On the outside looking in… is physiotherapy still the poor relation in the healthcare family?

Despite a GP recruitment crisis and recent Junior doctors strikes the governments response to easing pressure in general practice is to create doctors assistant positions and ignore the call from the CSP to place MSK physiotherapists as first contact practitioners in primary care. Instead the government will axe over 100 physiotherapy training places. A back drop to this is the recent withdrawal of MSK physiotherapy outpatient services by Mid Essex CCG. Even with Karen Middleton at the helm of the CSP,  who was listed in the top 100 most influential clinicians in health, it would seem that physiotherapy is still not winning the argument that it is vital and cost effective within services . My previous blogs over the years has exposed the paradigm on one hand we consider ourselves essential but traditionally have dragged our heels when it comes to a role beyond a non-essential 5 day a week 9-5 ‘family friendly’ profession. Personally I don’t think it is physiotherapy that is the problem but the lack of quality and innovation on how we deliver it. ‘That’s the way we’ve always done’ is our downfall along with a profession that is lacking in confidence.

I’m reminded of the time I attended a MSK Redesign work shop hosted by our local Clinical Commissioning Group. We were given a blank canvass to rethink the existing pathways and use all means of technology and innovation to see if a new vision of healthcare could emerge.  I was seated at a table of 10 health professionals that included GPs, Physiotherapists, Occupational Therapists, Therapy Managers and Orthopaedic Consultants.  The discussion was dominated by the GPs and the Orthopaedic Consultants whilst the rest of the health professionals adopted their position as unassuming spectators. The role of the physiotherapist would occasionally receive a token mention in the discussion but often as an afterthought. Depressingly, I left with the conclusion that the physiotherapy profession has made little impact on its peers since I qualified 20 years ago.

There must be something wrong with the way we portray ourselves to the outside world. How often have you heard a patient request osteopathy or chiropractic treatment for their low back pain because ‘physiotherapists don’t do backs’.  Unfortunately too often we are still considered the people to see for muscle problems…. the ‘rubs men’ or the ‘bucket and sponge’ carrier etc… I could put this down to my own personal paranoia but there are too many other examples. Most revealing was in 2009 when the Ministry of Justice tried to propose changes to court rules that omitted Chartered Physiotherapists from the list of eligible practitioners to act as expert witnesses in Low Value Personal Injury Road Traffic Collisions. Initially it was thought that this omission was simply an administrative error ….but no, it was completely intentional.  The CSP and OCPPP had to go in to overdrive to overturn the motion…. but what does it say about our credibility as a profession?

It is hard to pin down exactly where we are going wrong. Our strengths are also our weakness. I get the impression that we are viewed as nice, well meaning people.  We are a caring profession but don’t fill the caring niche like nurses do … we are a safe profession but often we aren’t  the first discipline that springs to the public’s mind if ‘they’ve put their back out’. We are probably considered the best at telling people how to sit up straight at their desks and how to correctly lift up a box…(sigh).

I pick up the Frontline Journal and I read the frequent articles about the ‘Move for Health’ campaign – we are ‘well placed’ to deliver health promotion about the importance of an active lifestyle (http://www.csp.org.uk/your-health/healthy-living/move-health-campaign).  I note a full page feature on how physiotherapists are ‘well placed’ to tackle the threat of global warming (http://www.csp.org.uk/news/2011/10/27/help-tackle-global-warming-threat-physios-urged). These campaigns are well meaning but if the public is struggling to understand what we do in our core role then these messages confuse matters still further.

It is tempting to point the finger at the CSP and they must surely take some responsibility for how we are viewed by the outside world….but there must be other issues.  The 5 day, 9 to 5 working culture and family friendly policies continually undermine our profession. It seems physiotherapy is a vocation that can be picked up and put down at will. Most enter the profession lacking any knowledge of how other sectors of industry work and so they are less understanding of the lives of our patients. The profession isn’t representative of the cross section of society it serves and I wonder if we fail to connect to the public if we are too white, too female and too middle class.

I suspect there are darker forces at work that we cannot  control. GP’s and Orthopaedic  Consultants are protective of their work and their income. They would not give up lucrative medico legal work lightly nor would they talk themselves out of clinical pathways if they can avoid it. They can be shrewd and more business minded than they let on. NHS reforms that allow them to be the buyer of services and also the provider of services offers up a huge conflict of interest and it would be surprising if they did not capitalise on this. We can only fight our own battles and we as a membership need to develop a more confident swagger. We need to sing our own praises more readily and shine as a profession. We need to focus on our strengths and work towards a more dynamic, innovative, fresh thinking profession. We should work towards being a curing profession not just a caring profession.

Our medical peers should know that we are more than an equal partner when it comes to MSK service redesign. The Personal Injury market should understand that we are experts in musculoskeletal conditions and as for the general public ….they need to know that yes, we ‘do’ backs as well!

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