Whose role is it anyway?

Since the creation of the CSP more than 100 years ago, the physiotherapy profession has evolved significantly. From our earliest existence as massage therapists, we have gained autonomy, earned the right to inject, to prescribe and to be first contact practitioners. 

Physiotherapy is one of very few healthcare professions to have its scope defined by a royal charter. 

This provides clarity but can also make it challenging for members to judge whether their own evolving practice is within the scope of the profession or not. This is particularly so with the recognition of ‘advanced practice’ roles that allow individuals to practise skills and capabilities outside the scope of their primary profession.

As our profession evolves, new challenges arise. When we expand in one area of practice, workforce supply issues are such that we risk leaving another area short of staff. 

For example, in Scotland where there are now more than 240 advanced practice physiotherapists in primary care, there has been little or no increase in physiotherapy training places. Vacancy rates across the country average at more than 10 per cent and waiting times are high. 

So, what does this mean for the profession? How do we evolve and take on new roles, whilst maintaining our professional identity? 

Evolving practice

A recent enquiry to our professional advice service sought guidance on developing advanced practice physiotherapy skills in the diagnosis, treatment, and medical management of ADHD. 

NICE guidance is clear that the management of this condition requires psychiatric, psychological and advanced pharmacology knowledge and skills outside current HCPC physiotherapist proficiencies. Is this where our profession should be looking to evolve, or should we stop and consider the impact of what is fundamental to our profession?

Throughout the 1980s and 1990s, with the advent of extended scope practitioner roles, tasks and techniques previously only carried out by doctors were taken on by physiotherapists. Interprofessional skill transfer is often fine, but becomes problematic when legislation fails to keep up with clinical practice. The current PRP issues are one such example.

Another potential problem of taking on new and additional roles is that we lose sight of our ‘core business.’ At the end of the day, who is doing the complex rehabilitation if we are moving into other areas? After all, we can’t do it all. 

New developments

New treatments and techniques in healthcare are being developed all the time. We are often asked whether they are in scope, whether it be a new expensive ortho-biological injectable, the latest fancy electrophysical modality, a manual technique, coaching or a lifestyle intervention. The response will always be – is it within the pillars of our profession, and does it have a robust evidence base? The efficacy of any new modality should also be considered; how does it compare to other interventions in terms of risk, cost, and effectiveness?

The future

To remain relevant in an ever evolving, pressured healthcare system, it is imperative we are able to demonstrate our impact on an ageing population, with co-morbidities and complex issues. We must improve our public-facing image of what we can offer both individuals and populations. Does the public fully understand what we do? That we don’t just help people with back pain and MSK disorders? That we have a role in population health and reducing health inequities? That exercise and rehabilitation is key to them living longer, happier, meaningful lives in their community?

So based on where we are now, is it time to refocus what we do, to reconsider our offer and concentrate on what is core and unique to physiotherapy? We are autonomous diagnosticians from the point of registration, who with additional training take on many advanced roles. This gives us huge potential if we properly utilise the skills we already have. How do you want to see the profession evolve? What’s important to you as a clinician, to your patients and to our population?

What will the future look like?