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Governance: How Scope of Practice enquiries are handled

The process for answering scope of physiotherapy practice queries. Members are encouraged to work through the prompt questions.

Stage 1: Using the prompt questions

As a first step it is suggested that members explore the information in the scope of practice resource and use the prompt questions.

If a member does not identify a clear answer to their query they should then contact the Professional Advice Service (PAS).

Where the area has been considered recently and a decision made, that decision will be followed unless there are new reasons for amending the decision (for example, developments in the evidence base, or related developments in physiotherapy practice), or if there are any significant contextual differences.

If a clear decision supported by previous cases cannot be made, the case is referred to Stage 2. The outcome at this stage is therefore one of the following:

  • The member is advised that the area does or does not sit within scope of practice (and the contextual factors that may affect this)
  • The query is referred to Stage 2 of the process for more detailed consideration

Stage 2

If the area of practice and/or its context have not been considered before, or if there is a new reason to consider it or the context of its delivery again, PAS applies the three criteria as described in A) B) C).

PAS may ask the member to provide additional information to support the case, if this is felt to be necessary to enable a full consideration of the issues.

This may be particularly sought if it is felt that the case requires formal consideration by the CSP Professional Practice & Service Delivery (PPSD0 sub-committee.

PAS may also seek independent expert advice. The outcome at this stage is one of the following:

  • The member is advised that the area sits within UK physiotherapy practice
  • The member is advised that the area sits within UK physiotherapy practice provided certain conditions are met (these usually relate to evidence of standards of practice being used, or to contextual factors)
  • The member is advised that the area does not sit within UK physiotherapy scope of practice at the present time
  • The member is advised that the area and/or its context requires consideration by the CSP Professional Practice & Service Delivery [PPSD] sub-committee because of its unusual, novel and/or innovative nature, with the member advised as to the timeframe for this process, and with the query progressed to Stage 3

Stage 3

PPSD sub-committee is presented with the case for consideration; it debates the case, drawing upon relevant supporting information and advice provided by the CSP and/or individual member.

PPSD sub-committee considers whether the area of practice sits within UK physiotherapy, and whether and how this is contingent on context. In so doing, it may draw upon independent expert advice.

The outcome at this stage is one of the following:

  • The member is advised that the area sits within UK physiotherapy practice
  • The member is advised that the area sits within UK physiotherapy practice subject to certain conditions being met (these usually relate to evidence of standards of practice being used, or to contextual factors)
  • The member is advised that the area does not sit within UK physiotherapy scope of practice at the present time

If a member is not satisfied with how his/her query is considered through the process outlined above, she/he can refer the matter for consideration by the CSP Practice & Development committee.

Oversight of the process

An essential part of the PPSD sub-committee’s role is that it maintains an oversight of developments in scope of practice and ensures that these developments are disseminated and informs all areas of CSP activity appropriately.

This role is integral to the CSP’s governance arrangements and to fulfilling CSP responsibilities as the guardian of the scope of practice of UK physiotherapy. The role is exercised in the ways outlined below.

PPSD Sub-committee receives an update three times a year on the areas of practice considered. In this way, the committee monitors developments and trends in the profession’s scope of practice (over the short and longer term) and oversees the maintenance of a record of scope of practice decisions that the CSP makes.

PPSD Sub-committee submits an annual report to the Practice & Development committee (more frequently if the number and scale of cases merits this) on scope of practice business. This enables developments in the profession’s scope of practice to be fed through to the CSP Council, the Society’s governing body.

The outcome of considering a particular area of practice is disseminated appropriately by the CSP both to members and externally using all available channels and media. This is particularly important when a new area of practice has been identified as fitting within the scope of UK physiotherapy practice, or if the case highlights issues on which advice to members is particularly required.

Decisions relating to scope of practice are used to inform all relevant CSP activity. This includes the following:

  • CSP promotion of physiotherapy and members’ practice
  • CSP quality assurance/enhancement of physiotherapy education at qualifying and post-qualifying levels
  • Broader CSP activity to provide supportive leadership to the development of physiotherapy education and to members’ career development (at all levels)

What the CSP scope of practice resource and governance arrangements are not designed to do

CSP members do not need to seek CSP approval to move into new roles. This process is only necessary if a member or group of members seeks to make changes to their individual scope of practice that would involve practising in areas that currently sit outside the recognised boundary of UK physiotherapy practice, and/or where there is uncertainty about whether an element or approach sits within these parameters.

CSP members do not need to seek CSP permission to make changes to their personal scope of practice in ways that already fit within the collective scope of UK physiotherapy. At the same time, there are areas of practice in which it depends how a member is planning to integrate a technique or approach into his/her practice that affects whether the area can be considered to fall within the scope of UK physiotherapy.

In essence, this will depend on how the member is intending to integrate the area within his/her broad scope of practice as a physiotherapist, whether s/he is planning to practise the technique or approach to the exclusion of others within her/his existing scope, and how s/he presents his/her services to those commissioning and using them.

The governance arrangements do not take away individual members’ responsibility to practise within their personal scope of practice and to determine themselves whether they have established and maintained their competence to practise in a particular way.

The governance processes do not prevent individuals from continuing to practise in areas outside the scope of practice of UK physiotherapy as long as they do this explicitly (and with appropriate forms of additional indemnity insurance, as required).

Enacting the process is in no way an attempt to achieve a fixed definition of what sits within and outside the scope of UK physiotherapy practice. The criteria and process are underpinned by the recognition that the profession’s practice is constantly evolving and that any attempt to ‘pin down’ UK physiotherapy practice would form a distinctly retrograde step.

All changes to individual scope (both those simply relating to what an individual does within the recognised scope of the profession, plus those relating to an individual’s wish to move into an area that is new for the UK profession) are covered by the CSP Code of Professional Values and Behaviour. It remains imperative that individual members do the following:

  • Demonstrate how they have established their competence in a particular area through keeping a record of their relevant learning
  • Limit their scope of practice to those areas in which they have established and maintained their personal competence
  • Maintain a critical awareness of how they are engaging in particular areas of practice in terms of how this fits draws upon physiotherapy knowledge, skills and values, how it fits within a physiotherapeutic pathway of care, and whether and how it is perceived by others (including service users) to form physiotherapeutic care

The CSP has developed scope of practice governance arrangements to support and enable the development of the profession in the UK. The governance arrangements:

  • Reflect the royal charter
  • Build on contemporary definitions of physiotherapy
  • Recognise the breadth of patient and population groups, environments and occupational roles in which physiotherapy is now practised
  • Ensure service user safety and best interests are the prime consideration
  • Set out the process through which the CSP discharges its function as the final arbiter of scope of practice for the profession in the UK
  • Support the regulatory processes enacted by the HCPC
  • Promote debate within the profession about how its scope of practice is evolving, the implications of this, and the opportunities it presents
  • Enable the profession to appropriately grow and develop and to articulate the value of its contribution to health and well-being

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