In perspective - Never mind the quality, feel the width

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Who would be a commissioner?  There you are, working away in a primary care trust (PCT), then along comes a new government facing an economic crisis.

Suddenly there is a move to close down PCTs and shift power to GPs in clinical commissioning groups.

At the same time, a new form of procurement called AQP – any qualified provider – is to be brought in during the transition!

Many NHS providers have held local monopolies for more than 60 years and were reluctant to believe they would have to compete in the market.

But AQP has the potential to force the reality of competition, and now both commissioners and providers have a choice.

Commissioners will need to decide which services will benefit from an open market by delivering choice for patients and improving quality as a result of competition.

 How many providers will practically constitute a market? How many providers are too many and will result in chaotic provision?

Providers are asking how their patients will respond to being offered a choice of provider.

Will it affect your current activity, and therefore staffing, levels?

Are GP-referred patients an important source of business?

Should you use the opportunity to review your business plan and consider concentrating on other revenue streams rather than scrap over this income?

Most commissioners’ approach when procuring under the AQP model has been to set the standards for prospective providers very low.

This ensures that the process yields a number of providers to choose from.

After all, if standards were too high, then there may be no providers of acceptable quality and what a waste of their time that would be!

So, they err on the side of caution and set the threshold too low and admit providers of very diverse standards and ability to deliver.

And therein lies the biggest problem with the AQP process. Commissioners don’t know how to set the quality thresholds to identify a sufficient number of the best providers to create choice for patients and eradicate complacency in the provider market.

On a practical level, they also don’t want to have to monitor the performance of lots of providers. Furthermore, patients and their GPs will be confused by excessive choice and the presence of too many (perhaps three) providers in the local market.

So, remember, commissioners are simply well-intentioned professional also trying to do their best under challenging circumstances.

They often do not have a good knowledge of the provider market to effect the AQP policy.

I would recommend less hostility to AQP and commissioners.

The latter need us to educate them on what a good provider looks like, so they understand where to set the benchmark in procurement to ensure physiotherapy is represented by good providers in this new world.
Andrew Walton is Chief Executive with Connect Physical Health


Advice line

Protection of title
Sally Gosling looks at what it means to call  yourself a ‘physiotherapist’

Recent debate on the CSP’s interactive network, iCSP, confirms how much members value ‘protection of title’, and the understandably high levels of concern that any apparent challenge to it generates.  

‘Physiotherapist’ and ‘physical therapist’ have been protected in the UK for the last ten years. Legislation that created the Health Professions Council (HPC) gave the regulator the power to protect the titles of the professions for which it maintains the register.   

This means only individuals who have qualified to practise physiotherapy in the UK through a programme approved by the HPC, or who are deemed to have an equivalent professional qualification and experience gained outside the UK, can secure HPC registration and call themselves a ‘physiotherapist’, or purport to be of the profession. (Individuals who had practised physiotherapy in the UK without a standard qualification could also apply to join the HPC register for a time-limited period when protection of title was introduced.)

Use of titles is limited to safeguard the public.

Anyone seeking or receiving treatment can have confidence that physiotherapists have completed a high level of education and are accountable for their professional activity and conduct.

Protection of title also strengthens a profession’s standing and credibility.

Members can be assured that only those who have reached and maintained high professional standards can call themselves a ‘physiotherapist’. Individuals who endanger the profession’s reputation by purporting to be a physiotherapist when they have not gained an appropriate qualification and are not subject to regulatory requirements are liable to have action taken against them.

Misuse of a protected title can lead to a fine of up to £5000.

The CSP campaigned for protection of title and continues to seek to uphold its rigorous implementation.

The CSP promotes the professionalism that the title ‘physiotherapist’ represents, physiotherapists’ distinctive contribution to meeting patient needs, and the added value of being a ‘chartered physiotherapist’.  

Members concerned that someone may be misusing the title ‘physiotherapist’ should contact the HPC to make a complaint [see ].
Sally Gosling is CSP’s assistant director for practice and development

Lynn Eaton

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