Physiotherapy and public health … where are we?

Do physios see public health as part of their role? Anna Lowe, senior lecturer in physiotherapy at Sheffield Hallam University, has been finding out

by Anna Lowe

Anna Lowe

Making Every Contact Count is a pragmatic approach to health promotion; one endorsed by Public Health England’s (PHE) as an approach to behaviour change which can be used by all health professionals, including physios. The simple idea is to use every opportunity to influence your patient’s health and wellbeing. Yet are physios doing this? And if they are, could they be doing more?

As part of a recent contract with PHE I was asked to coordinate a national survey of allied health professionals (AHPs) to help understand how much we are Making Every Contact Count.

The main aims of the survey were to improve our understanding of current public health practice, the barriers and the facilitators of change, and to get a baseline from which to measure progress.

The survey was live for three weeks in May, when it was circulated widely on social media and featured in Frontline. We had more than 2,000 responses from across the 12 AHP groups – so thank you everyone who responded.

The findings were shared at the chief AHP officer’s conference on 23 June and will be published in full later in the year. But here is a sneak preview of some of the physiotherapy-specific headlines. A note of caution: these are preliminary findings and the opinions expressed are my own!

While we had responses from physiotherapists across the UK, most came from England. Participants were largely in NHS posts in a range of clinical settings spanning community, primary and secondary care.
To gauge how physiotherapists viewed their own professional identity in relation to public health, we asked: ‘Do you consider public health (including prevention, health promotion and early intervention) to be a core part of your professional role?’

The physio response was overwhelmingly positive with a whopping 95% saying ‘yes’. This is such a positive start and supports the view that prevention is central to contemporary physiotherapy practice. And it is so important, given the radical upgrade in preventive care called for in the Five Year Forward View, and again more recently by the Richmond Group of charities.

The findings of our survey show that physiotherapists initiate conversations and deliver brief interventions on a whole range of public health priorities. These include managing pain and preventing falls, but also in areas not traditionally considered to be physiotherapy territory, such as smoking, alcohol and social isolation.

The survey suggests there is room to improve the way this information is recorded and collated; something we must be able to do if we are to show impact.

When asked ‘what (if anything) limits you when it comes to delivering healthy messages/Making Every Contact Count/interventions/brief interventions?’ a number of well-known barriers were cited, such as lack of time or organisational support. But in addition to these, lack of knowledge, access to patient education materials and awareness of local services were consistently seen as barriers to delivering preventative care.

Asked ‘is prevention included in the contract for your service?’ a large proportion of respondents (51 per cent) said ‘no’, while a further 19 per cent were ‘unsure’. If physiotherapists are delivering services in a culture that doesn't ask for, or expect, health-promoting practice, this may explain the organisational and cultural barriers to health promotion.

One recent development that may help change organisations' approach to health promotion, however, is the inclusion of a Making Every Contact Count clause in the Standard NHS Contract for 2016/17. The clause states

‘The provider must develop and maintain an organisational plan to ensure that staff use every contact that they have with service users and the public as an opportunity to maintain or improve health and wellbeing, in accordance with the principles and using the tools comprised in Making Every Contact Count guidance.’
I hope that this will help elevate health promotion to a more prominent position in physiotherapy practice.
This brief look at the preliminary findings of our survey suggests prevention is central to the professional identity of physios – which is so encouraging. It suggests that we are broadening our reach in health promotion, and using the opportunities we have to improve health, as well as contributing to national public health priorities. Keep an eye out for more detailed analysis and further discussion later in the year.

Anna Lowe is a senior lecturer in physiotherapy at Sheffield Hallam University. Follow her on Twitter @annalowephysio

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