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As part of my current role I am expected to exercise a high degree of personal professional autonomy and make critical judgments to satisfy the expectations and demands of the role. Within the governance framework, it includes undertaking aspects of roles traditionally undertaken by a General Medical Practitioners and secondary care Orthopaedic Consultants, in relation to musculoskeletal medicine.

As a leader I must ensure appropriate pathways of care and communication via liaison and referral to other agencies as required e.g. medical staff, and lead the development of clinical standards for the musculoskeletal service across the Health Board, including primary care services. This includes providing expert clinical leadership for lead practitioners within the Health Board Musculoskeletal Service, performing as the lead responsibility for delegated clinical governance requirements.

Key aspects of my role that show evidence of appropriate levels of skill and knowledge for this role include:

• Leading standards setting and implementation for practitioners in Hywel Dda Health Board regarding specialist management of complex patients. This includes leading a robust audit programme. Examples of this include setting a standard for key clinical activities, supporting colleagues in the Orthopaedic Service in service evaluation of Ultrasound guided vs. anatomically guided injections for the shoulder.
• Leading in the critical analysis, appraisal and synthesis of current research outcomes and or relevant literature in order to maintain expert levels of clinical knowledge and practice. This includes a Health Board Paper on the appropriate use of topical anti-inflammatory gel for primary OA knees, resulting in a Health Board wide (Primary and secondary) review of treatment policy for this condition. Through leading in the critical analysis, appraisal and synthesis of current research outcomes.
• Work with professional line manager and relevant multidisciplinary colleagues to identify opportunities for improvement of service, practice, products and systems in line with current national guidelines e.g. NICE, and ensure adherence to those guidelines. As one of first Bevan Commission Exemplars (2016) I led the development of a therapy led hand service, specifically for carpal tunnel. This project allowed me to attend the National Excellence Award as a finalist, breaking through professional boundaries (doing NCT’s, directly referring patients for surgery) and was recognised by Welsh government as a service development of excellence who requested a written report to be submitted to the Health and Social Care Committee.
• Leads producing annual evaluation reports, business plans, workforce planning and professional development in this service as delegated. An example of this is supporting the Senior Managers for the development of Operational Change to the service, supporting the development of colleagues into 8a Advanced Practitioner roles.
• Lead service response to national initiatives and policy within a clinical governance framework in partnership with service leads. Examples of this at National Level include being part of the working group at an All Wales level that supported the development of a Welsh Government Framework for the CMAT Service.

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