This could be an article, broad in scope; chlorinated chicken, Virgin suing the NHS, Grenfell, to name only a few of my current bugbears – but I’ll keep it limited to private physiotherapy practice.
This is the first in a series of articles looking at the bigger picture
Fundamentally, we’re all the same. A room, a plinth, two hands and some skills. Add one patient and magic happens. We make a living and the world keeps jogging.
But what happens if people (business people) decide they want to make money out of this? The NHS doesn’t make money and it’s widely regarded as one of the most efficient health care systems in the world. However, I don’t make much money and I’m widely regarded as “not bad with money”.
Systems happen. Efficiency savings happen.
But how does this affect your health? Especially if we take as red that all physios are competent, professional and diligent.
The first thing is cost; it’s been a while now since there has been easy access to MSK or sport physio on the NHS. So recovery and rehab comes only to those that can afford it.
The second would be facilities; a gym is expensive, a hydrotherapy pool is expensive. Even acupuncture needles and theraband affect the bottom line and your CEO’s golf club membership isn’t going to pay for itself. Most NHS physios have better access to more things including things like splinting, orthopaedic foot care and normally a well equipped gym and sometimes a swimming pool. In private practice this is less common – often just a room and a plinth.
Third would be income or funding or revenue (not sure of correct term). This is extra money not coming from the patients. One source is insurance companies – they want to pay as little as possible, some as low as £22 but don’t really pay for the extra administration required. Big business can access more money from the NHS budget by bidding for contracts. Some, like Virgin (I know, I said I wouldn’t mention that) even successfully sued the NHS for millions as a result of not receiving these contracts. Does your physio benefit from this? Well, let’s just say no physio I know is going through astronaut training.
But how does this affect your health?
A physio’s a physio, right? Well, most physios are paid the same “rate”. In the NHS you get time off if you’re ill, paid when you’re on holiday and Union benefits as well as, and this is important – training. Actual development of your own skills to make you a better physio. In order for this to happen in private practice you have to take unpaid leave and then pay someone to train you. This is mandatory as a physio but there are minimums – most physios I know exceed this but it comes at a cost.
By this rationale this must mean the best physios are in the NHS? Probably, but better in a different way. They will know more about what they are being paid to deliver but this is rarely MSK and sports rehab.
Most private physios take this aspect very seriously and tend to be more tangential in their thinking and training. They will train hard to meet their clients requirements. As well as training hard in general so tend to understand their client’s sports as well as their injuries.
So this brings us to the evidence.
It’s now commonly accepted by physiotherapy that treatment should be evidenced based. The NHS has a mandate to deliver only evidenced based practice. In the world of MSK rehab the strongest evidence supports exercise. Not massage, not “clicking”, not acupuncture. So this is what you’ll get from the NHS. Most people’s experience tends to be turning up for their appointment (that they waited several months for) and being given a exercise sheet and told to get in with it. Doesn’t inspire confidence nor does it improve compliance to their regime. Apart from anything else the best results are achieved from early intervention so it’s almost pointless seeing an NHS physio 6 months later.
In private practice physios do what works – let’s not forget that not everyone does their exercises! So you’ll get a massage, some acupuncture, maybe even adjusted (like wot a chiro does) but importantly you’ll ALSO be given exercises.
So whose best?
Answers on a postcard please.
Here’s a picture of me doing what it takes to get someone better.