Identifying political, social, economic and institutional factors that are influencing the delivery and organisation of healthcare can be important to a number of areas to support the development of physiotherapy and seek to continuously improve.

In my 2nd year of MSc physiotherapy, I completed a business proposal that could be delivered to NHS commissioners for an innovative service. Political drivers and policies were at the heart of this assignment and gave an insight into the areas of healthcare which will be developed in the coming years and which areas are being neglected. This is presented on this page as ' Business Case Powerpoint' and 'Business Summary'. The aim behind this healthcare reformation proposal was to make sure everyone counts and to improve lives. The NHS long term plan (2) was looked at in detail. The area of mental health was identified as an area which would be improved in particular, with more integrated pathways. Being able to read this piece of policy made me appreciate how things like technology, sustainability and treatments in healthcare can be politically influenced. Along with political influences - economical and organisational factors were also identified through risk analysis and by evaluating how the proposal would be sustainable. All of this work gave me great insight into things such as the tight budgets that a Clinical Commissioning Group (CCG) may be working with. I am now more aware of the importance of sustainability. Perhaps within my proposal, the service may not have been sustainable, as it would depend on how willing service users were to engage with it. In future, this is an area I will look at in greater depth, as to have a service commissioned, in needs to save money. Also, while I aimed to address a problem within the mental health population, my service may not have been entirely innovative and some similar services did exist. In qualified practice, I will ensure to gain more insight directly from the patient group, and comprehensively research existing services to ensure any service proposed truly meets the needs of the population.

Over the last 18 months we have seen the emergence of the COVID -19 pandemic. Much has changed within physiotherapy due to emergency policy implemented in order to reduce transmission of the virus. I have completed a reflection on my thoughts on the changes of COVID-19 and evidenced it as 'covid 19 reflection' within this portfolio page. My reflection demonstrate my ability to identify political, organisational, economic and social factors and how they have impacted on healthcare. This is important, particularly as I previously discussed the budgets placed on CCGS. One report during the pandemic, believed that CCG'S may cancel some physiotherapy services completely (3). It is this type of scenarios that shows the importance of physiotherapists extending their scope of practice to such areas as first contact practitioners and sonographers, in order to stay more relevant within CCG's. I feel slightly on the fence around these changes. While having physiotherapists acting as first contact practitioners is a positive step for the profession, I also feel it should not be a requirement to upskill an already highly skilled job just to remain employed. While I have reflected on these factors in this scenario, political, economical and social factors were not something I initially envisioned being part of my thought process. Following on from completing important modules in the second year of my study, I am much more focused on identifying these issues, and aim to continue reading frontline articles and the CSP website to ensure I am keeping up to date on affairs. By doing so, it will allow me to identify trends or changes, which may then influence the direction of my scope of practice. 

I feel that having completed the business assignment, I have a much better insight into political, social, economic and institutional factors and how they inform physiotherapy. However, this assignment was not my strongest and there are still many gaps in my knowledge in this regard. I believe many of these factors will be important when implementing service improvements once qualified - in this way my skills in the area will grow with assistance from seniors. The skills from this domain will be of great importance when within a management role in physiotherapy. However, I feel this is some years off and my CPD in this area will be slower than in other domains once graduated. However, I do aim to stay on top of all political, social, economic and institutional factors that may change the delivery and organisation of physiotherapy.

As a physiotherapist, I believe it is important to keep up to date on current affairs within the profession. As such I have been reading articles in the frontline magazine, the CSP website, recent research publications and also joined numerous networks within the iCSP resource. This allows me to get updates in areas I am particularly interested in and witness opinions of my peers on hot topics. It also allows me to gain knowledge of political, social, economic and institutional factors and understand how they are informing the delivery of physiotherapy. For example, with the emergence of Personal Protective Equipment (PPE) (4) following the COVID outbreak in early 2020. For me it was important to keep up to date on the guidance and updated policies, so that I was familiar with PPE on placement, knew its importance and knew how to use it. I created some short hand steps prior to my first clinical placement, 'donning and doffing'. For me this update in policy surrounding PPE meant a change to my scope of practice - as I felt I now needed to be aware of different levels of PPE, when they were appropriate, and the level of risk being reduced from using it. While before the COVID-19 pandemic, this was not something a physiotherapist needed to worry about. This is a profession wide change, and physiotherapists now must have a good level of knowledge on PPE to keep themselves and their patient safe. 

As previously mentioned, in the 2nd year of my degree, I joined various Interactive CSP networks. I primarily done this to be able to participate in professional networks and professional discussions and in doing so, seeking to continually improve my practice and supporting others learn and develop.  This is presented here as ' iCSP networks'. To inform on the development of policies, I have recently participated in a survey for long covid which was being used to form a resource by the CSP. This is presented here as 'Long Covid survey'. To date, I mostly have just read posts in different networks and reflected privately. This has allowed me to reflect on and review practice. As I have not yet finished my degree, I do not yet feel confident sharing my opinion, as my knowledge and experience only spans 1000 hours of practice placement, compared to some experts who have been working in their fields for years. When I settle into rotations and as my knowledge and experience broadens, I will feel much more comfortable giving my opinions (5).