Swimming upstream: Working as a Frailty Physiotherapist in a Primary Care Network

Vicky Johnston is a First Contact Physiotherapist specialising in frailty for a Primary Care Network (PCN) in West Cumbria. She qualified as a physiotherapist in London in 1996 and has worked in a variety of locations and services across London, Newcastle, Northumberland, North Cumbria and Suffolk. She is a past Chair of AGILE, the professional network of the Chartered Society of Physiotherapy for physios working with older adults, a committee member on the BGS Finance Committee and a tutor with Later Life training. Vicky’s areas of clinical expertise are fall reduction, frailty and rehabilitation. She posts on X: @greyhoundvicky

To mark National Allied Health Professions Day, Vicky explains why she is supporting the BGS #ChooseGeriatrics campaign.

My journey into specialising in working with older adults was unexpected. As a physiotherapy student and new graduate, I envisioned working in acute respiratory or neurosurgery. Having lived in London for 9 years, my husband and I were keen to move to a more rural area. I was very grateful for my time spent training as a physiotherapist and working in a large acute hospital trust in London, but we came to a point in life where we were spending most of our weekends away from London and longed for fresh air and country living.

My husband’s job was transferred to the North East of England, and we were excited to be moving to Northumberland. There weren’t any physio vacancies in acute respiratory or neuroscience at the time, so I applied for a rotational physiotherapy post specialising in rehabilitation for older people in Newcastle. I thought the role would be a way into the healthcare system and tide me over until something more exciting came up - looking back, I realise that was not a great attitude, sorry! 

Very soon into this new role, I suddenly had an insight into the exciting world of older adult rehabilitation – who could fail to be inspired by all the developments in multifactorial falls assessment and rehabilitation happening in Newcastle in the late 1990s?

Having completed rotations through in-patient rehabilitation, community rehabilitation and orthopaedic discharge/hospital at home, I was thoroughly hooked and decided that my future career development would be invested in the exciting arena of geriatrics and rehabilitation. I gained a senior physiotherapist role in a fabulous community hospital in rural Northumberland, specialising in stroke and orthogeriatric in-patient rehabilitation and at a day hospital which included out-patient rehabilitation, amputee clinics and falls prevention.

I had a further light-bulb revelation when Dr Susie Dinan-Young came to deliver an AGILE study day on exercise for older adults. Wow! I suddenly realised how effective a carefully tailored and progressed exercise programme can be. Getting the prescription and titration right can have a dramatic effect and enable older people to maintain independence through improving physical performance. I am forever grateful to Susie for this, which led to my subsequent involvement with Prof Dawn Skelton and Later Life training.

When you #ChooseGeriatrics as a career, you soon realise that a team approach is essential with a variety of professions and support staff providing support to the older person. Geriatrics is a complex specialty which requires a sound skillset in a bit of everything and each day I learn something new from both patients and colleagues. Keeping the patient at the centre of the wheel and supporting them to regain or maintain the skills to hold on to what matters to them is what makes me put on my uniform and turn up to the coalface.

Swimming upstream

In 2014, I had an unplanned move back to Cumbria. I took up a post as lead for an out-patient older adult rehabilitation unit. This was my dream job which provided proactive rehabilitation for people living with Parkinson’s, frailty, falls and any other complexities. When the pandemic hit, all outpatient rehabilitation services stopped. Changes within the trust, the stresses of redeployment, and other factors left me burned out. Trying to restore proactive and preventative rehabilitation against a tide of reactive Urgent Community Response, Discharge to Assess, repurposing of rehabilitation space and waiting lists made me question my ability to remain working within the NHS.

I saw a post advertised for an Occupational Therapist (OT) to lead the new Wellness Service in my local PCN, which sounded really exciting. Cheekily, I telephoned to ask whether they would accept an application from physiotherapist! They wouldn’t as they had plenty of OT applicants, but it did start a whole new conversation, and I was invited to a meeting with the Clinical Director and Operational Lead to pitch my ideas. I was still feeling very raw and anxious post-burnout and I wasn’t feeling very confident, but I must have made a positive impression because here I am, three years later, still working in Primary Care!

I describe my physiotherapist role in Primary Care in the words of Desmond TuTu; “There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.”

I work with three GP surgeries, alongside my home-visiting paramedic colleagues, frailty care coordinators, GPs, nurses and other members of the primary healthcare team. The bulk of my assessments are home visits with people who present with frailty and functionally are starting to tip – it could be worsening of a frailty syndrome, falls, frequent or increasing use of primary care services, other injuries or issues which are affecting physical function or wellbeing. With my skills and physiotherapist mindset being invested in the holistic care of older adults, this role provides the opportunity to bring the #ChooseGeriatrics ethos to primary care; and being a BGS NAHP member makes me feel part of the wonderful community that champions working within the specialty of Geriatrics.