Could systemic NHS problems be solved by physiotherapists?

Ahead of her imminent retirement, chief executive of the Chartered Society of Physiotherapy, Karen Middleton, reflects on the lessons her profession holds for the future of the NHS.  

It’s easy to feel despondent when it comes to the future of the NHS. Years of underfunding and neglect, not to mention a global pandemic, paint a bleak picture. We are seeing record numbers of people on waiting lists and increasing numbers of burnt-out staff choosing to leave the NHS. There remains stubbornly high vacancy rates and out-of-date buildings and resources that are costing the NHS dear. 

But as I hang up my hat as chief executive of the Chartered Society of Physiotherapy, I see hope on the horizon and believe many of the solutions to the systemic problems in the NHS lie within the physiotherapy profession itself.   

There has always been an obsessive focus on reacting to the symptoms of the NHS crisis when we need leaders to look at the root causes. This is exactly what physiotherapists do with their patients. If they were to focus solely on a patient’s symptoms, there is every certainty that they would need to come back and, most likely, keep returning. 

We can apply this approach to the NHS system by shifting the focus from acute services to community services. We know that without rehabilitation, patients have a high chance of ending up back in hospital, often via A&E. Or without the availability of community-based services, they may struggle to be discharged even if they do recover sufficiently. Every day, there are thousands of patients caught up in this revolving door across the UK, but still there remains a laser focus on acute services.  

Community rehabilitation services

We’ve got to switch that focus and invest in the community rehabilitation services that enable people to make a full recovery, so they don’t have to go back into hospital. These are the services that support people to remain independent and manage their long-term conditions at home. They have been undervalued and underfunded for years and the result is a health system at breaking point and a social care system that is on its knees.  

We could be at a turning point because rehab features in NHS planning more and more. But both the government and healthcare leaders can’t afford to rest on their laurels; they must capitalise on this momentum. It needs to be front and centre. Rehab could and should be the backbone of the NHS.  

 It’s not just about the patient either; paying less attention to what happens after someone leaves hospital has a knock-on effect on family members who are often forced to give up work to care for them.  

Reading the Chief Medical Officer’s annual report last month suggests the situation will worsen because demand continues to increase. People are living longer with chronic conditions and disability.  

Everything points towards the government and healthcare leaders needing to switch their priority, focus and money towards the cornerstones of physiotherapy – prevention and rehabilitation.  


One recent innovative example that encompasses both is the Community Appointment Day, which was dreamt up by the team at Sussex MSK Partnership due to a record backlog of patients in their area seeking MSK treatment. It was contributing to low staff morale because staff simply didn’t have enough time or resource to see everyone.  

The team decided to book out their local leisure centre and invite hundreds of patients on their routine waiting list to have one-to-one assessments, access an onsite physio appointment, and meet other community and charity organisations that deliver services to address their needs holistically. The results were impressive – half of the patients were discharged from the waiting list, and a third were directed to other services better suited to their needs. 

The team at Sussex felt emboldened by the fact they had found a promising solution and were improving patients’ lives.   

For me, the most exciting aspect of these events is the person-centred approach they take. The day focuses on having conversations – rather than consultations – with patients built around asking questions to find out what really matters to the individual. 

This approach is the embodiment of the rehab model as described in the integrated care framework and the new model for community rehabilitation published by NHS England in September. It allows clinicians to ascertain the unique needs of the patient rather than viewing them through the narrow focus of the MSK ailment with which they arrive. It enables them to provide better care by working with local community services, focusing on prevention and health promotion.   

Physiotherapists’ approach

This is a solution I hope can be replicated by many more health trusts across the UK with a view to serving their unique patient population. It highlights the virtues of a new system that contains such great promise for the future yet has faced an uphill struggle to bed in.  

Finally, as a physiotherapist, you must be an optimist. You must be able to give hope to patients who have lost every ounce of it. From my own experience, I think one of the most fundamental roles of a leader is to give hope. Part of the way physiotherapists do this is by taking an asset-based approach; they focus less on what is wrong with the patient and more on what they want to be able to do. That changes the conversation. It allows the patient and clinician to work collaboratively on stepping stones to a brighter future. 

I strongly believe that these clinical skills are transferable into leadership positions, and that’s why I’ve been such an advocate for countering the narrative that it can only be a doctor or nurse at the top. It really is time to do something different – like the team in Sussex did with their Community Appointment Day.

In our personal lives, the breaking points often provide the most clarity. They act as the catalyst we need to regroup and rebuild ourselves. The NHS is at this point, and the government and healthcare leaders must be prepared to dig deep and ask difficult questions, take some risks and pave a brave new way forward. 

So why not start by seeing what can happen if you put a load of physios in charge? 

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