Following a recent article in the Daily Mail, we discuss whether patients are being fobbed off with NHS physiotherapy and if there’s a better solution to the current approach.
A recent article in the Daily Mail described the unsatisfactory experiences of patients treated by NHS physiotherapists.
The complaints broadly fit into 3 main categories:
• Patients were offered telephone appointments in which no physical exam had taken place.
• They were given sheets of exercises which either didn’t work or made their issue worse.
• Patients were denied manual therapy when they thought it had helped them in the past.
Physiotherapy on the NHS
In order to reduce the burden on GPs, the NHS now offers direct access to physiotherapy for patients with joint or muscular system (MSK) issues.
This makes sense as many physios will be better placed to help with these issues than GPs themselves.
Just like GPs however, they appear to be swamped with patients.
Before the pandemic NHS physios were required to listen to their patient, diagnose the issue, and give a meaningful treatment in 30 minutes.
Post pandemic this schedule seems to have been squeezed further.
Given that the treatment most physiotherapists are rightly employing is exercise, this is woefully inadequate.
Even physios working in the private sector will struggle to make progress with their patients within the 5 sessions allowed by most health insurance companies.
From the perspective of somebody who works with clients for a minimum of an hour a week for at least 3 months, it’s truly jaw dropping
Exercise must be personalised and coached
As I mentioned the solution most NHS physios are employing is exercise. In most cases this is some form of resistance training.
Applied in the right way resistance training has been shown to help with all manner of issues including back pain, shoulder pain and osteoarthritis.
The key variables that determine success however are how the exercise is performed and whether it’s personalised to the patient.
This is unlikely to be successful if the consultation takes place over the telephone, or if the patient is simply given a sheet of paper with instructions.
As described in the article, in some cases it can make matters worse.
Prevention beats cure every time
If the proven solution is resistance training, then a major part of the problem is weakness in the muscular system.
Although pain and diseases like osteoarthritis are multi factorial in nature, there’s little doubt that appropriate exercise is beneficial in most cases.
The challenging part is applying exercise to people who are already in pain. They tend to be deconditioned either as a result of their pain, or because they haven’t been maintaining their muscular systems.
This can take hours of focussed attention to improve. Something that would be very difficult to deliver within the financial constraints of the NHS.
Contrast this with people who exercise regularly and now require help with a minor issue they’ve picked up along the way.
These people are much easier to help.
The underlying issue therefore is an ageing population which isn’t participating in regular resistance training.
This problem is only going to get worse. By 2071 there will be an additional 8.5 million people over the age of 65 in the U.K.
It’s difficult to see how the NHS will be able to cope if preventative strategies are not put in place.
Summary
The approach physiotherapists in the NHS are taking is actually the right one. They just don’t have the time or the resources to implement it effectively.
Moving forward this issue will be very difficult to solve given the changing demographics of our population.
A preventative strategy is required which promotes the use of resistance training to the over 50s. This will help reduce the risk of these issues occurring in the first place.