support to expert continuum
| complexity | predictability | sphere of influence (examples) | personal autonomy | |
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Delegated caseload
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Practice within predictable contexts
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Clients on caseload and delegating physiotherapist(s)
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Responsible to delegating physiotherapist(s).
Practice according to treatment protocols and Trust policies/procedures
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Delegated caseload - some
presenting with complex needs
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Practice within predictable and normally specialised contexts
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Clients on caseload; delegating physiotherapist(s); and MDT
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Responsible to delegating physiotherapist(s).
Practice according to treatment protocols and Trust policies/procedures
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Own caseload of clients with
complex needs
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Practice within complex and generally predictable contexts
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Clients on caseload; MDT; support workers (delegation)
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Responsible for own actions.
Practice according to professional codes and Trust policies/procedures
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Own caseload of clients with
complex needs
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Practice within complex and increasingly unpredictable contexts
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Clients on caseload; MDT; support workers (delegation and supervision); students
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Responsible for own actions.
Practice according to professional codes and Trust policies/procedures
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Specialised caseload of clients
with complex needs
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Practice within complex and unpredictable contexts which demands innovation
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Clients on caseload; MDT; staff in primary and secondary care; professional networks at local and national level; students
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Professionally and legally accountable for own actions
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Highly specialised
caseload of clients with complex needs
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Practice within complex, unpredictable and normally specialised contexts demanding innovative work
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Clients/carers on caseload; AHPs (clinical, professional and education leadership); public/other professions/policy makers at regional/national level
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Accountable for own actions.
Practice characterised by an element of risk taking - guided by own knowledge and relevant professional codes/standards/guidelines
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Describing a level of practice in this way helps us understand some more about the demands of different types of roles within physiotherapy. A strategic/leadership role for example, provides opportunities for influencing individuals beyond the immediate environment, and is likely to require the ability to work in highly complex and unpredictable situations. As a result, this role also demands the exercise of higher levels of personal autonomy. The approach also helps explain why people working in seemingly very different roles (e.g. community-based clinical specialist, extended scope practitioner working in A&E, or a physiotherapy lecturer) might all be working at the same level.