, Orthopaedic, Rheumatology, Neurology and Pain Management Consultants, Specialist Registrars, Senior House Officers, GPs with Special Interest, and others as necessary.

• To take a lead role in identifying research and audit needs in the musculoskeletal physiotherapy service and orthopaedic department; and develop a research and evidence based practice culture.

• To identify clinical research and audit priorities in order to drive the ESP and musculoskeletal physiotherapy clinical development strategy.

• To provide clinical education and act as a source of the highest specialist knowledge for other physiotherapy team members when encountering complex and/or problematic clinical situations that need immediate clinical input and provide advice for the ongoing management of such patients. 

• To provide clinical leadership and direction within the musculoskeletal physiotherapy service, working with the Physiotherapy Manager, other ESPs and Clinical Specialists.

• To contribute to the development of advanced clinical skills and reasoning of the physiotherapy department through in-service training, teaching in clinics, mentoring, reflective practice and presenting case studies.

• To act as a role model and clinical expert; supporting, advising and inspiring colleagues towards achieving excellence.

• To carry a caseload to meet the service needs, maintain clinical skills and continue professional development; and effectively manage patients who may be highly complex and /or challenging.


Physiotherapy Manager                                      Lead Orthopaedic Consultant

Extended Scope Physiotherapy Practitioner            Orthopaedic Registrar                  GPwSI



• To be an Physiotherapy Practitioner working in an extended scope role, working in both the orthopaedic team, i.e. Consultant Orthopaedic Surgeons, Specialist Registrars and General Practitioners with a special interest (GpwSI), and the Physiotherapy department.

• To undertake highly specialised, comprehensive neuro-musculoskeletal orthopaedic assessment, interpreting and analysing clinical and non-clinical information to form accurate diagnoses and prognoses; reflecting the philosophy of the consultant team. 

• To utilise expert clinical reasoning, evidence based knowledge and a wide range of assessment skills including specialised manual assessment techniques.

• To independently refer and interpret diagnostic procedures, such as MRI scans, Ultrasound, X-rays, blood tests and nerve conduction studies, in line with CSP and Kingston Hospital guidelines. 

• To refer for other tests, such as CT and nuclear medicine in consultation with the Orthopaedic Surgeons.

• To refer patients on to the appropriate speciality in primary, secondary and tertiary care, including physiotherapy, neurosurgery, rheumatology, pain clinic, neurophysiology, and Orthotics.

• Be skilled in explaining to patients when a treatment, investigation or surgical procedure is not indicated; for example to avoid over exposure to radiation.

• Ability to independently carry out procedures/interventions having gained competencies in line with CSP and KHNHST guidelines e.g. administer intra-articular and peri-articular injections/ aspirate ganglia.

• To undertake independent or dependent prescribing or administration of medication using Patient Group Directives, according to current legislation, having gained competencies.

• Appropriately list patients for orthopaedic surgery.

• To communicate effectively (verbally and non verbally) with patients, where there will often be barriers to effective communication eg, language problems, cultural differences, loss of hearing, pain and fear, so that consent to treatment and effective intervention is gained.

• To deal effectively and appropriately with patients, relatives and carers, who may be aggressive verbally and physically, and know how and when to call in help form others as appropriate.

• To use counselling skills gained by training and /or experience to give information and advice to patients, relatives and carers on extremely sensitive issues such as poor prognosis and lifelong disability.

• To be able to discuss with patients, relatives and carers extremely sensitive issues such as the consequences of non-intervention and or treatment.

• Be able to motivate and persuade patients with a wide range of complex conditions/disabilities in a way that empowers them to make informed choices about the management of their condition and engages them in the planning of and delivery o their treatment.

• To ensure there is comprehensive, well designed written information available for patients and members of the multi-disciplinary team, about their condition and/or post-operative treatment.

• To conduct clinics at Kingston Hospital and satellite clinics within Kingston, Richmond and Surrey Downs CCG’s.

• To work as a sole practitioner in clinics.

• Be responsible for initiating multi-disciplinary case meetings/team meetings to discuss individual patients or groups of patients.

• To provide specialist physiotherapy advice, which may involve challenging or requesting changes to treatment programmes/care plans/diagnoses from other health care professionals as necessary. 

• Analyse and understand the impact on patient care of various treatment plans / diagnoses from other disciplines, e.g. drug regimens from Rheumatology, Pain Specialists etc.

• Contribute to and participate in ongoing development / in-service training within the orthopaedic team. 

• Participate in regular patient case reviews with orthopaedic consultants and Orthopaedic team meetings to facilitate continued professional development and enhance patient care.

• To participate in the ESP CSP Professional Network and cascade appropriate information to other members of the ESP team and physiotherapy department at Kingston Hospital.

• To identify and access appropriate sources of clinical support, establishing and maintaining networks across professional and organisational boundaries in order to enhance own and service development.

Service Development

• Participate in cross trust/multi-disciplinary team working parties to develop the Musculoskeletal Team service. 

• Assist in the implementation of an electronic referral system for use by GPs referring into the MUST service in line with Government targets.

• To develop, update and gain consensus across the Trust treatment protocols and clinical care pathways including:
-          care pathways to assist GPs in appropriate referrals
-          comprehensive care pathways for individual conditions, investigations, injections and onward referral.

• Develop a unified approach within the MUST team with regard to patient assessment and management to ensure that any given patient will receive the same diagnosis and resultant care plan, reflecting the philosophy of the consultant team.

• To work with the Orthopaedic Consultants and Physiotherapy and Orthopaedic Service managers to develop the Orthopaedic Out-patient Service; supported by best practice, statistical evidence and audit results.

• To collaborate with the orthopaedic multidisciplinary team to ensure that patient management is quality driven; and that standards are set to reflect local and national standards.

• To work with the physiotherapy management team (KCCG and RTCCG) to ensure that users of the MUST and Physiotherapy service have a voice in planning, delivery and evaluation of services.

• To contribute to the business planning, service development and demand and capacity management by providing timely advice and information to the physiotherapy manager on all matters relating to the MUST service.

• To keep abreast of national agendas and published frameworks, guidelines (e.g. NICE), standards, protocols and policies, both clinical and professional. To use this knowledge to contribute to the development of the orthopaedic MUST service and Musculoskeletal Physiotherapy service, so that the services comply with and take account of these agendas, policies and guidelines. 

• To attend and present at Clinical Interest Group meetings in order to promote the MUST service and develop cross trust/multi-disciplinary links.

• To initiate clinical and operational progression or expansion of the MUST Service in response to orthopaedic service priorities. 

• Assist in the induction and training of newly appointed ESPs. Deliver theoretical and practical training and act as a coach and mentor.

• Be responsible for developing a competency framework for newly appointed orthopaedic ESPs.

• Visit other ESP services to incorporate and share clinical and service development information.

Professional, Education and Training/Self-Development

• Be responsible for maintaining a high standard of physiotherapy practice by working to the Chartered Society of Physiotherapy (CSP) ‘Codes of Practice’ and maintaining professional and legal accountability.

• To have a knowledge of, and comply with, the legal frameworks relevant to the speciality.

• To promote safe and effective practice in new aspects of the ESP service, where there are limited or absent guidelines due to the pioneering nature of the work; and developing guidelines and competencies as appropriate.

• To be aware and mindful of the boundaries of own extended scope practice, and support other members of the team to do the same. 

• Be responsible for maintaining accurate and up-to-date patient notes; and communicating outcomes with the referrer, such as GP or other relevant healthcare professionals.

• To be responsible for maintaining and developing Continued Professional Development (CPD) in line with the service and Trust objectives; and maintain a personal development portfolio. Identify own training and development needs and undertake appropriate training/education as required, supported by regular appraisal with the Physiotherapy manager.  

• To manage clinical risk within own physiotherapy caseload and contribute to ensuring that clinical risk is effectively managed with the musculoskeletal physiotherapy service.


• To produce timely and detailed clinical reports to GP’s, Consultants in secondary and tertiary care and other healthcare professionals. 

• To ensure the implementation of Government initiatives related to the NHS Plan, for example copying clinic letters to the patient in regard to the management of their care.

• Organise and manage appropriate delegation of administrative work to the MUST secretaries.

Governance, Research & Audit

• Be able to demonstrate a sound understanding of clinical governance; including ability to audit own and teams practice.

• Lead in clinical governance projects.

• To use specialist knowledge of current evidence to drive the clinical audit and research programmes and to identify sources of funding for research as necessary.

• To promote a research environment within the department through clinical enquiry and offer support and guidance to others.

• To use audit results, current research and government guidelines to recommend changes to service delivery and to clinical practice, demonstrating evidence based links to the development and improvement of clinical practice.

• Recommend and implement aspects of change, with consensus, in clinical and working practice in the orthopaedic and physiotherapy team. Ensure that where this impacts on other health professionals or services they are informed and assisted in managing the changes to work organisation/service delivery.

• To identify and utilise appropriate outcome and service impact measures, which accurately evaluate patient response and service development needs.

Physical Effort
• Carry out assessments and treatments of musculoskeletal conditions with moderate to high physical effort on a daily basis. 

• Make repetitive movements e.g. manual therapy on a daily basis. 

• Move, pull, and push adults, weights and equipment with and without the use of mechanical equipment on a daily basis. 

• Kneel, crouch, twist, bend or stretch regularly on a daily basis. 

• Movements can often be repetitive for several short periods of time throughout the day e.g. manual therapy treatment or teaching an exercise.

Mental Effort
• Work often requires extensive periods (over an hour) of intense concentration e.g. to assess and diagnose patients, dictate and write progress reports/letters on a daily basis. 

• Prepare regular teaching sessions of clinical/manual skills as well as presentations to management in the trust and the CCG, on a regular basis.

• Other colleagues, patients, answering the phone/email more than once day, regularly interrupt these work periods.

Emotional Effort
• Give unwelcome news to patients or carers e.g. informing them that they may have permanent physical limitations during assessment that may require surgical intervention or limit the success of the rehabilitation period. Daily basis.

• Dealing sensitively with patients and who have high levels of anxiety, depression and/or aggression caused by pain, dementia or limited mobility. Daily basis.

• Working alone, assessing and managing risk on a daily basis.

Working Conditions
The job involves frequent exposure to unpleasant working conditions e.g. bodily fluids/ aspirates including, blood, synovial fluid, urine, foul body odour and occasional exposure to verbal and physical aggression. More than once a week.

This job description is not intended to limit the scope and extent of the job to be undertaken and will be subject to review and alteration as necessary, following discussion with the postholder. 

Health Clearance
Applicants must complete a medical questionnaire, return it to the Occupational Health Department and, if required, undergo a medical examination before appointment to a post at Kingston Hospital.

Confidentiality and Disclosure of Information
In the course of your normal work with the Trust you will come into possession of confidential information concerning patients, the Trust and its staff.  This information should always be treated accordingly with inappropriate disclosure being subject to the Trust's disciplinary procedure.

Staff however, may on occasion have genuine concerns about healthcare matters and consequently the Trust endorses the principle that these may be raised in a responsible and appropriate manner.  Consequently the implications arising from the applicability of the disciplinary procedure would not apply.

Data Quality/Security
The postholder is responsible for ensuring that he/she maintains the integrity and quality of both computerised and manual data.

Acceptance of Gifts and Hospitality
The conduct of staff in the public service should be scrupulously impartial and honest and in this context offers of gifts or hospitality should be discussed with your manager, prior to acceptance.

Health and Safety
All staff are advised that, under the Health and Safety at Work Act 1974, it is the duty of every employee to take reasonable care for the health and safety of him/herself and of other persons who may be affected by his/her activities at work, and also to co-operate fully with the Trust and others in connection with arrangements to meet their statutory duties and responsibilities under the Act, including undertaking Health and Safety training.

Personal Property
The Trust is unable to accept responsibility for articles of personal property lost or damaged on its premises whether by burglary, fire, theft or otherwise and staff are advised to insure against all risks. 

Equal Opportunities
The Trust affords its employees equal opportunities in employment, training and development, irrespective of their sex, marital status, age, race, religion or colour.  The Trust has an Equal Opportunities Policy and supports the concept of equal opportunities for all. 

No Smoking
The Trust promotes a policy of non-smoking, and staff are therefore not permitted to smoke on the hospital site, except in designated areas.

Staff must wear their identity badge at all times to assist in maintaining the security of the hospital; be observant, and not afraid to enquire of people as to their business in the hospital.  Any suspicious behaviour must be reported to the Security Officer, manager, or the Support Services Dept.

Criteria for Selection
Essential Requirements 
Desirable Requirements Assessment Method 
Qualifications • Diploma/BSc Degree in Physiotherapy
• State registration with Health Professions Council
• MSc or equivalent experience
• Previous experience working as an ESP
• Injection trained • MSc
• Membership of the Manipulative Association of Chartered  Physiotherapists
• Membership of Chartered Society of Physiotherapy (CSP)
• Membership of other relevant professional bodies e.g. acupuncture association
• Member of ESP Occupational Group 
• Leadership management training Certificate

Registration details 
Experience • 7 years post graduate experience (5 years in a musculoskeletal role)
• Evaluation of clinical practice, including involvement in audit, management, research and service quality issues.
• Expert knowledge and experience of assessment, and administration of a wide range of approaches in the effective management of neuromusculoskeletal disorders, including relevant postgraduate training.
• Expert knowledge of evidence based practice.
• Knowledge of the influence of psychosocial and cultural factors, and health/illness behaviours.
• Organising and implementing training programmes for staff and students.
• Knowledge of recent NHS developments and their impact on service provision.
• Evidence of working effectively as part of a multidisciplinary team.
• Evidence of effective team work across primary and secondary care services and trusts. Training of other physiotherapists and students

Interview, Application form and references
Skills • Ability to present information, written and spoken, in a clear and logical manner to all levels of staff including management or senior medical staff.
• Ability to articulate a vision of an Extended Scope role
• Advanced clinical reasoning skills.
• Ability to use and apply a wide range of advanced assessment and treatment approaches, including manual therapy techniques.
• Ability to communicate effectively and flexibly, and to adapt communication style to the needs of patients and colleagues.
• Ability to lead, motivate and inspire others.
• Ability to support others (patients and others)
• Ability to establish and maintain good working relationships.
• Negotiation and conflict resolutions skills.
• Ability to pass on information and knowledge in both formal and informal environments.
• Ability to work outside traditional professional boundaries
• Ability to command the confidence of the multidisciplinary team members.
• Change management skills
• High level problem solving
• Ability to analyse activity and outcome data accurately and objectively.
• Remain updated with professional practice and new research
• Ability to organise, prioritise, delegate and manage time effectively
• Understanding of clinical governance and its implication for services; including experience of quality issues and audit
• Ability to comprehend and work within the Trust’s policies of data protection, equal opportunities and health and safety, and meet the differing needs of the patients
• Ability to carry out moderate to intense physical effort throughout the working day  and carry out concurrent activities requiring skill and dexterity. 
• Ability to cope working in a stressful environment, and with emotional or aggressive patients and carers Evidence of participation in research and audit

Presentation skills Interview and references

Knowledge Competent IT skills CPD Portfolio
Other • Clear vision of role and commitment to speciality
• Able to work flexibly, based on the needs of the service.
• Reliable work record
• Fluent in verbal and written English

Bank Partners is an employment agency/employment business (as defined by the Conduct of Employment Agencies and Employment Businesses Regulations 2003) and is acting on behalf of its client in relation to this vacancy.

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