Publication - Strategy/plan

Allied Health Professional Musculoskeletal Pathway Minimum Standards: A Framework for Action 2015-2016

Published: 8 May 2015
Part of:
Health and social care

The document provides a framework for Allied Health Professionals in the implementation of standards to support person-centred musculoskeletal pathways.

Allied Health Professional Musculoskeletal Pathway Minimum Standards: A Framework for Action 2015-2016


[1] Eumusc Net (2013) Musculoskeletal Health In Europe Report V5.0. Driving Musculoskeletal Health in Europe. Available at: [Last accessed 01/09/2014].

[2] Department of Health (2006) 'The Musculoskeletal Services Framework. A Joint Responsibility: Doing it Differently'. Available at: [Last accessed 01/09/2014].

[3] Jordan, K.P., Kadam, U.T, Hayward, R., Porcheret, M., Young, C., Croft, P. (2010) Annual Consultation Prevalence of Regional Musculoskeletal Problems in Primary Care: An Observational Study. BMC Musculoskeletal Disorders.11:144. Available at: [Last accessed 01/09/2014].

[4] NHSScotland Information Services Division (2007).

[5] European Bone and Joint Health Strategies Project (2005) European Action Towards Better Musculoskeletal Health. A Public Health Strategy to Reduce the Burden of Musculoskeletal Conditions. The Bone and Joint Decade, Lund, Sweden. Available at: [Last accessed 01/09/2014].

[6] Health and Safety Executive 2008/2009 Statistics 2008/09. Available at: [Last accessed 01/09/2014].

[7] Black, C. (2008) Working for a Healthier Tomorrow. Department of Work and Pensions. London: TSO. Available at: [Last accessed 01/09/2014].

[8] Audit Scotland (2010) Review of Orthopaedic Services. Prepared for the Auditor General for Scotland, March 2010. Available at: [Last accessed 01/09/2014].

[9] Scottish Government (2010) Demographic Change in Scotland. Available at: [Last accessed 01/09/2014].

[10] Woolf, A.D. and Åkesson, K. (2001) 'Understanding the Burden of Musculoskeletal Conditions', British Medical Journal, 322:1079-1080.

[11] Ahn, H., Bhandari,M., Schemitsch, E.H. (2009) 'An Evidence-Based Approach to the Adoption of New Technology', Journal of Bone And Joint Surgery(Am), 91, Suppl3: 95-98.

[12] Centre For Workforce Intelligence (2011) Medical Specialty Workforce Factsheet. Trauma and Orthopaedic Surgery. Available at: [Last accessed 01/09/2014].

[13] Gillam, S. and Pencheon, D. (1998) 'Managing Demand in General Practice', British Medical Journal, 316:1895-1898.

[14] Bevan, S., Passmore, E., Mahdon, M. (2007). Fit For Work? Musculoskeletal Disorders and Labour Market Participation. The Work Foundation. Available at: [Last accessed 01/09/2014].

[15] Scottish Government Health Department (2008) 18 Weeks: The Referral to Treatment Standard. NHSScotland. Available at: [Last accessed 02/09/2014].

[16] Scottish Executive Health Department (2006) A National Framework for Service Change in the NHS in Scotland - Building a Health Service for the Future. NHS Scotland. Available at: [Last accessed 02/09/2014].

[17] Scottish Executive Health Department (2006) Delivering Care, Enabling Health. NHSScotland. Available at: [Last accessed 02/09/2014].

[18] Department of Health (2002) European Working Time Directive. Department of Health, London.

[19] Department of Health (2004) A Compendium of Solutions to Implementing the Working Time Directive for Doctors in Training from August 2004. Department of Health, London.

[20] Department of Health (2003) Consultant Contract. Available at: [Last accessed 01/09/2014].

[21] National Audit Office (2008) NHS Pay Modernisation: New Contracts for General Practice Services in England. Available at: [Last accessed 01/09/2014].

[22] Goudie, A. (2010) Outlook for Scottish Government Expenditure. Available at: [Last accessed 01/09/2014].

[23] Conn, K.S., Sharp, D.J., Gardner, A.D.H. (2002) 'Orthopaedic Specialist Registrar Training and Attitudes to Spine Surgery in the United Kingdom: Reasons for Poor Recruitment and Suggestions for Improvement', European Spine Journal, 11:515-518.

[24] Logan, R. and Scott, P.J. (1996) 'Uncertainty in Clinical Practice: Implications for Quality and Costs of Healthcare, The Lancet; 347(9001):595-598.

[25] British Medical Association (2009) 'Factors Capable of Influencing an Increase in GP Referral Rates to Secondary Care (England Only).' Available at: [Last accessed 01/09/2014).

[26] Roberts, C., Adebajo, A.O, Long, S. (2002) 'Improving the Quality of Care of Musculoskeletal Conditions in Primary Care', Rheumatology, 41:503-508.

[27] Wennberg, J.E., Barnes, B.A., Zubkoff, M. (1982) 'Professional Uncertainty and the Problem of Supplier-Induced Demand', Social Science and Medicine, 16:811-824.

[28] NHS Institute for Innovation and Excellence (2009) 'Delivering Quality and Value: Focus on Musculoskeletal Interface Services'.

[29] Scottish Government Joint Effects (2011) 'An Update of the Involvement of Allied Health Professionals in Orthopaedic and Musculoskeletal Services in Scotland'. Available at: [Last Accessed 01/09/2014].

[30] Arthritis and Musculoskeletal Alliance (2011) (ARMA Scotland) 'Musculoskeletal Map of Scotland 2011'.

[31] Department of Health (2002) 'Improving Orthopaedic Services: A Guide for Clinicians, Managers and Service Commissioners (Action on Orthopaedics and the Orthopaedic Services Collaborative)'. Available at [Last Accessed 01/09/2014].

[32] Briggs, T.W.R. (2012) 'Getting it Right First Time. Improving the Quality of Orthopaedic Care within the National Health Service in England'. Department of Health. Available at: [Last accessed 01/09/2014].

[33] Daker-White, G., Carr, A.J., Harvey, I., Woolhead, G., Bannister, G., Nelson, I., Kammerling, M.A. (1999) 'A Randomised Controlled Trial: Shifting Boundaries of Doctors and Physiotherapists In Orthopaedic Outpatient Departments', Journal of Epidemiology and Community Health, 53:643-50.

[34] Weale, R. andBannister, J. (1995) 'Who Should See Orthopaedic Outpatients Physiotherapists or Surgeons?', Annals of the Royal Society of Medicine, 91:377-9.

[35] Rymaszewski, L.A, Sharma, S., McGill, P.E., Murdoch, A., Freeman, S., Loh, T. (2005) 'A Team Approach to Musculoskeletal Disorders', Annals of The Royal College of Surgeons of England, 87:174-180.

[36] Byles, S., Ling, R. (1989) 'Orthopaedic Out-Patients - A Fresh Approach', Physiotherapy, 75:435-437.

[37] Roland, M.O., Porter, R.W., Mathews, J.G., Redden, J.F., Simonds, G.W., Bewley, B. (1991) 'Improving Care: A Study of Orthopaedic Outpatient Referrals'. British Medical Journal, 302:1124-8.

[38] Ross, A., Davis, W., Horn, G. and Williams, R. (1983) 'General Practice Orthopaedic Outpatient Referrals in North Staffordshire', British Medical Journal. 28:1439-1441.

[39] West, R.R., McKibbin, B. (1992) 'Shortening Waiting Lists in Orthopaedic Surgery Outpatient Clinics', British Medical Journal of Clinical Research and Education, 284:728-30.

[40] Durrell, S. (1996). 'Professional Issue: Expanding the Scope of Physiotherapy: Clinical Physiotherapy Specialists in Consultant Clinics', Manual Therapy, 1:210-213.

[41] Owen, G. (1998) 'Extended Scope Practitioners in Orthopaedic Outpatient Clinics: A Growing Field in the UK', Rehabilitation Management International, 8:6-11.

[42] Rabey, M., Morgans, S., Barrett, C. (2009) 'Orthopaedic Physiotherapy Practitioners: Surgical and Radiological Referral Rates', Clinical Governance, 14(1):15-19.

[43] ACT Health (2008) Physiotherapy Extended Scope Practice: Phase 1. Final Report. Canberra, Australia: Australian Government Available at: [Last accessed 01/09/2014].

[44] Stanhope, J., Grimmer-Somers, K., Milanese, S., Kumar, S., Morris, J. (2012) 'Extended Scope Physiotherapy Roles for Orthopedic Outpatients: An Update Systematic Review of the Literature', Journal of Multidisciplinary Healthcare, 5, 37-45.

[45] NHS Education Scotland (2012) 'AHP Advanced Practice Education and Development Framework (Musculoskeletal)' Available at: [Last accessed 01/09/2014].

[46] Transforming Outpatient Services Change Package Getting Patients on the Right Pathway through Transforming Community Allied Health Professional (AHP) MSK Services. Available at: [Last accessed 01/09/2014].

[47] Scottish Government (2014), '4 Weeks Rapid Access to Allied Health Professional MSK'. Available at: [Last accessed 01/09/2014].

[48] AHP MSK Redesign (2014) 'Getting Patients on the Right Pathway NHS Scotland Quality Improvement Hub'. Available at: [Last accessed 01/09/2014].

[49] Scottish Executive Health Department (2007) 'Better Health, Better Care: Action Plan What it Means for You'. Available at: [Last accessed 01/09/2014].

[50] Sizer, P.S., Brismée, J.M., Cook, C. (2007) 'Medical Screening for Red Flags in the Diagnosis and Management of Musculoskeletal Spine Pain', Pain Practice, 7(1):53-71.

[51] Roach, K.E., Brown, M., Ricker, E., Altenburger, P., Tompkins, J. (1995) 'The Use of Patient Symptoms to Screen for Serious Back Problems', Journal of Orthopaedic and Sports Physical Therapy, 21:2-6.

[52] Greenhalgh, S. and Selfe, J. (2009) 'Red Flags II. A Guide To Identifying Serious Pathology of the Spine', Edinburgh: Churchill Livingstone.

[53] Ferguson, F., Holdsworth, L., Rafferty, D. (2010) 'Low Back Pain and Physiotherapy Use of Red Flags: The Evidence from Scotland', Physiotherapy, 96:282-288.

[54] Australian Acute Musculoskeletal Pain Guidelines Group (2004) 'Evidence-Based Management of Acute Musculoskeletal Pain: A Guide for Clinicians. Australian Government National Health and Medical Research Council. Available at [Last accessed 01/09/2014].

[55] Underwood, M. (2009) 'Diagnosing Acute Nonspecific Low Back Pain: Time to Lower the Red Flags?', Arthritis and Rheumatism, 60:2855-2857.

[56] Sieper, J., Van Der Heijde, D., Landewé, R., Brandt, J., Burgos-Vagas, R., Collantes-Estevez, E., Dijkmans, B., Dougados, M., Khan, M.A., Leirisalo-Repo, M., Van Der Linden, S., Maksymowych, W.P., Mielants, H., Olivieri, I., Rudwaleit, M. (2009) 'New Criteria for Inflammatory Back Pain in Patients with Chronic Back Pain: A Real Patient Exercise by Experts from the Assessment of Spondyloarthritis International Society (ASAS)', Annals of Rheumatic Diseases, 68(6):784-788.

[57] British Society of Rheumatology. Available at: [Last accessed 01/09/2014].

[58] Scottish Intercollegiate Guideline (SIGN 123) (2011), 'Management of Early Rheumatoid Arthritis, A National Clinical Guideline'. Available at : [Last accessed 01/09/2014].

[59] Aletaha, D., Neogi, T., Silman, A.J., Funovits, J., Felson, D.T., Bingham, C.O., Birnbaum, N.S., Burmester, G.R., Bykerk, V.P., Cohen, M.D., Combe, B., Costenbader, K.H., Dougados, M., Emery, P., Ferraccioli, G., Hazes, J.M., Hobbs, K., Huizinga, T.W., Kavanaugh, A., Kay, J., Kvien, T.K., Laing, T., Mease, P., Ménard, H.A., Moreland, L.W., Naden, R.L., Pincus, T., Smolen, J.S., Stanislawska-Biernat, E., Symmons, D., Tak, P.P., Upchurch, K.S., Vencovsky, J., Wolfe, F., Hawker, G. (2010), 'Rheumatoid Arthritis Classification Criteria: An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative', Annals of Rheumatic Diseases, 69(9):1580-1588.

[60] Podiatry Rheumatic Care Association. (2010) 'Standards of Care for People with Musculoskeletal Foot Health Problems. A Document Setting Out Standards of Care for Foot Health Services for People with Musculoskeletal and Rheumatological Conditions Managed In Community and Hospital Settings'. Available at: [Last accessed 01/09/2014].

[61] Edwards, B., Bunta, A., Simonelli, C., Bolander, M., Fitzpatrick, L.A. (2007) 'Prior Fractures are Common in Patients with Subsequent Hip Fractures'. Clinical Orthopaedic and Related Research, 461:226-230.

[62] McLellan, A., Reid, D., Forbes, K., Reid, R., Campbell, C., Gregori, A., Raby, N., Simpson, A. (2004) 'Effectiveness of Strategies for the Secondary Prevention of Osteoporotic Fractures in Scotland' (CEPS 99/03). NHS Quality Improvement Scotland, Glasgow.

[63] McLellan, A.R, Wolowacz, S.E., Zimovetz, E.A, Beard, S.M., Lock, S., McCrink, L., Adekunle, F., Roberts, D. (2011) 'Fracture Liaison Services for the Evaluation and Management of Patients with Osteoporotic Fracture: A Cost-Effectiveness Evaluation Based on Data Collected Over 8 Years of Service Provision'. Osteoporosis International, 22(7):2083-2098.

[64] Port, L., Center, J., Briffa, N., Nguyen, T., Cumming, R., Eisman, J. (2003) 'Osteoporotic Fracture: Missed Opportunity for Intervention', Osteoporosis International, 14(9):780-784.

[65] National Osteoporosis Society. Available at: [Last accessed 01/09/214].

[66] British Orthopaedic Association (2013) 'Commissioning Guide: Low Back Pain: Broad Principles of the Patient Pathway' Available at: [Last accessed 01/09/2014].

[67] Greenhalgh, S. and Selfe, J. (2009) 'A Qualitative Investigation of Red Flags for Serious Spinal Pathology', Physiotherapy, 95(3): 223-226.

[68] Ferguson, F. (2009) 'A Pocketbook of Managing Lower Back Pain'. Edinburgh: Churchill Livingstone Elsevier.

[69] Gustafson, D.H., Hawkins, R., Boberg, E., Pingree, S., Serlin, R.E., Graziano, F., Chan, C.L. (1999) 'Impact of Patient-Centred Computer-Based Health Information/Support System', American Journal of Preventative Medicine, 16:1-9.

[70] Klein-Fedyshyn, M., Burda, M., Epstein., B, Lawrence, B. (2005) 'Collaborating to Enhance Patient Education and Recovery', Journal of Medical Library Association, 93:440-445.

[71] Health Foundation (2011) 'Helping People Help Themselves: A Review of the Evidence Considering Whether it is Worthwhile to Support Self-Management': Available At: [Last accessed 01/09/2014].

[72] Gross A.R., Goldsmith, C., Hoving, J.L,, Haines, T., Peloso, P., Aker, P., Santaguida, P., Myers, C., and the Cervical Overview Group. (2007) 'Conservative Management of Neck Disorder: A Systematic Review'. Journal of Rheumatology, 34:1083-1102.

[73] Miller, J., Gross, A., D'Sylva, J., Burnie, S.J, Goldsmith, C.H., Graham, N., Haine, T., Bronfort, G., Hoving, J.L. (2010) 'Manual Therapy and Exercise for Neck Pain', Manual Therapy, 15;334-354.

[74] Green, S., Buchninder, R., Hetrickk, S. (2003) 'Physiotherapy Interventions for Shoulder Pain'. Cochrane Database Systematic Review, CD004258.

[75] Conaghan, P.G., Dickson, J., Grant, R.L. (2008) 'Care and Management of Osteoarthritis In Adults: Summary of NICE Guidance', British Medical Journal, 336:502-503.

[76] Zhang, W., Moskowitz, R.W, Nuki, G., Abramson, S., Altman, R.D., Arden, N., Bierma-Zeinstra, S., Brandt, K.D., Croft, P., Doherty, N., Dougados, M., Hochberg, M., Hunter, DJ., Kwoh, K., Lohmander, LS., Tugwell, P. (2008) 'OARSI Recommendations for the Management of Hip And Knee Osteoarthritis, Part l: OARSI Evidence- Based, Expert Consensus Guidelines', Osteoarthritis and Cartilage, 16:137-162.

[77] Curatolo, M. and Bogduk, N. (2001) 'Pharmacological Pain Treatment and Musculoskeletal Disorder: Current Perspective and Future Prospects', The Clinical Journal of Pain, 17:25-32.

[78] Gureje, O., Von Korpff, M., Simon, G.E, Gater, R. (1998) 'Persistent Pain and Well-Being: A World Health Organization Study in Primary Care'. Journal of American Medical Association, 280:147-151.

[79] Lawrie, I. and Simpson, K. (2007) 'Managing Musculoskeletal Pain'. Available at: [Last accessed 01/09/2014].

[80] Andersson, HI, Ejlertsson, G, Leden, I, Scherstén, B. (1999) 'Musculoskeletal Chronic Pain In General Practice. Studies of Healthcare Utilisation In Comparison With Pain Prevalence', Scandinavian Journal of Primary Healthcare, 17:87-92.

[81] Hunt, R.H., Choquette, D., Craog, B.N., Angelis, C.D., Habal, F., Fulthorpe, G., Stewart, J.I., Turpie, A.G.G., Davis, P. (2007) 'Approach To Managing Musculoskeletal Pain', Canadian Family Physician, 53:1177-1184.

[82] Silver J.K, Audette J. (2003) 'Pharmacological Agents and Acupuncture in Rehabilitation'. Chapter 9 pp187-203. In Rehabilitation of Sports Injuries Scientific Basis (Ed Frontera WR), Oxford:Blackwell Science.

[83] Cepeda, M,S, Camargo, F, Zea, C., Valencia, L.. (2006) 'Tramadol for Osteoarthritis. Cochrane Database Of Systematic Reviews', Issue 3. Art. No.: CD005522. DOI: 10.1002/14651858.CD005522.Pub2.

[84] Towheed, T., Maxwell, L., Judd, M., Catton, M., Hochberg, M.C., Wells, G.A. (2006) 'Acetaminophen for Osteoarthritis. Cochrane Database of Systematic Reviews' Issue 1. Art. No.: CD004257. DOI: 10.1002/14651858.CD004257.Pub2.

[85] Smart, K.M., Blake, C., Staines, A., Thacker, M., Doody, C. (2012) 'Mechanisms-Based Classification of Musculoskeletal Pain: Part 1 of 3: Symptoms and Signs of Central Sensitisation in Patients with Low Back (±Leg) Pain', Manual Therapy, 17:336-344.

[86] Smart, K.M., Blake, C., Staines, A., Thacker, M., Doody, C. (2012) 'Mechanisms-Based Classification of Musculoskeletal Pain: Part 2 of 3: Symptoms and Signs of Peripheral Neuropathic Pain In Patients with Low Back (±Leg) Pain', Manual Therapy, 17:345-351.

[87] Smart, K.M., Blake, C., Staines, A., Thacker, M., Doody, C. (2012) 'Mechanisms-Based Classification of Musculoskeletal Pain: Part 3 of 3: Symptoms and Signs of Nociceptive Pain in Patients with Low Back (±Leg) Pain', Manual Therapy, 17:352-357.

[88] Xu, B., Descalzi, G., Ye, H-R., Wang, Y-W. (2012) 'Translational Investigation and Treatment of Neuropathic Pain', Molecular Pain, 8:15.

[89] Scottish Intercollegiate Guidelines Network (SIGN) (2013) 'Management of Chronic Pain'. Edinburgh: SIGN. (SIGN Publication No. 136). Available at: [Last accessed 01/09/2014].

[90] Fitzsimmons, C.R. and Wardrope, J. (2005) 'Assessment and Care of Musculoskeletal Problems', Emergency Medical Journal, 22:68-76.

[91] Scottish Government Health Department (2012) National Access Policy. Available at: [Last accessed 01/09/2014].

[92] Salisbury, C., Montgomery, A.A., Hollinghurst, S., Hopper, C., Bishop, A., Franchini, A., Kaur, S., Coast, J., Hall, J, Grove, S., Foster, N.E. (2013) 'Effectiveness of Physiodirect Telephone Assessment and Advice Services for Patients with Musculoskeletal Problems: Pragmatic Randomised Controlled Trial', British Medical Journal; 346.

[93] Consulting J.J. (2011) 'A Survey of NHS Physiotherapy Waiting Times, Workforce and Caseloads in the UK 2010-2011', Chartered Society of Physiotherapy'. Available at: [Last accessed 01/09/2014].

[94] Derrett, S., Paul, C., Morris, J.M. (1999) 'Waiting for Elective Surgery: Effects on Health Related Quality of Life'. International Journal of Quality Healthcare, 11:47-57.

[95] Maniadakis, N, Gray, A. (2000) 'The Economic Burden of Back Pain in the UK'. Pain, 84(1):95-103.

[96] Waddell, G., Burton, A.K., Kendall, N.A.S. (2013) 'Vocational Rehabilitation. What Works, For Whom, and When?' Available at: [Last accessed 01/09/2014].

[97] Holdsworth, L., Webster, V., McFadyen, A. (2006) 'Self-Referral to Physiotherapy: Deprivation and Geographical Setting: Is there a Relationship? Results of a National Trial', Physiotherapy, 92:16-25.

[98] Holdsworth L., Webste, V., McFadyen A. (2006) 'Are Patients Who Refer Themselves to Physiotherapy Different from those Referred by GPs?: Results of a National Trial'. Physiotherapy, 92:26-33.

[99] Holdsworth, L. and Webster, V. (2006) 'Self Referral to Physiotherapy', Scottish Primary Care, 49:16-18.

[100] Holdsworth, L., Webster, V., McFadyen, A. (2007) 'What are the Costs to NHSScotland of Self Referral to Physiotherapy?, Results of a National Trial', Physiotherapy, 93:3-11.

[101] Holdsworth, L, Webster, V, McFadyen, A. (2008) 'Physiotherapist and General Practitioner Views of Self Referral and Physiotherapy Scope of Practice: Results from a National Trial', Physiotherapy, 94:236-243.

[102] Webster, V, Holdsworth, L, McFadyen, A (2008) What do Patients Think About Self Referral, Access & Physiotherapy? Results of a National Trial. Physiotherapy 94: 141-149.

[103] Holdsworth, L. and Webster, V. (2006) 'Patient Self Referral: A Guide for Therapists'. Chapter 12 The Most Frequently Asked Questions p46. Oxford: Radcliffe Publishing.

[104] Foster, N.E., Williams, B, Grove, S., Gamlin, J., Salisbury, C. (2011) 'The Evidence For and Against 'Physiodirect' Telephone Assessment and Advice Services', Physiotherapy, 97:78-82.

[105] Scottish Government Health Department (2012) 'AHPs as Agents of Change in Health and Social Care. The National Delivery Plan for the Allied Health Professions in Scotland, 2012-2015'. Available at: [Last accessed 01/09/2014].

[106] Information Services Division Scotland (2012) Findings from the AHP Waiting Times Census in Scotland. Patients Seen for First AHP Treatment from Monday 6 February to Friday 10 February Publication Date - 10 July 2012. Available at: [Last accessed 01/09/2014].

[107] Scottish Government Health Department (2011) 'EHealth Strategy 2011-2017'. Available at: [Last accessed 01/09/2014].

[108] European Pathway Association (2007) Available at: [Last Accessed 01/09/2014].

[109] Jenkins, F. and Jones, R. (2007) 'Care Pathways and the Allied Health Professionals'. Chapter 3 pp57-81. In Key Topics in Healthcare Management: Understanding the Big Picture (Ed: Jones, R. and Jenkins, F.). Oxford: Radcliffe Publishing.

[110] Vanhaecht, K., Panella, M., Van Zelm, R., Sermeus, W. (2010) 'An Overview on the History and Concept of Care Pathways as Complex Intervention'. International Journal of Care Pathways, 14:117-123.

[111] Rogers, H., Maher, L., Plsek, P. (2009) 'Better by Design: Using Simple Rules to Improve Access to Secondary Care', British Medical Journal, 338:384-387.

[112] Kravitz, R.L. and Melnikow, J. (2001) 'Engaging Patients in Medical Decision Making. The End Is Worthwhile, But the Means Need to be More Practical', British Medical Journal, 323:584-585.

[113] Leach, E., Cornwell, P., Fleming, J., Haines, T. (2010) 'Patient Centered Goal-Setting in a Subacute Rehabilitation Setting', Disability and Rehabilitation, 32(2):159-172.

[114] Health and Care Professions Council Standards of Proficiency Chiropodists and Podiatrists. Available at: [Last accessed 01/09/2014].

[115] Health and Care Professions Council Standards of Proficiency Occupational Therapists. Available at: [Last accessed 01/09/2014].

[116] Health and Care Professions Council Standards of Proficiency Physiotherapists. Available at: [Last accessed 01/09/2014].

[117] Health and Care Professions Council Standards of Proficiency Prosthetists and Orthotists. Available at: [Last accessed 01/09/2014].

[118] Schoeb, V. (2009) 'The Goal is to be More Flexible - Detailed Analysis of Goal Setting in Physiotherapy Using a Conversation Analytic Approach', Manual Therapy, 14:665-670.

[119] Levack, W.M., Dean, S,G., Siegert, R.J., McPherson, K.M. (2006) 'Purposes and Mechanisms of Goal Planning in Rehabilitation: The Need for a Critical Distinction', Disability and Rehabilitation, 28(12):741-749.

[120] Wade, D.T. (2009) 'Goal Setting in Rehabilitation: An Overview of What, Why and How', Clinical Rehabilitation, 23:291-295.

[121] Institute of Medicine (2001) 'Crossing the Quality Chasm. A New Health System for the 21st Century'. Washington, D.C: National Academy Press.

[122] Scottish Government Health Department (2010) The Healthcare Quality Strategy for NHSScotland. Available at: [Last accessed 01/09/2014].

[123] Chartered Society of Physiotherapy (2005) 'A Guide to Clinical Supervision'. Chartered Society of Physiotherapy, London.

[124] Kadushin, A. (1976) 'Supervision in Social Work'. New York:Columbia University Press.

[125] Waskett, C. (2009) 'An Integrated Approach to Introducing and Maintaining Supervision: The 4s Model'. Nursing Times, 105: 17.

[126] Waskett, C. (2010) 'Clinical Supervision Using the 4S Model 3: How to Support Supervisors and Sustain Schemes', Nursing Times, 106, 18:14-16.

[127] Chartered Society of Physiotherapy (2008) Scope of Physiotherapy Practice. Information Paper PD001. Chartered Society of Physiotherapy London. Available at: [Last accessed 01/09/2014].

[128] Dawson, L.J, Ghazi, F. (2004) 'The Experience of Physiotherapy Extended Scope Practitioners in Orthopaedic Outpatient Clinics', Physiotherapy, 90:210-6.

[129] Gilmore, L.G., Morris, J.H., Murphy, K., Grimmer-Somers, K., Kumar, S. (2011) 'Skills Escalator in Allied Health: A Time for Reflection and Refocus', Journal of Healthcare Leadership, 3:53-58

[130] Kersten, P, McPherson, K, Lattimer V, George, S, Breton, A, Ellis, B. (2007) 'Physiotherapy Extended Scope of Practice-Who Is Doing What and Why?', Physiotherapy, 9:235-242.

[131] McPherson, K., Kersten, P., George, S., Lattimer, V., Ellis B., Kaur, D., Frampton, G. (2006) 'A Systematic Review of Evidence About Extended Roles for Allied Health Professionals'. Journal of Health Service Research and Policy, 11(4):340-477.

[132] NHS Lanarkshire (2011) 18 Week RTT Newsletter Issue No 7 February. Available at: [Last accessed 01/09/2014].

[133] Jones, V. (2001) 'Tackling Delay in Orthopaedics', Bandolier, Jan:11-12. Available at: [Last accessed 01/09/2014].

[134] Hourigan, P.G. and Weatherley, C.R. (1998) 'Developments in Physiotherapy: The Extended Scope Practitioner', Association of Chartered Physiotherapists in Management, 3-5.

[135] Aiken, A.B. and McColl, M.A. (2008) 'Diagnostic and Treatment Concordance Between a Physiotherapist and an Orthopaedic Surgeon-A Pilot Study', Journal of Interprofessional Care, 22(3):253-261.

[136] Dickens, V., Ali, F., Gent, H, Rees, S. (2003) 'Assessment and Diagnosis of Knee Injuries: The Value of an Experienced Physiotherapist', British Journal of Therapy and Rehabilitation, 10(1):6-11.

[137] Mackay, C,, Davis, A.M, Mahomed, N., Badley, E.M. (2009) 'Expanding Roles in Orthopaedic Care: A Comparison of Physiotherapist and Orthopaedic Surgeon Recommendations', Journal of Evaluation in Clinical Practice, 15:179-183.

[138] Meyer, C., Kotecha, A. Kakati, S. Crichlow, T. (2009) 'Should Extended Scope Physiotherapists Place Patients Directly on Arthroscopy Lists?', Journal of Bone and Joint Surgery(Br), 91-B, Issue Supp_III:502.

[139] Ellis, B., Kersten, P. (2001) 'An Exploration of the Developing Role of Hand Therapists as Extended Scope Practitioners', British Journal of Hand Therapy, 6(4):126-130.

[140] Aiken, A.B., Harrison, M.H., Atkinson, M. and Hope, J. (2008) 'Easing the Burden for Joint Replacement Wait Times: The Role of the Expanded Practice Physiotherapist', Healthcare Quarterly, 11(2):62-66.

[141] Marangon, T., Buttress, S. (2008) In Scope. Horizon (UK Extended Scope Practitioners Occupational Interest Group). Newsletter. No 29. Jan: 3-10.

[142] Buttress SJ And Marangon T. (2008) 'Legal Issues of Extended Practice: Where Does The Responsibility Lie?', Radiography, 14; E33-E38.

[143] General Medical Council, (2013). Good Medical Practice. London: GMC. Available at: [Last accessed 01/09/2014].

[144] Council for Healthcare Regulatory Excellence (CHRE) (2009) Advanced Practice: Report to the Four UK Health Departments. Available at: [Last accessed 01/09/2014].

[145] Council for Healthcare Regulatory Excellence (CHRE) (2010). Managing Extended Practice. Is there a Place for Distributed Regulation?' London: CHRE. Available at: [Last accessed 01/09/2014].

[146] Department of Health (2006). The Regulation of Non-Medical Healthcare Professions-A Review by the Department of Health. Leeds: DOH: Available at: [Last accessed 01/09/2014].

[147] Syme, G., Rutter, M., Suckley, J., Payne, C., Russell, V. (2013) Resource Manual and Competencies for Extended Musculoskeletal Physiotherapy Roles in the United Kingdom. Edition 2. Extended Scope Practitioners. A Professional Network of the Chartered Society of Physiotherapy. Available at: ( [Last accessed 01/09/2014].

[148] Scally, G. and Donaldson, L.J. (1998) 'Looking Forward: Clinical Governance and the Drive for Quality Improvement in the New NHS in England', British Medical Journal, 317:61-65.

[149] Arthritis Research UK. Available at: [Last accessed 01/09/2014].


Email: Susan Malcolm