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46 APPENDICES Physiotherapy KCE reports vol. 40 7. UK 7.1. BACKGROUND INFORMATION ON THE HEALTHCARE SYSTEM 7.1.1. Existing Coverage Schemes The UK National Health Service (NHS) is a tax-based provider of universal public healthcare free of charge at the point of delivery. Co-payments are required for certain types of patients for dental care, ophthalmology and pharmaceuticals. Some 10% of residents have a private (complementary) insurance, mostly employmentbased and covering acute hospital care. 7.1.2. Institutional Framework In effect there are four NHSs operating in the UK: England, Wales, Scotland and Northern Ireland, each constituting a branch within their respective Departments of Health. In England 28 Strategic Health Authorities (SHAs) link the Department of Health to the various trusts (cf. infra). 7.1.3. Health Care Delivery The UK healthcare system employs providers from both public and private sectors, the latter accounting for 25% of provided services. In England, the so-called trusts are responsible for running various local services. Three main types of trusts exist: primary care trusts (PCT), secondary care and specialist trusts and ambulance trusts. 7.2. PHYSIOTHERAPIST PROFESSION 7.2.1. Minimal Entry Requirements The minimal educational requirement for practicing physiotherapy in England is 3 years of post-secondary education (BSc). Moreover, physiotherapists must be state registered with both the Health Professions Council (HPC) and obtain a licence to practice. Membership of the Chartered Society of Physiotherapy (CSP) is obligatory for those wishing to work under NHS-provisions. Furthermore, several professional associations of CSP-recognized professionals exist within various specialty fields: amputee and prosthetic rehabilitation, manipulation techniwues, women s health, acupuncture, etc. 7.2.2. Number of physiotherapists Currently, there are around 45.000 chartered physiotherapists, physiotherapy students and assistants . Newly graduated physiotherapists find it very hard to land a NHS vacancy as a practitioner ( No NHS for more than 9 out of 10 graduate physios as announced by the CSP in a press statement dated July 18 th 2006). Consequently, unemployment figures are on the rise. 7.2.3. Practice Most physiotherapists provide NHS covered services and receive salaried pay. All practitioners working for the NHS should be chartered with the CSP, the professional, educational and trade union body for the UK. 7.3. CONDITIONS FOR COVERED SERVICES In order to qualify for (full) NHS-reimbursement a GP referral is required. Long waiting lists for physiotherapy care are observed in the UK. As a remedial to this problem, a self-referral scheme can now be followed via the newly established Physio direct phone services in some NHS trusts (cf. infra).
KCE reports vol. 40 APPENDICES Physiotherapy 47 7.4. QUALITY ASSURANCE AND EVALUATION SYSTEM 7.4.1. Governmental Regulations The Health Professions Council (HPC) operates as regulator for 13 professions in the UK. It sets comprehensive standards for individual practitioners; the most relevant for the physiotherapy practitioners being: Standards of proficiency regarding skills and professional knowledge. Standards of conduct, performance and ethics. Standards of continuing professional development (CPD). The latter standards apply to the development of skills related to physiotherapy practice, teaching activities, management and research. Registrants of the HPC are obliged to maintain a record of their CPD activities and present a written profile to the HPC on request. Random checks are performed routinely by the HPC. As this obligation was only recently (1 st July 2006) introduced for health professions, the first wave of audits is only programmed from 2008 on. 7.4.2. Self (sector) Regulations The Chartered Society of Physiotherapy (CSP) laid down core standards of physiotherapy practice. These standards in part apply to individual practitioners and in part apply to health service delivery at an organisational level. For individual practitioners the Chartered Society of Physiotherapy adopted the principles of CPD In accordance to the HPC regulations. It offers support in individual practitioners CPD portfolio s and personal development plans and has developed its own CSP outcomes model . The model complements the CSP approach to CPD and focuses on broad outcomes 15 that constitute individual professional competence. Regulations for ensuring properly organised health services deal with health informatics, necessary medical equipment and general working conditions. The CSP also actively endorses the development of clinical guidelines through its guidelines programme. 7.4.3. Current (controversial) topics in quality improvement It is observed that, in some parts of the country, shortages of qualified health professionals such as physiotherapists exist. In the NHS Plan (2000) considerable increases in manpower have been programmed by 2008. It would seem, however, that currently vacant physiotherapist positions are not been filled in or even permanently lost due to budgetary constraints. Furthermore, training budgets for physiotherapists are reported to have been reduced. In general long waiting lists for physiotherapy care prove to be a burden on healthcare delivery. One solution mentioned to remedy this shortcoming is by direct self-referral, bypassing mandatory GP referrals. It is argued that the current gatekeeper system hampers efficient working standards at GP practices and further lengthens existing waiting lists. Alternatively, some NHS trusts, have set up a Physio Direct service for patients (e.g. the East Gloucestershire NHS trust) allowing patients telephone access to physiotherapists so patients can be presented with direct advise and exercises and seemingly acute patient cases can be fast-tracked (2). The purpose of Physio Direct is to lower organisational strain on GP practices and to optimise and tailor patient identification and timely follow-up. 15 Outcomes focus primarily on ethics, effectiveness, communication skills in professional conduct.
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