UK (Physiotherapy)

Original Editor - Rachael Lowe

Top Contributors - Admin, Abbey Wright and Rachael Lowe  

Patient Access to Physiotherapy or Physical Therapy Services / Entry Point

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

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

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

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

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

Degree/Credentialing

All Physiotherapists in the UK have at least 3-4 years training and a Degree from a Higher Education Institution. 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. 

Specialisation

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.

Professional Associations

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.

Information about the Patient Community

The population of the UK was nearly 67 million in 2019.  The main causes of mortality are Ischaemic Heart Disease, Cerebrovascular Disease, Respiratory Diseases and Cancer.

Social/Cultural Influences

• What is the influence of the family on a patient's health status?
• What are the typical patient's living conditions, family dynamics, and cultural back ground?

Delivery of Care

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.

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

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

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.

Community

• Special methods? Home health etc
  

Type of Health System

• 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 care.
  • 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

• 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

NHS 111

CSP

HCPC