Action on physio staffing now

The NHS Long Term Plan in 2019 proposed offering new nurse graduates NHS contracts. Frontline’s Gary Henson talks to head of policy Rachel Newton to find out more.

Illustration showing staff coping with vacancies

Since then, the CSP has been lobbying for this to be extended to physiotherapy and other staff that the NHS desperately needs. Now that NHS England has committed to providing a national workforce plan, the CSP is calling for measures to address the shortage of physiotherapy staff in the NHS. One of these is offering contracts to new graduates.

Why is the CSP calling for all new physio graduates to be offered NHS contracts?

The shortage of physio staffing is stark in the NHS, with millions of people missing out on receiving the physiotherapy and rehabilitation they need. 

The Long Term Plan in 2019 and the workforce plan that followed committed to 5,000 first contact practitioners (FCPs) in primary care. But it did not provide workforce targets for any of the other policies to address the unmet rehabilitation for people with long term conditions. These needs have grown as a result of the pandemic.

Without an expanded physiotherapy workforce these needs can’t be met. Furthermore, there aren’t enough physios in the NHS to create the pipeline of talent for roles, like FCPs, that require advanced practice skills, or provide backfill for those roles. 

The CSP champions the value of support workers and the potential for the non-registered workforce to do more. This is dependent on sufficient registered workforce to provide support and ensure safe delegation. 

Physiotherapy is in an enviable position of steady growth, with courses over-subscribed and a high completion rate. This presents an enormous opportunity to address urgent needs of the population, which is not yet being realised.

But if we are having problems with recruitment, how does creating more physio graduate posts help? 

Insufficient physiotherapy staffing damages the lives of patients and means overstretched staff are becoming demoralised and burnt out. 

In addition, newly qualified physiotherapists in the NHS are often not provided with early support in their development, and then when they are at the mid-point in their careers they commonly get stuck on middle bands for years without opportunities for progression. 

Not surprisingly, this makes it harder for the NHS to first attract and then also retain physios – particularly in parts of the NHS like the community sector where the pressure and need is the greatest and there are the least opportunities for staff development and progression. 

The combined problems with staffing levels, recruitment and retention of physiotherapy staff form a vicious cycle that the NHS must break out of. 

Creating more physio graduate posts is part of the solution. But it needs to be part of a package with measures to develop and retain physiotherapy staff. 

To put it bluntly, NHSE need to attract more physios into the NHS and then motivate them to stay. Any plan to do this needs to:

  • address staffing shortage so that physios can deliver a quality service to patients
  • offer contracts that enable physiotherapy staff to work across sectors
  • ensure clear career development pathways – with training and job opportunities 
  • implement national agreements to flexible working locally, so that people can balance careers with home commitments through flexible working
  • offer a fair pay deal so that working in the NHS is competitive. 

Isn’t this an example of the CSP ignoring the needs of sectors outside of the NHS?

The strong supply of physiotherapy graduates needs to continue and be distributed across all sectors. Because all sectors – including private providers, education, the military, the voluntary sector – play an essential role, and all have a need for an adequate supply of physiotherapists. 

And all sectors therefore have an interest in growth continuing and can help ensure it does by offering placements. 

The CSP call for all physio graduates to be offered an NHS contract isn’t about putting the needs of the NHS above other sectors. But rather about ensuring the NHS is leveraging its share of workforce growth, by attracting physios to want to have a career in the NHS. 

This means NHS employers making it easier for people who wish to work across sectors to do so and seeing the value of the breadth of experience this would provide. 

Isn’t this pushing physio graduates into the NHS even if they don’t want to? 

No, this is not to force physio graduates in England to work in the NHS, quite the opposite. 

In Wales the government introduced a system that did just this, and students were made to repay their bursary if they didn’t work in Wales for two years, and were forced into an NHS ‘streamlining’ recruitment scheme as part of the bursary tie-in. The CSP opposed its introduction and lobbied against it continuously until it was scrapped earlier this year. 

What we are proposing in England is that the NHS does more to attract physios into the NHS, and offers contracts to those who want them that provide flexibility to work across sectors, train and develop across their career. 

But the NHS is short of money, is it realistic to be asking for additional physio staffing and development at this point?

Yes, the NHS cannot afford not to. 

Even in the current financial context the argument, which the CSP contributed to with 105 other professional bodies, for a fully funded workforce plan for the NHS has been won. 

Within this, physiotherapy must be prioritised. The lack of investment in physiotherapy and rehabilitation in the NHS is contributing to rising costs as people are pushed into the most expensive parts of the system. 

Is the CSP being protectionist, and trying to prevent non-physios from contributing? 

Not at all. There is more than enough work for everyone. The CSP has been lobbying through its leadership of the Community Rehab Alliance for an expansion of all parts of the rehab workforce, including exercise professionals and the voluntary sector. 

But while some capabilities that physios have are shared with others, physiotherapists also bring a unique set of capabilities, with the depth and breadth of expertise to provide a holistic assessment of needs, manage risk and complexity, prescribe and issue Fit Notes.

These are skills that are urgently needed to meet the needs of the population who increasingly have multiple long-term conditions and to provide a pipeline for an expansion of physios operating at advanced practice level to reduce the pressure on medics and provide leadership. 

What can CSP members do?

In the last 12 months allied health professional (AHP) workforce leads have been funded by Health Education England to lead AHP workforce planning at trust and integrated care system (ICS) level. CSP members in these roles need to ensure that AHP workforce plans address the issues of staffing, recruitment, and retention in the round, including offering new graduates NHS contracts. 

CSP members involved in their AHP council and AHP faculty should be working with AHP workforce leads and seeking a place at the table for physiotherapy at the people plan board in their ICS area to make the case for action on staffing, recruitment, and retention to address the physiotherapy workforce challenge facing the NHS.

Physio managers must be clear about the physiotherapy staffing needed to deliver a quality service.

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