Your comments: 18 January 2017

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Growing dismay

I’ve read Frontline with a growing sense of dismay for years. The message has been clear since I qualified in 2002: ‘Forget all those manual therapy skills you’ve been honing at university; they won’t be required.’ The National Institute for Health and Care Excellence (NICE) recommends that you give everyone with low back pain a generic set of exercises, preferably in a class setting as it’s cheaper, bombard them with information on the neuro-physiology of pain and send them packing. What NICE doesn’t appreciate is that an individual with back pain walks away befuddled and unimpressed, and looks for a professional who will help them with more than words. I am an unashamed manual therapist and can testify to its efficacy alongside a specific tailored exercise programme for low back pain.  
Physios are increasingly ‘hands-off’ in the NHS. I enjoy the autonomy granted in private practice.  If we stop using manual therapy or acupuncture for low back we will become an irrelevance. Don’t blindly accept NICE dogma – exercise some judgement, your patients will appreciate it.
  • James Barrett

Carley King, CSP professional adviser, responds: ‘NICE recommends that manual therapy is considered as part of a multicomponent treatment package including exercise. The process NICE uses to produce guidelines is transparent, including the consultation phase.

We recommend that physios use their clinical judgement, alongside patient preferences.  

More information, please

CSP members may be unaware of proposals to develop apprenticeship standards as an alternative entry route to HCPC registration as a physio. The initial proposals suggest that the apprenticeship standard may take 27 months to achieve and that training would consist of four days a week in work and one day a week released for theoretical learning. This represents the biggest change in entry requirements to the profession since the move to all graduate entry in 1992.
The proposals have been discussed at CSP Council and are being given cautious support by the CSP.  Increasing the size and diversity of the physiotherapy workforce and offering alternative entry pathways to the standard A-levels route are, rightly, aims of the CSP. 
It is also clearly in all current and future physios’ interest to ensure that this proposal does not create a two-tier workforce and that, irrespective of training route, all physios develop critical thinking skills, leadership skills and research-literacy alongside the technical skills of the profession. There was an open public consultation on the proposals which closed on 11 December
I call on the CSP to do more to inform and engage members in the next steps of this process.
  • Ben Ellis, senior lecturer, Oxford Brookes University
CSP assistant director Sally Gosling, replies: ‘We are keen to raise members’ awareness and engagement in the agenda, and will provide regular updates. (See 
The recent consultation related to an expression of interest to develop a physiotherapy degree apprenticeship standard. It was not practical to seek input from members in the two-week time frame. However, we did alert physiotherapy education teams, and our response was shaped by CSP Council and committee discussions. Subject to the Department for Education approving the expression of interest, we will seek strong engagement in the standard’s development, and be clear about how members can get involved. 

Rehab DIY

I enjoyed the article on Sierra Leone (page 14, 7 December). It reminded me of setting up a rehab service during the Northern Ireland troubles. 
Hospital maintenance manufactured the parallel bars from plumbing pipes and the local garage made the rehab chair. This equipment was still in use when I retired 30 years later. I would be happy to share details.
  • Olwen Finlay
Frontline and various

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