(last updated July 2019)
Demand for physiotherapy services is met by around 55,000 state-registered physiotherapists, most of whom are employed in the NHS with around 4,500 or so working in private practice (around 3,000 of which are members of Physio First). The sector is regulated by the Health and Care Professions Council (HCPC) which ensures that the well-being of patients using state-registered physiotherapists is safeguarded. It's illegal for unqualified practitioners to use the terms 'physiotherapist' or 'physical therapist' when advertising their practices and the HCPC will prosecute those who do.
Patients may choose a private practice rather than an NHS physiotherapist for a number of reasons, including:
- they have been refused an NHS referral by their GP
- they are not prepared to wait to see an NHS physiotherapist - detailed research by the Chartered Society of Physiotherapists found that the average waiting time for physiotherapy in England was nearly twelve weeks, with waiting times in individual trusts longer than six months
- they have a long term problem and would prefer to always see the same practitioner - something that may not be possible in the NHS
- the private practitioner has a particular area of specialism and a track record in that area
Since August 2013 physiotherapists have been legally entitled to act as independent prescribers, so long as they have completed the appropriate training.
With NHS physiotherapy budgets having been cut in many areas, waiting times have increased and this may have created opportunities for private practitioners, particularly as the number of elderly people with musculoskeletal and mobility conditions is increasing.
Conversely, some private practices may have come under pressure from the increasing trend for NHS out-patients physiotherapy services to move towards a self-referral model allowing patients to by-pass the traditional GP referral route. Once the relevant NHS physiotherapy department has received the patient's self-referral form the patient is put on a waiting list and contacted directly with an appointment time. This is particularly popular with patients with long term conditions who know the type of therapy that they require. Some NHS physiotherapy outpatients departments also now offer walk-in assessment clinics.
Typically in a private practice, around half the patients will have their treatment paid for by private health insurance. When the economy is in difficulties, the number of people with private health insurance goes down. This happened after the financial crash in 2008 and although the economy started to recover in 2013 and continued to do so until the last half of 2015, the recovery stalled in the second half of 2015. The slowdown in the economy continued throughout 2016, made worse by the economic uncertainty and a loss of confidence amongst both consumers and businesses following the Brexit vote in June. The pound fell after the vote, increasing inflation and reducing consumers' spending power. The economy continued to perform weakly with low growth in 2017 and into 2018. Little change is forecast for the foreseeable future.
When the number of people taking out private health insurance goes down, the profits of the insurance companies suffer. To make up for this the insurance companies put pressure on the fees charged by private practitioners, including physiotherapists. In 2009 BUPA set up its BUPA Physiotherapy Network. Practitioners are required to sign up to the network under a two year contract which is renewable. When renewing BUPA compares the fees charged by the physiotherapist with other physiotherapists in the area and if they charge more than the others BUPA will only renew if they agree to reduce their fees. In the four years up to 2013 BUPA reduced the fees they were prepared to reimburse on contract renewals two or three times so that the income of many physiotherapists fell by between 20%-30%. The Chartered Society of Physiotherapists (CSP) thinks that the situation is unlikely to change in the foreseeable future.
Fees from self-paying patients also suffer during economic downturns. Paying for health care is seen as a luxury because there is a free alternative through the NHS so when people feel less well off they will often reduce or cut out this type of expenditure. There has been a long term decline in self funded healthcare and this always accelerates during a recession. To off-set this to some extent, people have become more health conscious and as a result of budget cuts do not always feel that the NHS can provide them with the service they need when they need it.
Types of private practice
Some physiotherapists working in the private sector choose to specialise, others opt for a general physiotherapy practice. There are advantages to both methods - a specialist practice can more easily target its customers (but is restricting itself to a certain type of patient) whereas a generalist has a larger potential customer base (but may find it more difficult to attract custom as the customer base is so broad).
The CSP is the main professional association for the physiotherapy sector as a whole (NHS and private). Membership of the Society gives a practitioner many benefits, including Frontline journal, favourable insurance rates and business advice.
The chartered private sector specifically is represented by Physio First, an occupational group of the CSP that produces a trade journal In Touch.
The Medico Legal Association of Chartered Physiotherapists (MLACP) is a division of the CSP that exists to promote high standards of medico-legal practice among its members. The MLACP offers members medico-legal training and provides a directory for legal professionals looking to find experts in physiotherapy practice.
Visit their websites for more information.
Physio First runs a large trade exhibition and conference every year as well as courses and events throughout the year. Visit the Physio First website for more information.