Advanced Physiotherapists

There’s an Alphabet Soup of Physiotherapy Practitioners now.

Physiotherapy has been changing fast in the last ten years. Opportunities for career progression have dramatically increased as the pressures on GPs, secondary services and budgets have grown.

Managers have realised that physiotherapists can do a great number of jobs which were previously the realm of a doctor, can do them just as well and at less cost. No longer do you have to choose a management route to get to the higher levels of the profession, there are many routes now.

This has led to a variety of approaches across the UK as new ideas are attempted, and along with that an explosion in new titles with their very own acronyms.

Extended Scope Physiotherapist – ESP

This title is the first advanced role which was developed in physiotherapy. When it was first proposed that physiotherapists take on roles normally reserved for doctors, such roles were “outside the scope of physiotherapy”.

Once these roles were developed, they were called Extended Scope Physiotherapists or ESPs.

I remember a practitioner in the hip clinics in Exeter in 1989 who was one of the first in the country, reviewing hip replacement patients at six weeks, recording their ranges and checking the X-rays.

ESPs initially worked in spinal and orthopaedic clinics, alongside consultants and registrars. They could order investigations and some could list patients for surgery.

What distinguishes ESPs is that they are mostly diagnostic replacements for doctors, and don’t “do” physiotherapy in the traditional sense. They perform a triage role and refer for physiotherapy if required.

The Alphabet Soup

Since then many new roles have been developed, affecting not just physiotherapy but occupational therapy, nursing, pharmacists and other professions. This has led to a slew of new titles just in physio – orthopaedic practitioner (OP), surgical practitioner (SP), specialist musculoskeletal practitioner (SMP), advanced practice physiotherapist (APP), clinical specialist physiotherapist (CSP), first contact physiotherapist (FCP).

So, with this confusing mass of names and initials, I thought it would be worthwhile discussing some of the recent ideas in physiotherapy roles and the opportunities they afford.

Advanced Practice Physiotherapist – APP

This is now the main name for advanced practitioners, superseding extended scope practitioners as a title. APPs can work in any area, including the Emergency Department, and can diagnose, investigate, inject and refer in many cases.

APPs can incline towards the diagnosis and triage roles (the old ESP role) or towards more of a treatment role where they assess and treat patients with the arsenal of physiotherapy modalities. They also have a significant consulting and teaching role for physiotherapy staff and others, including doctors and nurses.

First Contact Physiotherapists – FCPs

Medicine and allied professions are just as prone to fashion as any other part of human life, and the fashion for FCPs is in full swing at the moment. MSK conditions make up between 15-30% of a GP’s practice, constitute a significant burden and are the realm of expertise of a physiotherapist.

The FCP could see many of these patients instead of the doctor. Evidence shows that patients are happy with this and physiotherapists can safely manage these patients. FCPs work in GP practices, seeing patients with musculoskeletal problems, the vast majority of whom do not have a significant medical diagnosis.

Clinical Specialist Physiotherapist – CSP

CSPs are advanced “traditional” physiotherapists, with specialist skills in examination, diagnosis and treatment. They may also inject and prescribe.

The role of the CSPs, apart from treating patients with advanced skills, is also to promote best practice, support physiotherapy teams, teach and mentor more junior therapists and write and review treatment pathways and patient information.

Physiotherapy’s New World

Physiotherapists have developed several routes to increase their skills and responsibilities over the last ten years. This has included prescribing, injecting and diagnosing in orthopaedic clinics.

By a process of profession creep, physios have been chipping away at the “lower levels” of the doctors’ roles, taking on more responsibility and becoming the independent clinicians we have legally been for some years.

This provides a great opportunity for up-and-coming physiotherapists to make a strong impact in their local medical communities by becoming experts in a particular role or clinical area. This should also free up doctors’ time to make the more complex, judgement-based medical decisions that only they can make.

This process is likely to continue as capacity and cost pressures continue to rise. So if you want a career which takes you into the expert clinical realm, then physiotherapy is now a better option than ever.