Solihull Physiotherapist John Williams considers differences between musculo- skeletal physiotherapists in the NHS and in private practice. The Birmingham based physiotherapist has a useful website www.solihullphysiotherapist.co.uk where you can view information on back pain and other common complaints
As a Birmingham physiotherapist who has always worked in private practice and never spent any time working within the NHS John finds it interesting to talk to other local Birmingham physiotherapists who have either done both or have just spent their time providing physiotherapy services within the NHS.
There does appear to be a fundamental difference between the private sector physiotherapy and the NHS version. As you might imagine the time constraints within the NHS are a factor and with long waiting lists designated as a government target to address, this has affected frontline physiotherapy services.
In the private sector the customer’s needs are very important, physiotherapists can offer as much time as necessary in order to treat a patient. If a patient is not happy with the treatment or recovery progress is not as expected, they are at liberty to change from one practice to another without notice.
In private practice you survive or fail by your results. Sadly this is not the case in the NHS. It appears that successful treatment outcomes are not measured and instead only waiting times. How often do we hear politicians report that they have successfully reduced waiting times to see a doctor, surgeon or physiotherapist. This may be so, however being seen is no good if the treatment is not successful.
Many patients complain that they turn up at a physiotherapy appointment after waiting a number of weeks, which in some cases can be 12 weeks, only to be given a sheet of exercises to be done at home. No doubt this may be disputed by some, however it happens far too often and patients report that they attended for NHS physiotherapy which was a total waste of time!
If this occurred in private practice, then the physiotherapist would soon be out of work. As you can imagine faced with long waiting lists to cope with and a mandate to drastically reduce these waiting lists, management have to design a plan to achieve this.
As the targets are “being seen” and not successful outcomes, then handing a sheet of exercises and sending them away can tick the box of “being seen” and one physiotherapist can see a lot of patients in an hour. If the same physiotherapist had to examine and treat the patient, then reducing the waiting list would not be achieved.
Having talked this through with some NHS physiotherapists they feel frustrated that they are not allowed to treat patients anymore and the emphasis seems to be on the patient self managing their own condition.
In the cases of low back pain, which has to be the most common complaint of all, the patient experience is often very poor if using the NHS. First a visit to their GP will usually result in pain killers or anti-inflammatory oral medication. As most GP’s have little training in diagnosing the cause of back pain the patient usually is usually sent home without a proper examination and diagnosis.
If the pain persists then they are often referred for physiotherapy which can take months before they get an appointment. Imagine after suffering back pain for months and then eventually attending your physiotherapy appointment to be handed a sheet of exercises and sent away without any treatment.
The physiotherapy profession in musculo-skeletal is not being seen to be effective by patients however much the government announce success. The current system is not designed to help patients, its designed purely to address targets of waiting times.
As long as this continues physiotherapists in private practice will pick up work by default because patients cannot get the care they need under the NHS.
This is great news for our private practices but a sad reflection on a well established health service which was designed to meet the needs of the public and now seems to have lost its way.
As a private practitioner one could never work in a system that wasn’t patient focused,
Good practitioners are being wasted and eventually will lose heart. You can only swim against the tide for so long before you tire and give up.
As for the patient , they have choices, pay additional fees for their treatments and choose when and where they are treated in the private sector, or take up the free NHS programme after a substantial wait. Not everyone can afford to pay privately and sadly it is those people we are letting down.
The sooner the NHS scrap targets that are not designed to measure successful outcomes the better. If not, more and more skillful physiotherapists will leave the NHS to enter the private sector where they will get better job satisfaction and in many cases, better pay.