How can we argue that physios be part of the solution in primary care when they are in shortage?

This is the heart of the question posed by David Oliver on Twitter.

1 in 5 GP appointments is MSK related. Using a senior physiotherapist to deal with such cases can save GPs time and save money on needless diagnostics. David’s challenge is, given there are clear shortages of physios, should the CSP argue that physio can relieve pressures in other areas such as general practice?

This is just a quick exposition of the narrative and thought process, rather than an evidenced paper, so please read it as such.

The CSP is clear; there is a shortage of qualified physiotherapists. Fear of oversupply and low levels of funding for HEIs in past years have meant not enough new graduates have been joining the profession. CSP members, both managers and union reps, are reporting problems recruiting at entry-level physiotherapists (Band 5) right across the country.

The CSP’s workforce model, http://www.csp.org.uk/professional-union/practice/evidence-base/workforce-data-model suggests we need at least extra 500 physios graduating each year to meet existing population demand. Add to this the challenges faced by overseas-qualified physios; tougher visa restrictions and the uncertainty over Brexit, and the future may look bleak.

We were fully aware of this context when we started campaigning on extending physiotherapy in primary and community care. So how do we square the circle?

The environment is not as bleak as it at first appears. Firstly, some of the solutions the CSP is calling for do not require any more staff. Self-referral to physiotherapy changes how patients access local service, not the level of patient demand. What it does do is relieve pressure on GPs by cutting out needless appointments. Equally, moving more physiotherapy and rehab services from acute to community or primary settings changes where the service is provided, not the number of physios needed to provide the service.

Secondly, in the specific case of general practice physiotherapists, they are not drawn from the ranks of the newly qualified. First contact physiotherapists are typically Band 7 or 8 senior practitioners, with advanced practice skills. There are physiotherapist ready and able to step up into these roles. The challenge may be to backfill their old roles rather than filling the new general practice roles.

Thirdly, there is scope for trained physios who are not currently working in physiotherapy to be tempted back into the profession. Despite under supply of graduates we have seen growth in the HCPC physio register. We suspect more returners and fewer people taking shorter career breaks are part of the reason. Paul Chapman at HEE is doing excellent work promoting return to practice https://twitter.com/PaulChapman09/status/851770370868875264 .

Fourth,  there is likely to be an expansion of physiotherapy training over the next few years. Physiotherapy courses have long been oversubscribed with high quality candidates. The CSP supported the changes to bursaries and lobbied successfully for higher level funding for physio courses. We expect to see more universities opening physiotherapy courses and existing courses expanding. We know that practice based learning opportunities (placements) could be a blockage, so we are working to get more of our members to take students. Add to this the development of “earn while you learn” degree apprenticeships, and we can start to see that a better supply of newly qualified physios in the next few years. Given that it is quicker to train a physio than a doctor, this means that physiotherapy can become more of a solution over time.

Finally, expanding the support workforce in physiotherapy offers a way to manage some pressure within physiotherapy. Support staff – physiothepy assistants, rehab assistants, exercise instructors etc – have long played an important part in physiotherapy services. With training and supervision, they undertake many of the routine activities newly qualified physios might perform. In many cases, physio support staff develop expertise and high levels of skill that go well beyond this.

In a number of services we are now seeing the recruitment of qualified, but not in physiotherapy, staff a part of the support team e.g. sports theorists and sports rehabilitators. They are not physios. They are not regulated and have different training, but operating under clinical direction they can add capacity where newly qualified physiotherapists are in short supply. This frees up registered physios for work only they can do, in the same way physio can undertake work that both they and GPs can do.

So, whilst the message may feel contraintuitive,  it is coherent to say both that we need more physios and that physiothepy can relieve pressure on GPs.

 

 

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