Advanced Practice Under The Spotlight - Andy McDonough

In this episode of Chewing It Over, Jack is joined by Andy McDonough, consultant physiotherapist and incoming co-chair of the Advanced Practice Physiotherapy Network (APPN), for a wide-ranging discussion about what advanced practice actually means.Andy argues that advanced practice is a level of practice, not a job title, profession or collection of technical skills. Being able to request imaging, take bloods or administer injections doesn't automatically make someone an advanced practitioner. The distinction lies in the clinical reasoning, diagnostic breadth, autonomy and responsibility underpinning those decisions.The conversation explores the increasingly contentious issue of undifferentiated patients, including debates about which professions should assess them and how physiotherapists can develop the knowledge required to manage more complex presentations safely.Drawing on his emergency department experience, Andy shares examples of serious pathology initially presenting as apparently routine MSK complaints, highlighting the importance of broad differential diagnosis, multidisciplinary supervision and knowing the limits of one's competence.Jack and Andy also examine the governance of advanced practice, including credentialing, professional regulation, education and the use of titles such as advanced practitioner and consultant physiotherapist.A particular concern is whether these titles can become misleading when used without clear standards or appropriate assurance, especially across different healthcare sectors.The discussion concludes with a call for stronger professional collaboration, transparent governance and greater recognition of the contribution physiotherapists can make across healthcare.Ultimately, advanced practice isn't about moving beyond physiotherapy. It's about demonstrating what physiotherapy can achieve at its highest levels.5 clinical/professional takeaways- Advanced practice is a level of reasoning, not a list of procedures. Taking bloods, requesting scans or delivering injections may form part of an advanced role, but the advanced component is knowing when those interventions are indicated, how to interpret the findings and what decisions follow.- Managing undifferentiated presentations requires diagnostic breadth. Patients don't arrive with confirmed diagnoses. Advanced practitioners must be capable of considering serious non-MSK causes of symptoms, particularly in settings such as emergency departments and first-contact services.- Supervision should extend beyond professional boundaries. Learning from medical colleagues and other disciplines can expose clinicians to different diagnostic approaches and improve their ability to manage uncertainty and risk.- Governance and titles matter. Terms such as advanced practitioner and consultant physiotherapist carry expectations for patients and colleagues. Their use should be supported by appropriate competence, accountability and transparent professional standards.- Advanced practice should strengthen physiotherapy identity, not obscure it. Progressing into complex diagnostic, leadership, research or governance roles doesn't mean leaving physiotherapy behind. Andy argues that clinicians should be proud to demonstrate what physiotherapists can contribute across healthcare.

CLICK HERE FOR SPLOSEIn this episode of Chewing It Over, Jack speaks with Nick, founder of Splose, about the evolution of practice management software, artificial intelligence and the challenges facing modern MSK clinics.Nick shares his unconventional journey from building websites for allied health professionals in Australia to developing an all-in-one practice management platform. After repeatedly encountering clinicians frustrated by disconnected systems, time-consuming documentation and inefficient administration, he decided to build something different.The conversation explores how Splose has evolved, particularly following the introduction of AI functionality in 2024. Its AI scribe now extends beyond simple transcription, incorporating patient histories, previous consultations and administrative information to support clinical documentation.However, Nick is clear that AI should support rather than replace clinical judgement. Jack challenges him on the future of automated objective assessments, the potential for increasingly sophisticated monitoring technologies and the risk of clinicians becoming complacent when reviewing AI-generated records.They also discuss Splose's expansion into the UK, where the complexity of private medical insurance billing initially presented unexpected challenges. Nick explains how partnerships with Healthcode and ePractice-related providers helped address these barriers.The discussion broadens into software development, customer feedback, investor expectations and the importance of maintaining a product-led philosophy while scaling a technology business.Finally, Nick identifies clinician burnout, administrative overload and financial pressures as major challenges facing allied health.Ultimately, the episode argues that the most valuable healthcare technology isn't necessarily the most autonomous. It's the technology that gives clinicians more time, attention and capacity to care for patients.5 clinical/professional takeaways- AI scribes are becoming much more than transcription tools. Integrating previous patient history, consultation information and administrative workflows could make documentation significantly more useful, rather than simply faster.- Clinical judgement remains essential. AI can help generate and organise documentation, but clinicians must still review and approve their records. Objective assessment is particularly challenging when important findings cannot be reliably captured through audio alone.- Automation introduces new risks as well as efficiencies. The easier it becomes to produce clinical notes, the easier it may become to approve them without sufficient scrutiny. Saving time must not come at the expense of clinical accuracy.- Practice management software needs to reflect local healthcare systems. Splose's experience entering the UK demonstrates how billing, private medical insurance and payment processes can become major barriers, even when the underlying clinical software is well received.- Reducing burnout requires more than technology. Administrative automation can reduce unnecessary work, but it cannot independently solve the emotional, professional and financial pressures facing clinicians. Education, mentorship and appropriate clinical support remain essential.

MSKAwards.comThank you to the absolute legend that is Adam Meakins for hosting Jack on his podcast to discuss the MSKAwards amongst other things like social media, the ineptitude of professional bodies and regulators as well as cowboys!MSKAwards Nominations close in 8 days (end of Sept) so click on the link and nominate yourself or a colleague/service for one of the 8 awards. Awards are open to NHS and non-NHS nominations plus the party will be absolutely fantastic so checkout the ticket options too. We will see you there!!

In this episode of Chewing It Over, Jack is joined again by Asaf Weisman for a deliberately challenging discussion about some of the prevailing ideas within modern pain science.Asaf argues that pain medicine has spent decades on a series of intellectual “side quests”, particularly following the development of the biopsychosocial model and modern definitions of pain in the 1970s. His criticism isn't that psychological, social or neurological factors are irrelevant, but that theoretical possibilities have sometimes been promoted with greater certainty than the evidence warrants.A central theme is nociception and the role of the brain. Asaf challenges descriptions of pain as simply an output of the brain or a neurological expression of perceived threat. Instead, he argues that pain requires underlying somatic signalling, while the brain participates in processing and modulating that experience rather than independently generating it.The discussion explores the language clinicians use around pain, the distinction between modulation and causation, and whether attempts to explain persistent pain have sometimes made the subject unnecessarily complex.Importantly, the conversation also identifies areas of agreement. Asaf accepts that psychological and social factors can substantially alter an individual's pain experience, even when underlying nociceptive signalling remains unchanged. Stress, context and other factors can influence pain through modulation.For clinicians, this creates a more practical discussion about management. Rather than becoming trapped in theoretical explanations, Asaf argues for identifying and addressing modifiable risk factors associated with persistent pain, while using exercise, modalities and other interventions where they help patients pursue meaningful activity.It's a provocative conversation that challenges clinicians not simply to replace one pain model with another, but to scrutinise the assumptions underneath both.Be precise about causation versus modulation. A psychosocial factor influencing the intensity of someone's pain doesn't necessarily establish that it independently caused the pain. That distinction is central to Asaf's argument.Don't turn theoretical models into established biological facts. Models can help generate hypotheses and guide research without every component of the model having been empirically demonstrated.The brain isn't being dismissed. Asaf's position is more nuanced than “pain is peripheral”. He explicitly accepts that the brain processes and modulates pain and that stress and psychosocial circumstances can change the resulting experience.Language matters clinically. Terms such as “pain output”, “threat”, “nociception” and “biopsychosocial” carry assumptions. Using them casually can make a proposed mechanism sound more established than it actually is.Don't let the theoretical debate distract from modifiable factors. Whatever model a clinician favours, the practical priority remains identifying things that can meaningfully be changed — including activity, physical health and relevant psychosocial stressors — and helping the patient address them.5 clinical/professional takeaways

In this episode of Chewing It Over, Jack is joined by Laura Bevan, Head of Communications at Physio Matters, for a complete guide to the inaugural MSK Awards — and, remarkably, Laura's first ever podcast appearance.Taking place on 27 November in Birmingham, the MSK Awards have been created as a dedicated celebration of excellence across the MSK community. Rather than another conference or educational event, the evening is designed to recognise the clinicians, leaders and teams making a genuine difference to patients and colleagues — including those whose work often happens quietly behind the scenes.Jack and Laura discuss the thinking behind the awards, the categories, nominations and judging process, as well as what attendees can expect from the evening itself. The ambition is to create something that combines a prestigious awards ceremony with a genuinely enjoyable end-of-year celebration: dinner, entertainment, networking and a proper party with the wider MSK community.They also reveal that two-time Olympic triathlon champion Alistair Brownlee will join the event as its celebrity guest speaker. Rather than simply making an appearance, Brownlee will be interviewed about his experiences of injury, rehabilitation and working with MSK professionals throughout an extraordinary elite sporting career.With leading MSK clinicians and educators attending alongside teams from across the profession, the awards are intended to become an annual opportunity to recognise the breadth of work happening across MSK healthcare.The message is simple: our profession spends plenty of time discussing how it can improve. Sometimes it should also celebrate what it's already doing brilliantly.

dataplayer.ioIn this episode of Chewing It Over, Jack speaks with Elona Bregasi and Xhesika Tusha from Dataplayer about why many clinic owners are effectively “flying blind” when it comes to understanding the performance of their businesses.Clinicians are trained to deliver healthcare, not necessarily to run data-driven organisations. As a result, many practices rely heavily on intuition, revenue figures and diary occupancy when making business decisions. The problem is that a busy clinic can still have significant weaknesses hidden beneath those headline numbers.Elona and Xhesika highlight patient retention as a particularly important example. A clinic may have a full diary because it continually attracts new patients, while simultaneously losing existing patients earlier than expected. Without measuring retention, cancellation rates, utilisation and future appointment coverage, owners can miss these underlying problems.The conversation also explores another growing challenge: having too much data. Information may be scattered across practice management, accounting and booking systems, while clinic owners increasingly experiment with uploading spreadsheets into generic AI tools. Without a consistent data model or appropriate expertise, this can create misleading conclusions and potentially introduce concerns around sensitive patient and business information.Dataplayer aims to bring these different sources together, turning raw operational information into dashboards and actionable insights tailored to each clinic.Ultimately, the discussion argues that good clinic data isn't about collecting everything. It's about identifying measurable, actionable metrics that help owners understand what's actually happening—and using them to make better decisions about patients, clinicians and the future of their business.

Preve.co | Discount code Chew26What if AI in physiotherapy could do more than write your notes?In this episode of Chewing It Over, Jack speaks with physiotherapist, clinic owner and Preev co-founder Calum Trott about using AI to tackle one of private MSK practice's biggest challenges: patients dropping out before completing their planned care.Preev has been designed around more than clinician efficiency. It aims to turn information from the consultation into a clear patient treatment plan, helping patients understand where they're going, what happens next and why continuing their care matters.Jack and Calum discuss the problem with traditional metrics such as patient visit average, why expectation management matters, and whether clinics should instead be measuring how successfully patients complete the individual treatment plan actually recommended to them.They also explore:Why AI scribes are only the beginningPatient drop-off and self-dischargeCreating personalised treatment plansImproving communication between appointmentsReducing administrative burden for cliniciansPatient retention versus simply increasing appointment numbersThe limitations of PVA/PBA as a clinic metricMeasuring planned completion ratesUsing AI to identify patients falling off their recovery pathwayEarly results from clinics using PreevWhere AI-supported MSK care could go nextCalum shares early examples of clinics reporting significant improvements in rebooking among patients receiving treatment plans, including one clinic where average visits per case reportedly increased from around 4.5 to 7 following implementation.The bigger question is whether healthcare AI should simply make existing work faster—or help us deliver a fundamentally better patient experience.🧠 5 clinical/professional takeawaysAI doesn't have to stop at documentation. The more interesting opportunity may be using information already captured during consultations to improve what happens between appointments.Expectation management is part of treatment. A patient who understands the proposed journey, expected number of appointments and purpose of each stage is better equipped to engage with their care.PVA/PBA can be a crude metric. Seven appointments might represent excellent care for one presentation and incomplete care for another. The number alone lacks clinical context.Planned completion could be a better measure. Comparing the clinician's recommended plan with what the patient actually completes creates a more individualised measure of engagement.Efficiency and patient experience are connected. Asking clinicians to produce detailed plans and follow up every disengaged patient manually creates more work. The opportunity for AI is to make better care easier to deliver consistently—not simply to make notes faster.

In this episode of Chewing It Over, Jack speaks with Luke Kellaway about his MSKMag article, The Biggest Wins in the NHS Are Cheap, exploring whether healthcare innovation has become too focused on expensive technology at the expense of simpler solutions that already work.Luke highlights the enormous burden musculoskeletal conditions place on the NHS and argues that relatively inexpensive initiatives can produce substantial improvements in waiting lists, patient outcomes and service efficiency. Yet these less glamorous interventions can struggle to attract the attention given to AI and digital health pilots.The conversation questions what healthcare actually means by efficiency. Saving clinicians time with technology sounds valuable, but if that additional capacity simply allows more patients to enter an already constrained pathway, it may increase spending rather than reduce it. Improving one part of a system also achieves little if patients simply reach the next bottleneck faster.Jack and Luke discuss the importance of examining and redesigning clinical workflows before adding technology. Rather than assuming AI will fix inefficient systems, organisations should first understand where delays occur, streamline existing processes and then identify where technology genuinely adds value.They also explore the challenges surrounding healthcare AI, procurement and medical-device regulation. As increasingly sophisticated technology enters clinical practice, both managers and clinicians need enough digital literacy to question how these systems work, whether they are appropriately regulated and what they mean for patient safety.Ultimately, the discussion makes the case for pragmatic innovation: empower clinicians, improve pathways, scale interventions that already work and introduce technology where it solves a clearly defined problem—not simply because it is new.

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In this inspiring episode of Chewing It Over, Jack speaks with Laurie, whose remarkable story spans decades of living with the consequences of a devastating childhood injury, multiple reconstructive surgeries, and an extraordinary journey back to mobility.Laurie reflects on undergoing complex limb reconstruction surgery after living with altered biomechanics and chronic pain for over 40 years. Her rehabilitation became even more challenging when the COVID-19 pandemic prevented access to the specialist physiotherapy service that had been planned, forcing her to largely guide her own recovery.The conversation explores how she gradually relearned to walk, rebuilt strength, and adapted through careful trial and error. Despite setbacks, including muscle weakness and knee problems caused by years of altered movement, Laurie describes how she slowly regained confidence and function. Today she is pain-free, regularly attends the gym, and continues to surprise herself with what she is capable of achieving.Jack uses Laurie's story to challenge the common assumption that decades of abnormal movement patterns permanently limit rehabilitation potential. Instead, her experience highlights the remarkable adaptability of the human body when combined with persistence, patience, and realistic expectations.The discussion also touches on resilience, mindset, and the value of lived experience. Laurie explains that while she is unsure whether optimism can be taught, she believes sharing experiences with others beginning similar rehabilitation journeys can provide reassurance and hope.This is an uplifting conversation about recovery, perseverance, and the importance of believing that meaningful improvement remains possible—even after decades of disability.The human body can continue adapting after decades of altered movement. Long-standing biomechanical changes do not automatically prevent meaningful recovery.Patient-led rehabilitation can still be highly successful. When supported by sound principles, self-directed recovery can produce impressive outcomes, particularly when circumstances limit access to healthcare.Recovery is rarely linear. Setbacks, muscle weakness, and periods of uncertainty are often part of successful long-term rehabilitation.Mindset and persistence matter. Optimism alone is not enough, but resilience and willingness to keep progressing can profoundly influence rehabilitation.5 clinical/professional takeaways