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PT and the Greater Good

Hands Off!

Published April 17, 2012 9:58 AM by Dean Metz

I've received a bombardment of emails from PT friends back home. Most of them written in all caps (meant to be screaming) at the outrageous approach one provider has adopted to the treatment of back and neck pain here in the UK. Physios are now banned from actually touching patients who present with back or neck pain to a social enterprise physio provider in Nottinghamshire. Please read this article in the national commuter newspaper.

An article on this also appeared in the CSP weekly, Frontline (the UK equivalent to ADVANCE). That article gave a little more clarity. First, the back and neck service in this community had previously been attached to the NHS. The people involved thought they could do a better job than the NHS so they came up with a business plan and bid for the contract.

That process is called "Social Enterprise" here. It allows for services to take their wares to the open market and serve the NHS as any "qualified provider." In this way, they break free of the constraints of the NHS. They won the bid. Things looked rosy for a while. After a year they realized that not only were they not making any money, they were losing it... seriously. So now they have adopted the two sessions of advice and guidance with no hands-on protocol to recoup losses and hopefully make money the next year. The CSP is not happy and neither is the press.

Do I think the NHS will change this? Absolutely not! Back pain is one of the least profitable areas of PT because of the chronic nature of the ailment, the presence of secondary gain issues, and comorbidities that delay or impair progress. The NHS would only be too happy to drive people with back pain into the offices of chiropractors and osteopaths. The NHS doesn't cover those services. In one fell swoop, they get rid of one of the biggest financial drains on the system. From a business point of view, it makes perfect sense. From a physio point of view, it is degrading.

Remember when I said the NHS was like a giant HMO? Is that analogy making more sense now?


Miss Wells, from your use of the word "ward" I'm guessing you were an inpatient at the time? You give a perfect anecdote as to why working with evidence based protocols is necessary and that PTs and physios don't simply "do their own thing". Unfortunately, as in every profession, there are great physios, good physios, and the ones we don't talk about. Sounds like you got one of the latter. I sincerely hope your back pain was resolved in the end.

Dean Metz February 25, 2014 6:09 AM
So Tyneside UK

I have had terrible problems with my back following my 2nd pregnancy and was referred to an nhs physio down here in Hampshire. It seemed like all they wanted to do was drive me from their ward! They gave me exercises that exacerbated the problem and when I told them they gave me further exercises including ones that were already causing excruciating pain. Now I'm all for no pain, no gain. I used to be an international gymnast so know my body quite well but what they were doing was ridiculous, all the while making light of my situation telling me it's not a serious problem and not to lay around all day (chance would be a fine thing with 2 children under 2). All in all I found them very patronising whilst giving me advice I could have found myself on the Internet. So you guessed it, I went to a chiropractor in the end.

Alex Wells February 24, 2014 2:05 AM


(I couldn't resist)

The article could just as well have been an ad for Coca-Cola and been as enlightening. Frustrating.

When I got into PT over 25 years ago, it was still about medicine (or at least to a doe-eyed twenty year old it seemed that way), but even then it had begun its morphing into more and more focused on big business.

I fear we may not be far behind you.

Jane Goude April 20, 2012 12:47 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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