Changing how we think about physiotherapy is one thing, changing how we practice it is another challenge altogether, says CSP professional adviser Tamsin Baird as she continues the conversation about physiotherapy and exercise
Stop, collaborate and listen
In our previous article in this series, (August Frontline), leaders in physiotherapy education laid down a bold and clear vision: collaboration with other exercise professionals is essential to meet societal needs.
But now comes the real challenge. How do we turn these insights into meaningful changes in everyday clinical practice? As Albert Einstein wisely pointed out, ‘in theory, theory and practice are the same. In practice they are not.’
Navigating this transition isn’t always easy. Professional silos, unclear role boundaries, concerns about skill dilution, and organisational barriers can make collaboration feel more like a battlefield than a partnership.
But here’s the thing, if we don’t adapt and embrace these challenges, we risk being left behind as the fast-paced healthcare landscape evolves around us.
The key is to identify solutions – many of which are being developed within our profession.
Let’s hear from three leading practitioners who are building bridges in the exercise space. What challenges have they faced and how have they overcome them?
Orla Prowse, head of service for physiotherapy adult acute services at NHS Lothian, leads a dynamic team focused on delivering comprehensive care to patients across various specialties. Her service features a multidisciplinary team of physiotherapists, exercise professionals and other healthcare practitioners – all working together to ensure optimal patient outcomes.
Orla emphasises the critical role of effective collaboration in meeting future needs of our population. ‘Exercise is essential in prevention, recovery, rehabilitation, and prehabilitation across a wide range of specialties,’ she states. ‘However, it’s challenging to envision having enough physiotherapists to meet this growing demand. Partnering with exercise professionals allows us to provide a more comprehensive and enriched service.’
From her experience, Orla identifies several barriers that can impede effective professional collaboration. ‘A lack of understanding or clarity around different roles and responsibilities can lead to a lack of trust or confidence, limiting success or resulting in engagement that is short-lived or not scaled-up. Establishing trust is crucial to working alongside other exercise professions, including the delegation of tasks.’
Orla also highlights physiotherapists’ concerns about the future of their profession. ‘Some physiotherapists fear that they could become non-essential. However, I am confident that there is more than enough work for everyone.’
Fostering understanding and trust
To address these barriers, Orla and her colleagues at NHS Lothian have implemented several processes aimed at fostering collaboration. They provide clarity of roles and responsibilities within inter-professional teams, ensuring that everyone knows who does what, when and how. Orla states that ‘taking the time to ensure the team understands each members contributions allows us to harness the strengths of the entire group’. By fostering clarity, teams can leverage the strengths of every member, enhancing collaboration, understanding and trust.
Orla further stresses the importance of up-to-date job descriptions that clearly outline professional and operational accountability.
When roles and responsibilities are well-defined, it builds confidence and facilitates smoother collaboration. It’s not about competition, it’s about collaboration, she asserts.
Looking ahead, Orla highlights the need for physiotherapy to adapt and evolve. ‘We must continuously assess our services and determine where an appropriate skill mix, including roles for exercise professionals, is needed to meet growing demand and optimise patient outcomes,’ she advises. As new funding streams become available, she believes that strategic resource allocation will be crucial, particularly if prehabilitation is to expand effectively. ‘Incorporating exercise professionals into our teams will allow us to handle much of the physical activity component required for comprehensive patient care,’ she explains.
Orla underscores the unique contributions that each team member brings to the table. ‘In the realm of exercise and rehabilitation, physiotherapists are key in delivering targeted, specialist assessments and interventions. There is a place for all of us in addressing both current and future healthcare priorities.’
Uzo Ehiogu works as a consultant physiotherapist and a strength and conditioning coach within the Royal Orthopaedic Hospital and in private practice. He stresses that collaboration between physiotherapists and exercise professionals is essential in contemporary healthcare across all settings. ‘Collaboration with exercise professionals is an important strategy to ensure patients have the best chance of reaching their full potential,’ he states. ‘As physiotherapists, we often can’t take patients all the way from injury to peak performance alone.’
He identifies a significant barrier to effective collaboration: a lack of understanding and respect between professions.
Physiotherapists are traditionally viewed as the primary exercise professionals, but our training often falls short in areas like power development and maximal strength training.
Exercise professionals, such as strength and conditioning coaches, possess expertise that can greatly enhance patient care,’ he explains.
Uzo illustrates the need for inter-professional collaboration with practical examples. ’Consider a football player recovering from an ACL injury. They may require a rehabilitation programme that includes both physiotherapy and strength and conditioning to rebuild power and agility.
‘Similarly, a construction worker recovering from a hip replacement needs tailored exercises that prepare them for the physical demands of heavy lifting,’ he explains. ‘In both cases, collaborating with exercise professionals is essential for creating comprehensive rehabilitation plans that address each patients’ specific needs and ensure a safe return to peak performance.’
To foster effective collaboration, Uzo advocates for shared clinical environments and joint educational initiatives, such as conferences or training courses. ‘Collaboration must happen at the coalface – working together with personal trainers, strength coaches and other professionals. This builds mutual respect and enhances patient outcomes,’ he states.
Looking to the future, Uzo envisions a physiotherapy profession increasingly focussed on exercise and rehabilitation. ‘I believe NHS organisations will begin to recognise the value of physiotherapists who specialise in exercise prescription. More practitioners will become advanced practice physiotherapists, leading the strategic development of services at both local and national levels,’ he predicts. He also acknowledges the growing role of artificial intelligence, which will facilitate novel ways to deliver exercise programmes and enhance patient engagement.
He emphasises that physiotherapists will play a crucial role as leaders in this evolution. ‘We must view patients through an optimal performance lens – considering their occupational, sporting, and functional needs – rather than confining ourselves to subspecialties such as MSK, respiratory and neuro,’ Uzo concludes.
This holistic approach will empower physiotherapists to guide patients towards their highest levels of performance in both life and work.
James Gay, physiotherapist and head of nursing, professions and quality at Southern Health NHS Trust, believes that collaboration is crucial for delivering timely contemporary person-centred healthcare. He states that, ‘by integrating diverse expertise from different professional groups, healthcare providers can better challenge existing approaches and improve access to care.
This collaborative effort allows for tailored interventions that meet individual patient needs, enhancing outcomes in both the short and long term.
However, James acknowledges several barriers that can hinder effective collaboration. He believes that one significant concern is the fear of physiotherapy losing its professional identity.
’There is a perceived threat that the roles of physiotherapists could diminish,’ he explains. He also notes scepticism regarding the education pathways, training standards, and regulation of other professional groups, creating an immediate barrier to exploring collaborative opportunities. James reassures, ‘we are not going to run out of patients’, highlighting that he believes there will always be demand for physiotherapists.
To overcome these challenges, James stresses the importance of fostering a culture of professional respect. At Southern Health, they have implemented a competency-based approach to recruitment of registered staff within their MSK services, leading to the formation of multi-disciplinary teams.
‘Broadening the pool to recruit from and getting other professionals involved improves our offer to patients and will improve patient outcomes,’ he states.
Initially, there was some resistance to this approach, but by ensuring a shared understanding of each other’s training and sharing successes, a culture of respect and collaboration quickly developed. ‘A competency-based recruitment model doesn’t disadvantage the physiotherapy profession; it gets the best person with the right skill set for the job,’ he explains.
Looking ahead, James highlights the growing emphasis on preventative healthcare. ‘We must empower our patients to take control of their health and wellbeing,’ he advises. By developing shared decision-making practices, physiotherapists can work with patients to create holistic, sustainable health plans that extend beyond traditional settings.
James also details the unique contributions of physiotherapy to collaborative care. ‘By considering biopsychosocial factors during assessments, physiotherapists can identify key influences on recovery and engagement, allowing them to develop personalised care approaches. Integrating this understanding into collaborative teams ultimately enhances the quality of care and outcomes for patients.’
Engage in the conversation
The conversation about collaboration between physiotherapists and exercise professionals has evolved – it is no longer a question of ‘if’, but ‘how’.
The practitioners featured here advocate for a collaborative landscape, echoing the views of educational leaders. They acknowledge the barriers to effective collaboration, such as fear of losing professional identity, unclear role descriptions, and a lack of mutual respect.
However, they also present strategies to overcome these challenges, demonstrating that solutions do lie within our profession.
A recent CSP membership survey asked, ‘How comfortable are you with exercise professionals being part of physiotherapy services?’ The results revealed varied opinions: about 1/3 feel comfortable, another 1/3 express discomfort and the final 1/3 are unsure.
The members featured in this article clearly belong to the ‘comfortable’ group. However, we must acknowledge that this means that many of you readers, along with a significant portion of the profession, may not yet feel at ease with this collaborative approach.
Moving forward, the CSP has a crucial role in supporting all members on this collaborative journey, ensuring everyone feels empowered and equipped to adapt to the evolving needs of healthcare.
We invite you all to engage in this vital conversation. Together let’s identify resources and support mechanisms that foster comfort with collaboration, shifting our focus from rethinking physiotherapy to actively reshaping our practices. Join the conversation and share your views on social media using #CollaborateDontCompete.
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