Question time

The launch of the health White Paper in July marked a watershed for the NHS in England as we know it.

Strategic health authorities are to be scrapped; primary care trusts are to go; any trust that does not already have foundation status will be forced to become one in the next two to three years. And, at the top, the role of the Department of Health will be changed beyond recognition, while the bodies set up to monitor provision of services, such as the Audit Commission, will be scrapped completely.  Sally Priestley reports

Q: What is it going to mean for CSP members?

A: While policy makers in Whitehall have been working to flesh out the wide-ranging proposals, the CSP is working to ensure its members have the best guidance on what lies ahead and are properly equipped to fight their corner in the months and years ahead. In one of our regular updates on the White Paper proposals, Frontline looks at how some of the coalition government’s plans are likely to affect physios.

Q: What are GP consortia and how will they affect me?

A: The White Paper proposes setting up consortia of GP practices - groups of local GP practices - who will commission the great majority of NHS services for the patients in their area, replacing the role of the PCTs. They will, therefore, be buying in physiotherapy services for their area, which could change the way you currently provide a service as it will no longer be commissioned by the PCT.

Q: What will they look like?

A: We don’t yet know their structure, nor do we know how many there will be. There could be as many as 400-500 of them in all, replacing the 157 PCTs. Interested GPs are currently being invited to bid to become ‘pathfinder’ organisations, who will take on budgets early next year. They will form part of a Department of Health evaluation of GP commissioning.

Q: What’s meant by the ‘any willing provider’ approach?

A: ‘Any willing provider’ means the healthcare system will, essentially, be opened up to competition from bodies outside the NHS, including third and independent sectors or social enterprises, who will be able to provide services. This will be a significant change for physios working in the NHS, who will have to prove their value in competition with non-NHS providers. The CSP is awaiting further details on this area of reform but is already building a portolio of information to help physios argue the value of the service they provide in the NHS. (See further information.) In future, physios will have to prove they are not just clinically effective, but cost effective too. And there’s going to be a much bigger focus on providing data and evidence to support this. The government wants the health system to deliver what the patient wants. This is going to be key for physios.

Q: Do the changes signal the end of the NHS as we know it?

A: Yes, definitely. This is potentially the biggest organisational change in the NHS since its inception in 1948, yet there is no evidence it will deliver improvements. The NHS will continue to be free to patients but services will be provided by a variety of organisations, which will no longer be state owned. The CSP believes the direction and speed of these reforms will lead to fragmentation of services, creating barriers to co-operation and collaboration and will therefore undermine quality patient care.

Q: I work in the NHS. How worried do I need to be about my job?

A: The proposed changes will be a significant drain on already stretched resources, adding to the likelihood of physiotherapy staff job cuts. There will also be a greater chance NHS physios will be transferred into, or competing for business with, an independent or social enterprise company, adding to job insecurity.

Q: What will all this mean for my employment terms and conditions – and my pension?

A: National NHS pay, terms and conditions will be under threat as they can be set locally under the proposals. This didn’t work in the past and the CSP believes it won’t work now. Increased competition could also lead to a downward spiral in conditions of employment, including your NHS pension, which may be at risk.

Q: The government says the NHS has been saved from the spending cuts, but surely the efficiency savings will impact on services for patients?

A: Yes they will. The government has given the NHS 0.1 per cent above inflation but has already transferred £1 billion from the NHS to social services. The need to make £20 billion savings over three years means some health services will have to go or be reduced or radically changed. The likely reduction in staff posts means patients may see a reduction in the services they have come to expect, and are especially worrying given the growing elderly population. 

Q: Is there anything physios should be doing to prepare for the changes?

A: It’s important to be actively engaged in the CSP’s regional networks (see further information) and to help promote the role of physiotherapy as an efficient and effective intervention in patient care. Physios can also help themselves by finding out which GPs are beginning to surface as likely pathfinder consortia leads and seeking to link with and influence them. At the same time they need to continue to seek to influence PCTs as the current commissioners. They need to build collaborative links with others, including other AHPs. This may include campaigning with work colleagues locally where jobs and services are under threat.

Q: What’s the CSP doing to respond to the planned changes in the NHS?

A: The CSP is producing a series of new guidance and materials to help members (see further information). It continues to lobby ministers and seek one-to-one meetings to give its views on the new policy and to put the case for physiotherapy within the new framework. It’s working to show how it can provide solutions to the NHS efficiency cuts, through its evidence base and cost effectiveness.You can find full details of all the Society’s representations on the White Paper and the supplementary papers on the CSP website. (See further information.)

Q: What about physios working in devolved countries? Does the White Paper affect them?

A: In Scotland, Wales and Northern Ireland, where decisions about health are devolved to the local administrations, the White Paper will not be implemented. However, such radical changes in healthcare in England are likely to have a knock on effect on healthcare delivery in the devolved nations. And the UK government’s spending plans will affect the financial settlement made available to the devolved governments over coming years. A large part of these budgets include spending on health. fl

Our commitment to CSP members

CSP chief executive Phil Gray sums up the CSP’s three-pronged approach:

We will support members by:

  • analysing the White Paper and making members aware of the implications it has for the future of physiotherapy
  • lobbying for changes where possible and joining with other health organisations doing the same
  • supporting members no matter where they are working in the new structures to demonstrate that physiotherapy has a very strong future as a cost and clinically effective part of modern healthcare.

Further information

  • Check out ‘Physiotherapy works’, our new set of evidence-based briefings which show the clinical and cost effectiveness of physiotherapy, and the clear benefits to patients. They cover COPD, stroke, musculoskeletal disorders and occupational health.
  • The annual report 2009, ‘Physiotherapy works’, distributed with the 3 November issue of Frontline and available on the web, sets the case for physio services.
  • Our regional networks can help you work with others to promote the benefits of the services physios provide. Contact details for your local network are available on the CSP website.
  • Our White Paper submissions, including press releases summarising the main responses, are available on CSP’s website.
  • For help and advice on impact on jobs etc
  • For information on making a business case for your services, see ‘business case development’ at
Sally Priestley

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