With the completion of CSP’s workforce review Nina Paterson hears from Rachel Newton, head of workforce policy, about its findings and impact
Whether you’re the patient at the receiving end watching your waiting times increase for much-needed care or aftercare, or whether you’re part of a team without enough staff to provide the service you want to, we all understand the consequences of workforce shortages and understaffing.
We all also appreciate the difference services and interventions make when fully resourced – shorter waiting times, improved clinical outcomes, time for service improvement, as well as reduced pressure on existing staff and services elsewhere in the system. With an ageing population, more of us living with multiple long-term conditions, not to mention improving survival rates following stroke, trauma, and cancer, it’s clear that physiotherapy is key in keeping people healthy, raising life expectancy and reducing health inequalities.
That’s why it’s vital to continue to make the case for physiotherapy, lobbying and campaigning collectively for patient benefit. To make those arguments as robust as possible, you need the evidence.
Beginning in 2022, the CSP carried out a workforce review to better understand the size and diversity of the UK physiotherapy workforce (physios, support workers and students). The review, carried out by the North of England Commissioning Support Unit, was guided by a steering group of CSP staff led by head of policy Rachel Newton.
Getting to the heart of the data
If you work with workforce data at a local level, you’ll know it’s difficult to navigate, with data held by multiple stakeholders with different priorities and reasons for collecting their datasets. Rachel explains that the purpose of the workforce review was to draw datasets together so that we all have a better map of the landscape across the four countries and regions, including the differences. Understanding the differences ensures that workforce solutions remain right for each setting and administration.
So what did the review find?
Firstly, there isn’t a single UK-wide picture. Knowing this helps to focus efforts on the right workforce solution locally, allowing the CSP to work collectively with others to make the case for doing things differently.
Growth
When it comes to growth, we know there has been a 42 per cent increase in physiotherapy registrants in England in the last 10 years. We also know 83 per cent of all graduate physiotherapists are employed within 15 months of graduating, and that there’s further growth potential since supply has been catching up with demand after a sustained period of undersupply between 2010-2015.
The review has also highlighted how much the UK needs to catch up with international norms in terms of numbers of physiotherapists, with the UK second from bottom of the 11 countries in the world where physiotherapists are autonomous practitioners on graduation – with just nine physiotherapists for every 10,000 population, compared to 27 in Denmark at the top of the table and 14.5 in Australia.
83% of all graduate physiotherapists are employed within 15 months
Workforce distribution
What’s also come out of the review is a clear picture of where the profession works. Rachel says the workforce is distributed across sectors, with 24 per cent working in the independent sector, a further 10 per cent working primarily in another sector, but with some NHS work alongside, and around 60 per cent of the workforce working solely within the NHS.
She notes that there are many reasons why the NHS hasn’t been able to capitalise on the increase in graduates, but in England the lack of specific physiotherapy targets hasn’t helped and has meant that NHS England objectives around two key areas - community services and rehab – have stalled.
The newly released NHS Long Term Workforce Plan does now include a 3.3 per cent annual increase for physiotherapist posts. While welcome, having the data from the review shows how much more ambitious the NHS could be if staffing levels were to increase to meet patient need in tandem with the implementation of policies to retain and develop staff.
In the UK there are just 9 physios for every 10k population
The review has also shown that there’s clear appetite to incrementally increase the support worker workforce to deliver the patient care that’s needed, but this increase is dependent on the sustained growth within the registered workforce.
Armed with this understanding, those campaigning and lobbying for the workforce within England are able to do so more effectively.
Similarly, having robust data enabled the CSP, over this summer, to challenge the political inertia that resulted in a recent decision to cut pre-registration physiotherapy places as part of a cost-saving exercise by Northern Ireland’s administration [read the report from the BBC here]. And in Wales, it’s enabling the CSP to lobby for a growth in both band six and senior roles. The lack of investment in these roles is impacting sustainability, governance, and career progression opportunities.
Having physiotherapy-specific data also enables everyone involved to understand when an AHP-wide initiative might not be right for physiotherapy. Student recruitment for example isn’t an issue for physiotherapy, despite some country-specific variation (7.3 applicants per place in England, 8.2 in Northern Ireland, 8.5 in Wales and 13.1 in Scotland). That said, the diversity data and trends that came out of the review may prove useful in developing targeted promotional activity for physiotherapy itself.
Likewise, having data on what happens to students after graduation shows that even in England, where supply has continued to grow, there is no problem of oversupply on the horizon. As trends begin to manifest, with CSP monitoring these datasets over time, any emerging trends may help trusts and boards understand how their policies or infrastructures impact on different communities within their workplaces, supporting them in their goals to be inclusive employers with diverse and thriving workforces.
Next steps
Headline data will be available soon along with country-specific position statements, with an interactive format available in 2024 for CSP members to use.
For members interested in influencing local workforce planning the CSP is hosting a webinar on 11 October (book your place here). In the meantime, to find out more contact the team on policy@csp.org.uk.
Doing things differently: challenging the existing supply model
Scotland is rightly and ambitiously seeking to transform primary care and expand community rehabilitation, both very much needed for the patient populations. However, the supply of registered physiotherapists in Scotland has been flatlining, and this has knock-on effects. That impact, for example, can be seen in primary care where recruitment from the existing musculoskeletal workforce creates gaps elsewhere in the system.
Data is essential in building the case for expanding the physiotherapy workforce
While funding exists in Scotland for those on BSc (Hons) physiotherapy programmes, there is a lack of funding for pre-registration masters, which provide around 50 per cent of the graduating workforce elsewhere in the UK. Furthermore, funding levels mean that universities have little financial incentive to increase provision. Expansion therefore remains difficult.
Healthcare courses are costly to deliver. Under the existing model, to remain able to sustain the national workforce supply, universities in Scotland offset costs by offering higher percentages of places to non-UK domiciled applicants than universities across the rest of the UK.
Taken together this means that Scotland has barely increased its student numbers in the last 15 years.
By understanding the landscape, CSP staff, NHS managers and the universities have been collectively making the case to Scottish Government for physiotherapy to be a ‘controlled subject’, meaning that Scotland’s Department of Health would set targets for the number of physios needed, in the same way they do for paramedics and nurses. Alongside this, knowing that pre-registration applications are buoyant in Scotland, they’ve also been able to challenge the misconception that the answer lies in AHP-wide student applicant recruitment initiatives.
Kenryck Lloyd-Jones, public affairs and policy manager for Scotland, said: ‘The greatest challenge facing the physiotherapy profession in Scotland is the workforce shortage. To date there has not been the expansion needed, meaning waiting times and service improvements can’t be progressed, new roles in primary and community care cannot be filled and the real potential of physiotherapy is lost.
‘Data is essential in building the case for expanding the physio workforce. The review reveals the narrative around why and how Scotland lags behind, and what can and must be done to increase training places to meet Scotland’s health needs’.
More on workforce
Profession ready to grow. Frontline 1 June 2023.
Thousands more physiotherapists needed.
More ambitious physiotherapy targets required.
NHS England workforce plan FAQs.
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