The Chartered Society of Physiotherapy The Chartered Society of Physiotherapy

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Ten years at a glance

The decade since Frontline was launched has seen a sea change in the profession and the way it's perceived by politicians and public alike. Rael Martell takes a look at some of the key developments.

Physiotherapists have been at the vanguard of change in the past 10 years - transforming and modernising both the health service and the profession. They are swelling in number throughout the UK, extending the boundaries of practice, innovating against a backdrop of rising demand and increased patient expectation, and implementing research into practice - all to provide the best possible patient care. With this has come concrete recognition at long last that doctors and nurses are not the be all and end all of healthcare.

In fact, the profession's current high profile is one of the most notable successes of the decade since Frontline first appeared, says CSP chief executive Phil Gray. Physiotherapists themselves have helped to raise their profile by drawing attention to their versatility, he says, explaining:

'A good practical example of members articulating the importance of their work is the way in which they have drawn attention to the benefits of self-referral direct to a physiotherapist.'

He adds: 'Physiotherapists have demonstrated the effective way that they provide rehabilitation through intermediate care systems and their ability to reduce waiting lists for surgery in the field of orthopaedics. We are also moving towards a situation where we have the same prescribing rights as nurses and pharmacists.'

Of course, the Society too is working hard to promote the work of its members. Take the Sharing effective physiotherapy practice project, for example. A report of the project, Making Physiotherapy Count, was launched at a special reception at Westminster last year which enabled members to mingle with MPs and explain their work face to face. The report and accompanying database outline innovative services for people with musculoskeletal conditions, with the aim of identifying models of good practice and promoting high standards across the profession. The project is also intended to provide practical help and support for members seeking to improve their clinical practice and to challenge physios to develop better services for patients.

Among the services highlighted by the Society through the project are those which show the economic and clinical benefits of expanding direct access to physiotherapy treatment - a concept which has been enthusiastically backed by Labour MPs. Nowadays physiotherapists - and support workers too - tend to find their contribution flagged up in a broad range of government health policy. There's an increasing emphasis on their crucial role in delivering improvements in public health, primary and critical care. All this attention is matched in the media. Jennie Edmondson, the Society's head of press and public relations (PR), says people are increasingly 'sitting up and taking notice of the profession'.

'Evaluation of our media coverage shows that our messages are now reaching a broader and more diverse audience. In 2004, our PR initiatives achieved coverage in around 1,000 different media outlets, reaching more than 40 million people every month. A number of our projects also captured international interest,' she points out.

The Society's determination and success in making physiotherapy more visible in the public arena has been matched by the changes in the profession that make it such a very different one to that of 1995. To call the past 10 years in the world of physiotherapy in the UK eventful would be an 'understatement', says Pen Robinson, director of CSP member networks and relations. The increasing emphasis on evidence-based care has brought about huge changes in the way physiotherapists practise their profession. 'Also, the voice of the consumer has got louder, along with a sea change in patients' expectations,' Mrs Robinson says.

The year Frontline was launched was highly significant for the profession, with a review which eventually led to what the magazine called 'the biggest regulatory shake-up in 40 years'. This saw the 'creaking and old-fashioned' Council for the Professions Supplementary to Medicine abolished and replaced with the Health Professions Council (HPC).

The new regulatory body guarantees allied health professions more autonomy. It has used its teeth to place an emphasis on continuing professional development (CPD) and protection of title - and not before time, says Mrs Robinson. CPD is no longer an add-on within a professional's practice, she explains, but a mandatory part of their job. Its purpose is to ensure health workers continue to develop professionally and keep up to speed with clinical advances. Ultimately, of course, its goal is to improve patient care.

Meanwhile, gaining protection of title marks the end of a battle the Society's been fighting for 20 years. 'From July this year, unless your name is on the HPC register, it is illegal to call yourself a physiotherapist,' Mrs Robinson says.

She also draws attention to a widening of prescribing rights. 'Opening up prescribing legislation will benefit patient care. Physios will be able to decide whether a patient needs more or less of a certain medicine - for instance, those used to treat spasticity. It represents a recognition of physiotherapists' professionalism.'

Going back in time, it would be impossible to ignore Labour's landslide victory in1997 and its effect on health professionals. 'This was important because it led to a move away from the internal market back to the more altruistic ideals of the NHS,' says Mrs Robinson.
It's also seen devolution in the UK, with different healthcare systems developing in Scotland, Wales and Northern Ireland. The CSP responded swiftly to these changes by appointing policy officers to each of the three countries. The Society's associate members and students now have added support too, from two officers dedicated specifically to looking after their needs.

More recently, last December saw the NHS introduce the long-awaited Agenda for Change agreement. This complete overhaul of the service's pay and grading system means staff will now be rewarded for the work they do. It ensures any remnants of the divisive policy of local pay bargaining which dogged NHS industrial relations in the mid-1990s are well and truly buried. Lesley Mercer, the Society's head of employment relations and union services, firmly believes that AfC is an improvement on its predecessor. 'It is a much more coordinated core framework underpinned by skills and knowledge and competencies which should be matched with physiotherapists' remuneration.

'It represents a recognition of the clinical side of the profession, allowing clinicians to move forward. Before AfC you had to move into management or education to further your career.' The drive towards improving public health has accelerated over the past decade, the message now being 'prevention is better than the cure'. It's embodied in documents such as the Wanless report of 2004. Shifting government priorities have led to a move away from hospital-based care and into community-based primary care.

This latter is an area where the profession's particular skills will become increasingly important. 'It is in primary care that the real opportunities for physiotherapists lie,' says Pen Robinson. 'That is where the government is putting the money.' 2002 saw another opportunity open up for physiotherapists when Paul Watson became the UK's first physiotherapy consultant. Employed as a senior lecturer/honorary consultant in pain management and rehabilitation in a post created by the University of Leicester and the University Hospitals of Leicester trust, Mr Watson's appointment marked what physios have known all along - that they can operate at the highest level of multidisciplinary practice.

Jill Higgins, director of learning and development at the CSP, cites the advent of consultant physiotherapists as one of the most significant events of the past 10 years. Going hand in hand with the development of masters degrees and professional doctorates in physiotherapy, the increased research and evidence base is ensuring clinically-effective practice. The Society will be looking for ways to underpin these developments by growing the evidence base still further.

Exactly what the future might hold remains to be seen. With the profession's increased power and influence, the next 10 years could be a 'golden age' for physiotherapy. One thing's for certain though - the profession shows no sign of slowing down.

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