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PT and the Greater Good

The Fourth Largest Employer in the World

Published August 19, 2009 4:33 PM by Dean Metz
It has been determined that I am fit to practice in the United Kingdom by the HPC. Now the question is: How does one go about finding work? Of course I went back to the internet. Google and Bing send me holiday cards thanking me for their support now. In any case, my first search was for "physical therapy jobs UK" which yielded "no results."

Was the job market really that bad over there? No, I just forgot that now I am a "physiotherapist." That yielded much better results. Most of which were from placement agencies. Just like here in the States, there are tons of agencies willing to place PTs in positions around the country. I started reading some of the ads, they read like this:

Locum Band 6 under the AFG scheme MSK Physio required in large Midlands hospital maintained by the NHS such and such a county trust.

Well, I was able to figure out that MSK meant musculoskeletal, but what is "Locum" and what is "band 6?"

I've made my living over the past years by being very well versed in Medicare and Medicaid issues, concerns and entitlements and how they relate to rehab. All of that is now useless in my new country. Now it is time to learn first hand about the socialized health care system in the UK, the National Health Service or NHS. After a quick search, I discovered that many companies claim to be the fourth largest employer in the world, including UPS and Siemans, but here is a bit from the NHS site directly:


Nationwide, the NHS employs more than 1.5m people. Of those, just short of half are clinically qualified, including some 90,000 hospital doctors, 35,000 general practitioners (GPs), 400,000 nurses and 16,000 ambulance staff.

Only the Chinese People's Liberation Army, the Wal-Mart supermarket chain and the Indian Railways directly employ more people.

The NHS in England is far and away the biggest part of the system, catering to a population of 50m and employing more than 1.3m people. The NHS in Scotland, Wales and Northern Ireland employ 158,000, 71,000 and 67,000 people respectively.

The number of patients using the NHS is equally mind-boggling. On average, it deals with 1m patients every 36 hours - that's 463 people a minute or almost 8 a second. Each week, 700,000 will visit an NHS dentist, while a further 3,000 will have a heart operation. Each GP in the nation's 10,000-plus practices sees an average of 140 patients a week.

It is clear that this is a BIG organization. How on earth to begin to navigate through it?

I've searched the NHS site, which actually is rather user friendly and informative (take note CMS!). I've discovered that the pay scales in the UK are very regimented under the "Agenda for Change" and that different professions fall into different areas of the schematic. Physical therapist assistants start around Band 3 and can work up to Band 5. Physical therapists start at Band 5 and can work up to Band 9. So Band 5 is the equivalent of a new grad, Band 6 a senior staff therapist and so on. You can see the whole schematic here.

Now that I've figured out what a "band" is, I still have to learn about the "trusts" which include acute, care, primary, ambulance, etc. I'm assuming these are the governing bodies or plans for each locality and service. Here is a general description from the NHS home page:


The Department of Health (DH) is in overall charge of the NHS with a cabinet minister reporting as secretary of state for health to the prime minister. The department has control of England's 10 Strategic Health Authorities (SHAs), which oversee all NHS activities in England. In turn, each SHA is responsible for the strategic supervision of all the NHS trusts in its area. The devolved administrations of Scotland, Wales, and Northern Ireland run their local NHS services separately. 

The New York Times published an interesting article from someone who, like myself, has transitioned from the US to the UK but as a consumer.

The really amazing thing is how much I feel like a new grad all over again. I'm starting from zero in terms of how to navigate this health care system and how to position myself to start working. This move will also require that I start working at a lower band than would be my level here in the states until I learn the ins and outs of the system. That will be an adjustment. I'm sure I'll manage as this is something I really want to do, much like the challenges I read from my fellow bloggers as they graduate school or tackle advanced degrees, with some concern, fortitude and resilience.

I will be submitting my visa application tomorrow. Now that is a blog in and of itself. More about that later...



Thanks for sharing your perspective on transitioning to the world of  European rehabilitation.  I've worked with a lot of foreign trained PTs.  Though we talked about some of the differences, I don't know that I've ever thought about how difficult that process must have been for them.  Good luck as you navigate your whole new world.

Janey Goude August 22, 2009 7:16 PM


You are brave to make this big transition.  I applaud you.  It must be interesting, exciting and frustrating trying to navigate through all the information.  

Jason August 22, 2009 9:44 AM

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About this Blog

    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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