To work as a physiotherapist, importance is placed on the ability to assure the quality of your practice and your commitment to quality of care. Echoing this, the CSP and Public Health England have policies in place to ensure effectiveness, efficiency and quality of a service is maintained (2,3). Firstly, to demonstrate fulfilling requirements of policy and frame work, I have evidenced an example of my hours sign off from placement. This is presented as 'placement hours signed off'. As part of accreditation from the CSP for a pre-registration programme, a student must gain a minimum of 1000 hours of practice based learning (4). By completing my 1000 hours of placement I am demonstrating meeting this requirement. A screenshot is presented 'Total Hours Completed'; as evidence of meeting this.  Similarly, before going out on placements, online training modules were required to be completed, these can be seen in 'mandatory evidence' .I have also demonstrated how I have attempted to meet the CSP framework (1) but also the NHS values, HCPC standards and CSP standards throughout this portfolio. By keeping up to date with these various standards, it helps a student/ newly qualified physiotherapists to fulfil the requirements of legal and policy frameworks governing professional practice. Meeting standards is not something I have struggled with. I believe this is due to it being a requirement, so if it is not fulfilled I will not be able to practice.

Reflecting and reviewing practice is an important process, as stated by the Health & Care Professions Council (HCPC). For me, reviewing practice  means looking out for unknown conditions which can have an influence on the world of physiotherapy. One such condition which has emerged following the Covid-19 pandemic, is 'Long Covid'. Long Covid is described as the symptoms that persist after an acute Covid-19 infection (5). Due to this, I was driven to read the latest NICE guidelines (6) and CSP resources on Long Covid (5). This ensured I was able to maintain my fitness to practice, while meetingthe requirements of legal and policy frameworks. I would not feel entirely comfortable assessing a patient with Long Covid yet. I would hope to shadow a more experienced colleague for a couple of assessments in order to see how this may influence my own assessments.

While on my third placement, I recognised a situation where a number of patients on the ward were receiving inappropriate amounts of oxygen. This was due to mistakes being made with the oxygen flow meter and choosing inadequate verturi valves to match the flow of oxygen. I was able to reflect on and review practice by completing a 'PDSA' (plan, do, study, act) and came to the realisation that the effectiveness of the service was compromised. Therefore, I decided to create a 'Service Improvement poster'; to act as a reminder for staff that attended the patient to check that the patient was receiving correct volumes of oxygen, through the correct method of delivery. The completion of my service improvement allowed the criteria of recognising situations where the effectiveness, efficiency & quality of a service are compromised, & with support, taking appropriate action to challenge the situation to be fulfilled.

This process was not straight forward for me. It was not until my third placement that I was able to identify a service that was compromised. Even though I had been considering my service improvement project since the launch of the SE707 module, which our class was briefed on in October 2020. I must admit, the whole concept of service improvement was difficult as I felt inadequate to improve a service that so many experienced professionals were a part of. By having various discussions with educators over the course of my placements I realised that services are continuously improved through small regular changes and that the important aspect is identifying something small that could be optimised. I reflected on these conversations and went about identifying effective and ineffective services I had witnessed. Unfortunately, due to only identifying the compromised service in my final few weeks of placement and with other study commitments, I was unable to see my idea implemented, and completed the project in retrospect. The work I completed was however worthwhile and will mean that in future practice I can seek to continuously improve services and demonstrate leadership and innovation when identifying ineffective services. By being competent in these areas, I have demonstrated a change to my personal scope of practice. 

Reflection on personal performance is a major component to ensuring quality and can be seen throughout this portfolio, including within the service improvement project. I have attempted to regularly reflect throughout the two years spent on this course, albeit sometimes unsuccessfully. On a number of occasions, my reflections have led to the enhancement in the effectiveness, efficiency and quality of future practice. For example, my 'service improvement reflection'. Being able to look back at the project as a whole and identify what made it difficult, allows for greater ease in navigating these difficulties in future work. In this case, attempting to identify a complex service improvement led to initial struggles and worry. While for the next stage of my practice, I will aim to keep my service improvements small and achievable. Similar to this, completing a reflection on the use of outcome measures ('outcome measure reflection'), led me to identify an area that was lacking in my practice. Following on from this, I was able to better understand the best suited outcome measures for a range of situations and implemented those more into practice, as can be seen on my 'placement 5 feedback'. Throughout my career, I will continue identifying areas of my practice that are lacking and reflecting on the topic to implement change into my practice.

I feel the role of ensuring quality has changed due to the COVID-19 pandemic. For example, services which were normally fully face to face changed to remote consultations during the start of the pandemic- in particular Musculoskeletal outpatient services. Over the course of the pandemic the service has changed further to allow for triaging of patients over the phone followed by certain patients being offered face to face appointments. This has ensured that effectiveness, efficiency and quality of a service remain, even though the service has had to take appropriate action to challenge the situation. (I have completed a project to identify a new service for a set population, whos needs are not being met, 'business case'.) The scope of practice of many physiotherapists, including myself has had to adapt to this change while still keeping the needs of the service user at the centre of decision making. This may be a change that is taken into the future, if it is seen to have progressed the service. However, without the emergence of COVID-19 some of these service changes may never have come into place.