UK (Physiotherapy)

Original Editor - Rachael Lowe

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Patient Access to Physiotherapy or Physical Therapy Services / Entry Point[edit | edit source]

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There are three main treatment routes if you are resident in the United Kingdom and wish to see a physiotherapist:

  1. NHS (primary or secondary care)
  2. Private practitioners
  3. Independent sector

Primary Care[edit | edit source]

Patients who are not currently in hospital but would like to have physiotherapy via the NHS, depending on where they live, will first need to make an appointment with their general practitioner (GP) and then ask to be referred to see a physiotherapist. Onward referral will be at the discretion of the GP.  A number of hospitals are now offering self-referral to physiotherapy. If their hospital/GP surgery is offering this service, they can make an appointment to see a physiotherapist without needing to see your GP first.

Secondary Care[edit | edit source]

If already in hospital following surgery or due to illness patients will have the opportunity to see a physiotherapist if deemed appropriate for their condition.  The physiotherapist will use their clinical reasoning skills to select patients on the ward that require physiotherapy treatment or patients will be referred for physiotherapy treatment by a member of the multi-disciplinary team.  These patients are always under the care of a consultant.

Private Care[edit | edit source]

If in a position to pay for their own treatment patients can have direct access to physiotherapy without the need to see a doctor beforehand.  There are a large number of physiotherapists across the UK offering treatment in dedicated physiotherapy and sports injury clinics as well as many who will treat people in their own homes. 

Independent Sector[edit | edit source]

Via the independent sector, some large employers run occupational health schemes for their employees that may include provision for physiotherapy treatment or private medical insurance schemes for individuals through the independent healthcare sector will often include physiotherapy treatment.

Therapist Preparation[edit | edit source]

Degree/Credentialing[edit | edit source]

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All physiotherapists in the UK have at least 3-4 years training and a Degree from a Higher Education Institution, although historically this was a diploma which if gained before the degree program is still applicable. The degree program became essential in 1992[1]. This entitles them to become a member of the Health Professions Council which then entitles them to practice in the UK.  The Chartered Society of Physiotherapy (CSP) provide a list of qualifying programmes in the UK

Professional Associations[edit | edit source]

A graduate degree (BSc) entitles physiotherapists to register with the UK regulatory board, the Health & Care Professions Council (HCPC). In order to call yourself a "physiotherapist" in the UK you must be registered with the HCPC.

UK physiotherapists can also choose to become a member of Chartered Society of Physiotherapy (MCSP) although this is not required it is highly recommended.  The CSP also has a number of Clinical Interest and Occupational Groups that UK physiotherapists can choose to become a member of.

Specialisation[edit | edit source]

Most physiotherapists specialise in an area of their particular interest.  Many graduates continue their studies to gain a Masters and/or Phd in a particular area that they are interested in working although this is not a requirement.

Information about the Patient Community[edit | edit source]

The population of the UK was nearly 67 million in 2019.[2]  The main causes of mortality are Ischaemic Heart Disease, Cerebrovascular Disease, Respiratory Diseases and Cancer.
MSK conditions in the UK affect 1 in 4 of the adult population (many being young and of working age) which is around 9.6 million adults and 12,000 children in the UK.[3] They also account for £4.76 billion of NHS spending each year[4].

Social/Cultural Influences[edit | edit source]

British culture is influenced by the combined nations' history; its historically Christian religious life, its interaction with the cultures of Europe, the traditions of England, Wales and Scotland, and the impact of the British Empire. Although British culture is a distinct entity, the individual cultures of England, Scotland, Wales and Northern Ireland are diverse and have varying degrees of overlap and distinctiveness.[5]

Delivery of Care[edit | edit source]

In the NHS physiotherapy referrals are often put on a waiting list. The length of waiting list depends on region to region and can even vary depending on what NHS trust your GP falls under. The average wait for musculo-skeletal (MSK) physiotherapy in the NHS can vary between 2-12 weeks[6].

In the private or independent sector the waiting times are significantly shorter and the majority of patients can be seen within the same week as referral, again this can vary depending on region and access to healthcare.

Outpatients[edit | edit source]

Classical the majority of MSK physiotherapy is delivered in an outpatient setting in a clinic which may include a small gym, electrotherapy equipment, treatment plinth and office space.

Typical outpatient gym

Virtual[edit | edit source]

Since COVID-19 there has been a sharp increase in the amount of virtual clinics aka "telemedicine" for MSK physiotherapy. In the NHS this can be over the telephone or via video calls. The CSP outlined guidance during the initial waves of COVID-19 helping practitioners decide whether it was appropriate to see patients face to face.

Following the implementation of these virtual clinics it was found to be time efficient and gave relatively good outcomes for patients with persistent lower back and knee pain, so virtual clinics are likely to remain for physiotherapy assessments in the future alongside face to face appointments[7].

Inpatients[edit | edit source]

Some patients will have physiotherapy in an inpatient (ward) setting. This may be following elective surgery, trauma or following a neurological event such as stroke or brain injury. The type of injury will depend how specialist the rehabilitation is i.e. there are specialist inpatient units all over the UK for strokes or traumatic brain injuries which will have different equipment and clinically specialised physiotherapist.

Community[edit | edit source]

If patients have reduced mobility or are unable to attend an outpatient clinic there are services available on the NHS or privately for physiotherapists to do physiotherapy at the patients home. This is known as community physiotherapy.

The normal conditions this type of physiotherapy focuses on is general mobility, preventing falls or neurological physiotherapy. Their may also be a waiting list for community physiotherapy and this can vary depending on the region and urgency of the referral.

Type of Health System[edit | edit source]

The National Health Service (NHS) provides free healthcare - funded by national insurance tax - to all citizens of the UK.

Most services are accessed via the GP (non-emergency, routine care), 111 (non-emergency advice number) or 999/ accident & emergency (emergency care).

There are also private hospitals and services that can be accessed for people with health insurance or willing to self-pay. These services are non-emergency based and are normally accessed to allow the user quicker access for routine or elective car. For example accessing faster elective orthopaedic surgery without having to use a waiting list which can be up to 1 year on the NHS.

Payment System[edit | edit source]

  • To access the NHS no payment is required. The NHS is funded via national insurance tax which all working people pay.
  • Health insurance, either provided by an employer or privately paid for, can be used to access private services.
  • Self-funding i.e. paying for your care, is a way people can access private services.

Resources[edit | edit source]

NHS 111

CSP

HCPC

References[edit | edit source]

  1. The Chartered Society of Physiotherapy. CSP History. Available from: https://www.csp.org.uk/about-csp/who-we-are/our-history/csp-history [last accessed 3/8/20]
  2. Office for national Statistics. Population Change. Available at https://www.ons.gov.uk/ [last accessed 10/03/21]
  3. Musculoskeletal diseases. UK Parliament. Available from: https://hansard.parliament.uk/commons/2011-07-04/debates/11070442000002/MusculoskeletalDiseases [last accessed 4/7/11]
  4. Department of health programme budgeting 2011-2012. Available from: https://www.gov.uk/government/publications/2011-12-programme-budgeting-guidance [last accessed 5/9/12]
  5. Little, Allan (6 June 2018). "Scotland and Britain 'cannot be mistaken for each other'". BBC News. Retrieved 6 June 2018.
  6. CSP. A survey of NHS Physiotherapy waiting times, workforce and caseloads in the UK 2010-2011. Available at: https://www.csp.org.uk/system/files/csp_pd090_waiting_times_survey.pdf [last accessed 24.03.2021]
  7. Tack CT, Grodon J, Shorthouse F, Spahr N. “Physio Anywhere”: digitally-enhanced outpatient care as a legacy of coronavirus 2020. Physiotherapy. 2020 Jul 18.