Here I share insights into how private physiotherapy compares to National Health Service (NHS) physiotherapy. Having previously worked in the NHS as a physiotherapist, and also having been able to work in private practices apart from public healthcare, I understand the strengths and weaknesses of each side.
It must be noted right here that the topic of discussion is MSK physiotherapy rather than general physiotherapy. General physiotherapy within the NHS works as a cog within a machine; the individual part can’t be removed from the system. What we are discussing here is the benefits of seeing a private MSK physiotherapist vs seeing a public MSK physiotherapist, both of which work fairly autonomously.
The availability of NHS care to every citizen in the UK, and its effect in physiotherapy practice and treatment can’t be taken lightly. Look at two main examples which demonstrate how national health affects individual practice:
Triage – providing healthcare to a whole population with limited resource, the care is prioritized in a specific way so that those who need the care get the care. The concept of triage is also applied to public physiotherapy care, and best care isn’t looking at the best care for each individual but rather for the whole population.
Budget – public care isn’t free care. Accessible care for every person is provided by government income such as taxes received. The type of care provided is dependent on what budget is available. It can’t therefore be expected that the care for each patient is the best it could be. We see that with selections of medication which are no longer covered by the NHS, or with eye care or some dental care which isn’t available on the NHS.
We’re not here to argue about the pros and cons of a public healthcare system. The point to make here is that it needs to be made known that physiotherapy care within the public sector isn’t meant to be the best care for the individual, rather it’s for the whole population. Because of this, public physiotherapy has a ceiling to prevent best practice for the individual and it should be clear that the best practice for a service like physiotherapy would be in private care rather than public care.
Being more specific about the benefits and the weaknesses within choosing a private physiotherapist over a public physiotherapist, take a look at this list below.
Benefits:
Provide treatments not available on the NHS
Be flexible with time slots
More individualistic with treatment
Closer working relationship between the physiotherapist and client
Better communication with the physiotherapist
More relaxed, not stressed physiotherapist
Referral letters made towards GPs and other private practitioners
Free market empowers the client for choice of therapist and gives incentive for the physiotherapist to improve their practice
In summary of the benefits, the private physiotherapist has a freedom to act the way they’d like towards each individual client. This leads to a multitude of benefits as listed above for the individual client. The freedom is twofold because the client has freedom to choose as there is rarely a monopoly in healthcare.
Weaknesses:
Clients must have some form of disposable income, and treatment would be dependent on what clients can afford
Outside of NHS framework which is made to reduce malpractice and incompetence
Private physiotherapy doesn’t have access to NHS pathways which is important for patients who want to be referred to other NHS services
Private physiotherapist’s incentive is profit-driven
In summary of the weaknesses, the private physiotherapist doesn’t work within a system. The system is able to safeguard against incompetence and malpractice, it connects the physio to a wider team, and the incentive isn’t profit driven.
Restrictions and Boundaries within NHS Physiotherapy
When working within a large organization such as the NHS, there are boundaries for how one can work as a physiotherapist. Some of these boundaries are strict boundaries, others are indirect boundaries from how the system is built and how the service works. These boundaries affect the way that an NHS physiotherapist can practice, and in contrast, a physiotherapist outside of this can practice more freely to how they want to. The following are examples of restrictions and boundaries of practice that exists within public care as opposed to the freedom in private practice.
System restriction:
Booking slots within the NHS are 20-min. These are back-to-back and within this is time required to write notes and referral letters. In private practice, these booking slots can be however long the therapist chooses. The reason NHS booking slots are set up at 20-min is to keep waiting lists down, and that the essential tasks of assessing the patient and providing education, exercises or direct them towards a helpful referral can be done within this timeframe.
This type of system restriction is helpful in ensuring each person within a whole population is equally looked after. The essential treatment and processing are achieved with this, so one could imagine why a system would keep it at this length. When looking at individual care, this doesn’t make sense. Individuals do not want the barebones essential treatment; they want best treatment. One client may require more time than another, one client’s treatment may require more time than another.
Boundary of practice:
Hands-on treatment such as massage, joint manipulation or stretching generally isn’t available with NHS physiotherapy. This is because the time of consultation doesn’t allow for hands-on treatment, and also that to get an effect, there needs to be weekly or biweekly follow-up sessions over a period of weeks and this isn’t possible with the current NHS waiting lists.
Physiotherapy acupuncture isn’t normally available within NHS physiotherapy. The reason for this is similar to what’s mentioned above, however, the other issue is that evidence for clinical effectiveness is often lacking. This isn’t to say that it wouldn’t work, it’s that there is more of an unknown into its effectiveness, along with a poor understanding in the theory behind its effect. Because of this, NHS physiotherapy practices generally prioritize what is known to help in the long term – exercises, and forgo treatments such as acupuncture.
These boundaries of practice are helpful within a system to ensure each person of the population accessing this care is able to receive all that they need in the long term. For the individual client accessing the care, this however, isn’t very helpful. Many conditions benefit from hands-on treatment and acupuncture – it’s just highly dependent on the practitioner’s ability and the timing of when and for what condition it is used for. And to say that only long-term solutions are helpful is false. Just look at the amount of short-term relief pain medication our society gets through!
To say that these boundaries are just restrictive and prevent best practice would be misleading; there are positive and negative points to this:
Positives for restrictions and boundaries
Framework is formed by people with a focus on research into best practice
Booking boundaries ensures every person in the UK can get treatment, and that each person is provided with equal treatment
Treatment restrictions ensures that each person can access this treatment
Treatment restrictions helps to prevent providing treatment which does not work
Negatives for restrictions and boundaries
Each physiotherapist has a different practice, framework doesn’t allow for flexibility in how each practice
Each patient/client is an individual person with different needs. Some may require needs outside of the usual practice
Each physiotherapist investigates and stays in touch with best practice. Best practice is rarely very exact.
Physiotherapists work within the HCPC register and the Chartered Society of Physiotherapy. These bodies enforce their clinicians to stay on top of best practice.
Despite being a private physiotherapy provider, I hope to have portrayed an even balance between the pros and cons to restrictions and boundaries within public physiotherapy. At the end of all this, the main point is whether the individual private practitioner can be trusted or whether the system can be trusted. The system is put in place to safeguard against incompetence and malpractice. Therefore, it is never advisable for a therapist to immediately delve into their own private practice until years of experience.
One major advantage to seeing a public MSK physiotherapist is that they have access to NHS pathways otherwise inaccessible by the private physiotherapist. Pathways I refer to include NHS referring for imaging, orthopaedic specialists, chronic pain teams. The private physiotherapist is only able to write referral letters to GPs, and other private services such as private orthopaedic specialists and privately funded imaging.
Who Should You Choose?
There is much to weigh up here. How much do you trust the private physiotherapist? Are you getting stuck in the public system? Do you have the finances to cover private physiotherapy? Do you need more specialized care? Hopefully you now understand more about the differences between how a public physiotherapist and a private physiotherapist function. You make the decision here about your health, and if you didn’t know, you are entitled to see both an NHS physiotherapist and a private physiotherapist at the same time!
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