Are physiotherapists too bound to be boundary spanning?

Impact Accelerator Unit, Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle‐under‐Lyme, Staffordshire, UK Centre for Health and Clinical Research, University of the West of England, Bristol, UK NHS Bristol, North Somerset and South Gloucestershire CCG, Bristol, UK The Haywood Foundation, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Stoke‐On‐Trent, Staffordshire, UK

For example, the Chartered Society of Physiotherapy (CSP) is committed to empowering members, embracing change and advocating for the profession in different settings (CSP, 2020).
In order to increase the sharing and uptake of knowledge between different sectors, and raise awareness of these opportunities, we champion the importance of boundary spanning roles. This piece explores a multi-system approach to supporting boundary spanning roles and portfolio careers, presenting two case examples from physiotherapy. Whilst this piece focusses on the physiotherapy profession, we believe the issues discussed are relevant to nursing, midwifery and other AHPs. We challenge the profession to consider how it prepares and supports its membership for such roles throughout the career pathway.
Boundary spanning roles involve individuals that are embedded within more than one organisation with an intended purpose to bring together knowledge, skills and ideas from different perspectives, to facilitate co-designed, evidence-based decision-making and practice (Bornbaum et al., 2015;Swaithes et al., 2019). Traditionally, this has been achieved through portfolio careers, whereby diverse skills from different settings are acquired from multiple part-time roles over time. In contrast, evolving boundary spanning roles are frequently co-funded by different organisations and create opportunities to better understand current contexts from varied organisational perspectives to facilitate change in real time.
For many years, physiotherapists have undertaken lecturerpractitioner roles (Gosling, 1999;Stevenson et al., 2004), likely representing the first boundary spanning role within the physiotherapy profession. Contemporary boundary spanners are increasingly diverse, including roles in NHS commissioning or higher level management, national organisations such as Public Health England (AHPF, 2015) and Health Education England, University leadership, and research implementation .
Whilst these emerging roles are not seen to be any more or less valued than pure clinical roles, we believe the profession and professional bodies should champion a range of career options, especially considering the NHS has recently advocated portfolio careers in other disciplines such as general practitioners and practice nurses (Interim, 2019). The CSP's scope of practice recognises the evolving nature of the profession in response 'to changing opportunities for professional and career development' and that 'practice may challenge the boundaries of the scope of practice of UK physiotherapy'. Individuals who adopt 'cross-boundary' roles can support the implementation of best-practice physiotherapy at a systems and organisational level.
Benefits may include: enhancing understanding of individual systems and creating more whole systems working; improved understanding of drivers and barriers to change; filtering best evidence and translating it to varied stakeholders in a meaningful way, thus overcoming 'language' barriers; creating and strengthening organisational relationships and networks (Swaithes, 2020).
From an advocacy perspective, such roles may improve the 'physiotherapy voice' in multiple health arenas (policy, commissioning, service design) and encourage a collaborative approach across diverse teams that minimises silo working. Furthermore, these roles can support the development of a skilled, confident profession who can rapidly access and apply different knowledge and skill sets to different contexts, view problems from multiple perspectives and facilitate change.
Recognising these benefits, we challenge the profession to consider how to best support and facilitate boundary spanning roles and portfolio careers as 'mainstream' physiotherapy career options.
Considering this more broadly, we question whether we as a pro- Case study 2 (Box 2) illustrates similar multi-system benefits of a boundary spanning role which incorporates 'traditional' physiotherapy clinical practice with service evaluation, research and implementation. Case study 2 highlights the importance of leadership across organisations and the multiple actors and agencies required to work in collaboration to establish the role.
In preparing the next generation of physiotherapists, should we push the boundaries of undergraduate programmes to include a broader portfolio education? We believe core skills should be retained but providing students with additional opportunities to gain credits in management, public health, implementation or health economics could be considered. Additionally, we need to consider if traditional 'clinical hour' placements could be adapted to expose students to alternative providers. This may ensure that next-generation physiotherapists develop transferrable skill sets that are applicable to a range of career options early in their careers, enabling them to pursue their preferred pathway as a graduate rather than further along their career path (White, 2020). Universities and placement providers should champion alternative career options, provide novel physiotherapy placements and enhance readiness for future 'practice' (Cole, 2018).
Whilst the benefits of innovative boundary spanning schemes are recognised Simkins et al., 2020;Stevenson et al., 2017), the challenges associated with infrastructure support, as identified in case study 2, may mean these roles are less 'visible' to undergraduates and postgraduates alike. For those who do seek cross boundary working, this is often personally driven, with individuals 'building' such roles, yet the resources and energy required to attempt this (especially in early career stages) are often prohibitive. Whilst the relatively recent initiative of NIHR clinical-academic fellowships is an F I G U R E 1 Boundary Spanning-a multi-system approach example of a system-facilitated boundary spanning pathway that is advantageous to nurses and AHPs (NIHR, 2018(NIHR, /2019(NIHR, , 2020, this competitive opportunity still integrates relatively traditional crossboundary working between clinical practice and research domains.
We believe a key area in which the profession must evolve is the creation and support of more split-post opportunities at each pay band, with collaboration between diverse organisations to secure such jointly funded posts, as illustrated by our exemplar cases. This may help overcome current challenges for physiotherapists working across boundaries, including uncertainty surrounding job security and career progression, particularly if forced to accept short, fixed-term contracts; feelings of isolation as a consequence of not being part of a fixed team or peer group (Lowe & Bithell, 2000); the risk that combining dual roles may result in 'burn out' from competing demands; or concerns around deskilling in one area whilst pursuing development in another. In considering these issues, along with the evidence from case studies 1 and 2, we propose that a multi-system approach ( Figure 1