Megan Kirbyshire

Megan Kirbyshire is a Senior Project Manager here at the West of England AHSN. Her role is to facilitate the roll-out of two national programmes: ESCAPE-pain and Serenity Integrated Mentoring (SIM). Our Communications Officer, Lauren Hoskin, caught up with Megan to find out more about ESCAPE-pain and the world of physiotherapy.

What brought you to your role here at the West of England AHSN?

Before coming to work here, I was working clinically as a senior physiotherapist in Cheltenham General Hospital. I’d see a real variety of patients throughout the day, ranging from sub-acute injuries to long standing chronic pain. Even within my relatively short period of working in the outpatient setting, I could see a shift occurring towards self-management, behaviour change and population health.

Clinically, it was the behaviour change that started to appeal to me. In physio it’s the constant challenge of getting people to increase their physical activity levels – one of ‘magic pills’ to keeping healthy.

I’d been running ESCAPE-pain as a physio for two years, and long-story-short it was my passion for it that bought me in to my current role.

What is ESCAPE-pain and why does it work so well?

ESCAPE-pain is a group education and exercise programme that enables individuals to self-manage osteoarthritis of the hip and the knee. It fits in perfectly with my interest in behaviour change.

Throughout the five to six weeks, participants discuss a range of topics from the benefits of exercise, pacing and diet through to analgesia (numbness). Then they spend the rest of the session exercising in a way that doesn’t aggravate their pain.

Everyone knows that they need to exercise, but often people have low motivation or they don’t know how to when they have arthritis. Most commonly they think that exercise is harmful as it often causes them pain. So it’s trying to overcome all of those fears and difficulties with the long term goal that they will continue to increase their activity levels.

How do you go about implementing ESCAPE-pain across the region?

Across the West of England geography there are a number of different models for implementing ESCAPE. In Gloucestershire, Swindon and Wiltshire I’ve been working with the physiotherapy leads to get the course embedded in to their offering within the NHS.

Across Bristol, North Somerset and South Gloucestershire, however, we are working towards the course being out in the community with more of an onus on the participants to self-refer themselves.

Regardless of the setting of ESCAPE, it’s been really important to bring the physiotherapy departments and the leisure centres side by side for a larger collaborative approach.

How does your work make a difference to people/healthcare as a whole?

It’s vital that people get the right care at the right time — think the GIRFT (Get It Right First Time) initiative. Often individuals can bounce from one area of healthcare to another and/or be seen at the wrong time for them. Both SIM and ESCAPE enable people to have access to the right people, whether that’s within the NHS or in the community.

Particularly with ESCAPE-pain, patients can end up going to see the consultant for a hip or knee replacement without having had any form of conservative management. There is absolutely a place for joint replacements, but we need a shift in culture from them being ‘the only thing that can help’ to it being ‘the last resort’ if conservative management fails – and we know that it helps the majority of people.

How does working at the AHSN compare to your previous job as a physio?

The two roles couldn’t be more different. In my previous role I loved seeing patients and helping them work through their problems. It can be a very rewarding role and will regularly give you a feeling that you’ve helped people accomplish their goals.

Unfortunately though, it often feels when working on the front line in the NHS that you have no time to think. You move from one patient to another without any time to step back and reflect.

Working within the AHSN I can now see the broader picture of the NHS and its complex (and confusing) structure. It’s fantastic to see all of the ideas that are succeeding and spreading, both geographically and in other clinical areas. And it’s fascinating to see how difficult it can be to implement innovations that feel like they should be ‘simple’ to spread.

It takes some creativity and problem-solving, both of which I’ve always had to do but now it comes with some form of ‘headspace’. It took a little time to get used to but it’s extremely refreshing!

Posted on May 20, 2019

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