Pulling pelvic health physiotherapy out of the broom cupboard

Perinatal pelvic health services are being rolled out across England to improve access to pelvic health care throughout the perinatal period – from pregnancy until the baby reaches one. A team of experts at Brunel University, London, led by Lucia Berry, senior physiotherapy lecturer, and research assistant Marie Fell were commissioned by NHS England to investigate the challenges and solutions in recruiting pelvic health physiotherapists and developing perinatal pelvic health services (PPHS).  

Set to roll out across England’s local maternity systems from April 2024, the service is about preventing and treating pelvic floor dysfunction, and postnatal recovery. Through better access to care and funding for perinatal pelvic health physiotherapists, its goal is timely assessment, management and treatment of pelvic floor dysfunction. 

Challenges influencing perinatal physiotherapy recruitment and implementation 

Working conditions that impact recruitment:

• Inflexible working contracts.
• Lack of prioritisation and support for band 5 roles/training.

Lack of support and recognition: 

• Direct perception that perinatal care not a priority for service leaders.
• Fighting to be heard.
• Lack of transparency in funding.

Challenges with implementation of PPHS:

• No clinical space.
• High administrative workload.
• Unknown demand due to lack of data support leading to poor decisions for pelvic health services.

Variability in services:

• Misconceptions of what perinatal physiotherapy provides.
• Inequalities in care provided due to a lack of standardisation for a PPHS service.

The challenges

Pelvic health physiotherapists’ workspace provision is poor. Many struggle to make the best of poorly-lit disused cupboards without enough space for a patient, baby and buggy. There’s nowhere to undress, no sink, nor computer.

Many services just don’t allocate perinatal pelvic health space at all.  Likewise, the overstretched, overlooked pelvic health workforce striving to develop this service change has limited support. Few pre-registration physiotherapy degrees feature pelvic health and few services offer a band 5 rotation in this area limiting the development opportunities for physiotherapists in this area. Band 6 physiotherapists are mostly self-funding training in the specialism and few services have pelvic health physiotherapists paid in band 8 leadership roles. 

Solutions supporting the recruitment of perinatal physiotherapists within pelvic health

Pelvic health leadership driving services forward:

• Leaders understand service user needs.
• A solid foundational understanding of perinatal care.
• Consultants actively promoting physiotherapy in their services and funding jobs.

Development training roles:

• Supporting band 5 & 6 to perinatal pelvic health.
• Empowered advanced practice of PH physio.
• Provide flexibility in physiotherapy roles, for example pelvic health and MSK.

Integration of services:

• Leadership pelvic health posts/presence within women’s and children’s directorate.
• Pelvic health champions.

Collaborating across service boundaries:

• Networking with GPs, MWs, HVs, consultants, physios,
• Interprofessional joint clinics,

The solutions

Lucia and Marie’s analysis of the early implementer perinatal services piloting the improved provision will support the national service specification for perinatal services – setting out a framework for key staffing and service requirements.

Interprofessional joint working clinics are the future for perinatal services. Recognition of advanced clinical practice in perinatal physio should recognise skills such as wound care suturing, ultrasound scanning, pessary fitting, and prescribing. 

Pelvic health physios should be able to provide clear leadership and communicate between senior management therapy teams and maternity services. This will help ensure pelvic health physiotherapy is better understood and supported with roles at band 8 level. 

Strategic workforce planning is key, working with therapy and maternity leaders to support the development of the perinatal workforce. 

The development of pelvic health physio services needs the support from musculoskeletal physio through providing band 5 & 6 perinatal pelvic health rotations, placements and training and development opportunities across all services. 

The new PPHS has empowered pelvic health physios to move into leadership roles and start to ask questions about commissioning, demand and capacity models and work collaboratively within exemplary MDT clinics and it feels like it is moving into a very exciting era.