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?