Pillar Talk

Let’s talk about the four pillars of physiotherapy practice and what they mean to you, CSP professional advisers Tamsin Baird and Sara Conroy

Pillar Talk
The four pillars of practice [Illustration: Ben Hasler]

The four pillars of practice – clinical, education, leadership and research - are applicable to all of the physiotherapy workforce, not just those in advanced level practice.    

Whilst this statement may be widely accepted by those in Wales and Scotland, where established frameworks that align to the pillars are in place, for others it may be a relatively new concept.   

So what does this mean to you? How can you practice within all four pillars when in a busy clinical role? Let’s think about how the four pillars can integrate, rather than separate, your day-to-day work.  


The clinical pillar is the easiest for us all to associate with, especially in our early careers. It describes the knowledge, skills and behaviours needed to provide high quality healthcare that is safe, effective and person-centred. Such skills include clinical reasoning, critical thinking, decision-making and caseload management. 


Conversely, the research pillar is often the most misunderstood. This may be down to it sounding complicated and difficult. Let’s keep it simple, this pillar involves using evidence to inform our practice. Yes, this may include formal research or the writing of journal articles but it also involves audits, being involved in service improvements and applying guidelines into practice. 

After all, how can we know if our interventions are effective if we don’t measure outcomes? How can we request investment in services if we don’t measure their impact? How will our practice evolve if we don’t test change? All physiotherapists at all levels should have these skills, alongside a clear responsibility to take part in such work to maintain HCPC standards. 


Next up we have the education pillar. You may automatically think about formal teaching here but don’t overlook the essential and plentiful work we do educating and empowering others, facilitating student learning, engaging in in service training, supporting colleagues, and actively learning from clinical supervision among many other examples. Every physiotherapy staff member at every level is involved. Education is achieved in many different ways; some formal and planned, such as courses or journal clubs, and others informal and opportunistic, such as supporting a colleague in their treatment implementation. These are all of equal importance and with reflective practice, all contribute brilliantly to this pillar.   


The leadership pillar is essential to the delivery of high-quality services. However, when we think of leadership, we often focus on those in clinical lead or management positions. This mind-set must change. Leadership is a skill not a role and as such, can and must happen at every level. We must recognise our leadership roles in delivering care and empowering and influencing others. Some healthcare support workers or junior physiotherapists find it difficult to recognise and articulate their contribution within this pillar, but be assured it is considerable! Your input to meetings, collaborative working and teams’ ability to plan and engage in the supervision of students are just a few examples. 

It is important that your role contains an element of all four pillars. Why? Because we need a strong and diverse workforce to champion what we do. A workforce with the ability to influence, lead and work with others, to demonstrate quality and evidence-based practice, to be actively involved in educating and empowering others and to be providing patient-centred and safe care. With more career opportunities than ever alongside a fast-paced and complex health and care system, this is crucial to drive the profession forward. 

As an individual’s career progresses, the proportion of their role within the different pillars will change. This is okay. Actually, it’s more than okay, it’s great. You can move between pillars offering opportunity, development and a non-linear career path.

We urge you to familiarise yourselves with the pillars of practice, reflecting on your role and current contribution to each. The CSP is planning to firmly embed these pillars into our profession to better define the knowledge, skills and competence we can all offer. To be able to better plan our careers, aspire to different levels of practice and seek learning and development opportunities. Let’s talk pillars! 

The CSP’s Professional Advice Service team gives advice and support to members on complex and specialist enquiries about physiotherapy practice, including professional practice issues, standards, values and behaviours, international working, service design and commissioning, and policy in practice. 

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