Scoping your practice - Gwyn Owen on scope of practice

Your scope of practice

Physiotherapy is an active and interactive practice that works in partnership with people to maximise their capacity for movement and function.

Physiotherapy’s focus on bodies and movement means that its practices – the things that the physiotherapy workforce can do, the people it works with and where practice happens – is dynamic.

Changes to healthcare design and delivery, and the developments in science and technology over the past two decades, have provided opportunities for the continued development and expansion of physiotherapy practice.

Physiotherapists can be found using techniques shared with other disciplines (such as  acupuncture, Pilates and sensory integration) or performing tasks traditionally undertaken by doctors (such as  injecting medication and prescribing).

While such developments offer positive opportunities for enhancing the quality of care, for personal career development and for promoting the added value of the profession, they can also raise questions about the scope of physiotherapy practice.

This article will explore the changing scope of physiotherapy practice and help you think afresh about how your day-to-day practices relate to the overall scope of physiotherapy in the UK.

What is the scope of physiotherapy practice?

Physiotherapy practice is defined by the royal charter which was granted to the Incorporated Society of Trained Masseuses (the precursor to the CSP) in 1920.

The charter defines physiotherapy as being practices that incorporate manual therapy, exercise and movement, electrophysical modalities and kindred physical approaches.

Whenever I think about how physiotherapy has evolved over its 110-year history, I’m struck by the foresight of our founders in establishing such a broad scope of practice for the profession.

The charter does not prescribe a list of techniques that are ‘in’ or ‘out’ of scope, but sets a boundary on physiotherapy practice that maintains the profession’s continuity over time while accommodating developments that occur in practice.

This approach allows physiotherapy practice to evolve as physiotherapists respond to changing healthcare needs, developments in research and technology, and the social, political and economic factors that shape how professional practice is organised, designed and delivered.

Professional responsibilities for defining your scope of practice

As CSP members we have a professional responsibility to understand and take responsibility for our personal scope of practice. This expectation is clearly laid out in principle 1 of the CSP’s code

Section 1.2 calls on members to ‘act within their individual scope of practice’ and advises members that their individual scope of practice (the practices an individual is educated, trained and competent to undertake) sits within the evolving scope of physiotherapy practice in the UK.

The CSP has produced a new resource to help members think critically about their individual scope of practice and how that relates to the scope of physiotherapy practice in the UK.

The resource which is available in the ‘professionalism’ section of the CSP’s website works through a set of prompts to help members consider:

• how a technique or activity sits within the scope of practice defined by the Charter

• how a technique or activity relates to an individual’s role and competencies

• how a technique or activity might sit outside the scope of physiotherapy (collective and individual)

• what action to take if so, including developing appropriate competencies and support/supervisory processes, and insurance cover for practice that sits outside the scope of physiotherapy.  fl

Physios’ use of ultraviolet light

Ultraviolet light (UVL) was introduced into physiotherapy’s practice repertoire in 1928 as part of a campaign by medicine to regulate its use.

‘Artificial sunlight’ and other forms of medical electricity had become a popular treatment used by a number of ‘quacks’ to treat the non-specific disorders of a fee-paying public.

Encouraged by medicine, the Chartered Society of Masseuses and Medical Gymnasts (the precursor to the CSP) introduced a training syllabus and examination in electrotherapy and light. The examination was of mutual benefit to medicine and physiotherapy.

Medicine was able to reinforce its status by delegating the application of ultraviolet light to a body of competent practitioners.

Physiotherapy was able to lay claim to a specialised body of knowledge and skill and differentiate its practice from the ‘quacks’ who were competing for clients.

Physiotherapy’s use of UVL extended during the 1930s to treat the constitutional ‘diseases of darkness’ such as skeletal tuberculosis and rickets.

Artificial sunlight

By the 1940s, public health measures to improve air quality and limit overcrowding reduced the demand for artificial sunlight as a treatment for constitutional disease.

Physiotherapy responded to this change by transferring its practice to support developments in dermatology.

Here, physiotherapists applied UVL to activate the medicated ointments used to treat skin conditions such as psoriasis, acne and alopecia.

During the 1950s, developments in medical physics produced lamps that could direct the antiseptic and healing properties of UVL to a specific area of the body.

This new mobile technology was adopted by ward-based physiotherapists to treat wounds, pressure sores and ulcers caused by lengthy periods of bed-rest post-surgery.

Developments in surgical and nursing technology, together with the changing organisation of healthcare during the 1980s, meant that physiotherapists’ use of UVL was in decline by the 1990s.

Over time, static lights were relocated into dermatology departments for use by a new generation of trained healthcare assistants, while the mobile lamps were superseded by ward-based practices focused on pressure care and patient mobility.

This account shows how physiotherapy’s scope of practice is shaped by shifts in population need, developments in technology and change in the organisation and delivery of professional practice.

The timing of the declining use of UVL is significant.

The year 1977 marks the formal recognition of physiotherapy’s technical autonomy – its capacity to assess, diagnose and treat.

While the application of UVL requires specialised knowledge and skills, in the hands of physiotherapy it is a treatment modality rather than a diagnostic tool.

The independent decision-making processes associated with physiotherapy’s technical autonomy are therefore redundant, which meant that UVL could be safely delegated to others.

The process of delegation itself served to protect the credibility of physiotherapy’s technical autonomy and reinforce its status as a profession.

How to use this piece for your CPD

This activity will help you think afresh about your personal scope of practice and how it sits within the evolving scope of physiotherapy practice in the UK (CSP code, section 1.2).

Take a sheet of A4 paper (probably easiest if you hold it in a ‘landscape’ format) and divide it into four columns

• use the first column to list the techniques you use in your day-to-day clinical practice

• use the second column to note how each of the techniques listed in the first column links to the practices defined by the charter – manual therapy; exercise and movement; electrotherapeutic modalities; and kindred approaches. If you’re feeling unsure about how your individual scope relates to the scope of UK physiotherapy practice, visit the CSP’s scope resource for further information and advice.

• use the third column to evaluate your knowledge, skills and confidence in applying each approach, modality or technique. You could use the descriptors from the CSP’s framework: see ‘Physiotherapy practice skills’ 

• in the fourth column make a list of evidence to support your evaluation. The evidence could be formal (such as  certificates) or informal (such as  feedback from clients or peers). Completing this column should help you evidence current strengths and highlight where continuing professional development activity is needed to help maintain or develop your scope of practice

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