Development of the Arthroplasty Practitioner Team at Wrightington

Development of the Arthroplasty Practitioner Team at Wrightington. . . . A Narrative Jane James Advanced Practitioner (Arthroplasty) – Operational Lead

Introduction to Wrightington Hospital �Site for Elective Orthopaedic Services & Rheumatology �Part of Musculoskeletal Division/Specialist Services � 21 lower limb consultants � 10 upper limb consultants �Arthroplasty Practitioners since January 2007 �Team of 9 practitioners (8. 14 wte) � 2 Admin Support Staff

How it all started. . . �BOA meeting 2006 (Edinburgh) �Presentation about Arthroplasty Practitioner roles �Wrightington - Follow Up Backlog 8000+ (mainly LL) �Lower Limb Consultants felt they had found their solution!! �For us Arthroplasty Practitioners it was the start of this. . . AP

. . . Phase 1 �Trip to Arthroplasty Practitioners, Edinburgh �First 2 AP’s appointed Dec 2006/ Jan 2007 � 1 Nurse and 1 Physio (MSc) �Role initially based around Outpatient Follow Up issue � 4 Consultants identified with largest FU backlog �Commenced tandem outpatient clinics �Introduced BOA guidelines for long term FU �Assigned to AQUA/CQUIN work �Gained admin support

. . . . Phase 2 �AP’s Explored role progression: �ACPA membership and networking �Other NHS hospital visits �Glencove Exchange Programme Oct 2009 (Do. H and NHS Elect) – role of physicians extenders!! �Aim for role spanning patient journey �Business case for 3 more Arthroplasty Practitioners and further admin support

. . . . Phase 2 (cont. . ) �Spring 2010 - Appointed 1 Physio, 1 Nurse, 1 theatre Nurse (Surgical Assistant) �Expanding role through other aspects of pathway (theatre and wards, virtual clinics) �Competency framework developed with Skills for Health, ACPA and BOA sponsored by Do. H �Now 5 Arthroplasty Practitioners, 8 Orthopaedic consultants

. . . Phase 3 � 2011/12 Theatre 9 arrived �Further business case, 2 Consultants, 2 AP’s � 1 Nurse, 1 Physio �AP Service covered 5 more Consultants �Pelvic team expanded and Pelvic Practitioner emerged �Now 7 Arthroplasty Practitioners, 13 Consultants in total

. . . . Phase 4 � 2013 - Theatre 9 (#2) & Theatre 10 � 4 new consultants (2 upper limb/2 lower limb) �Business case for 4 APs (2 UL/2 LL) �For LL, 1 Nurse, 1 Physio �Foot & Ankle team Practitioner �Restructured team managerially �Revised AP allocation �Now 9 Arthroplasty Practitioners(~8 wte), 19 LL Consultants

Challenges �Highly skilled, diverse team!! �Lack of operational foresight into building a team �Different AP roles for different teams. . negativity �Job title �Victims of our own success �In last 7 years: � 6 Head of Nursing � 5 Divisional/General Managers (and their teams) �Senior Nurse/Practitioner Review AP

Challenges Arthroplasty Practitioners Operational Managers Nursing Managers Consultants AP

Successes �Role now includes: �‘New’ patients �Peri & intra operative role �Telephone helpline �Follow up � OPD � Virtual Clinics �Joint injections �Mo. M management �Research Projects and Audit �CQUIN’s/CIP’s/Pathway redesign. . etc

Successes �Recognised within Division as a valuable resource – had investment �Highly skilled, diverse team � 5 Nurses, 4 Physios and 2 Admin Support �Educational support ++ �Single modules � Conferences �MSc Advanced Practice �Recognised success re: - FU backlog � 8000 ~2000, even split between UL/LL �Ongoing. .

Thankyou Any questions? ? jane. james@wwl. nhs. uk