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CHAPTER CONTENTS

INTRODUCTION

FINAL

This chapter aims to provide the reader with an insight

Introduction

1

into what it means to be a professional (in the context

Characteristics of being a professional

2

of this

chapter,

a physiotherapist),

focusing on the

responsibilities, both ethical and practical, that are

Responsibilities of being a professional

5

inherent in claiming to be a professional working in

Becoming an autonomous profession

6

the UK.

-

NOT

The current status and privilege of physiotherapists

Clinical governance

7

as autonomous professionals will be placed in the con-

OF

ELSEVIER

Evidence-based practice 8

text of the history of the profession, and the impact of

autonomy on clinical practice will be explored. The

Clinical effectiveness

10

chapter will reflect on the implications for physiothera-

pists of the increasing expectations of both the general

public and the government for health professionals to

Applying national standards and guidelines

locally 10

deliver high-quality health services. Explanations of

Evaluating services

12

how

physiotherapists can

meet

these expectations

through clinical governance will be provided. Finally,

Continuing professional development

13

the reader will be offered a look at the possible future

CONTENTof the profession in light of the changing shape of

Having the right workforce (and using it

health services in the UK.

appropriately) 14

Physiotherapists come into the profession because

Monitoring clinical governance

15

they have an underlying sense of

and commitment

The future

15

to

helping others and improving

their quality of

life. Indeed, Koehn (1994) argues that professionals

Sources of critical appraisal tools

17

can be

thought

of as being

defined

by a distinctive

PROPERTY

commitment to

benefit the client.

Physiotherapists

Acknowledgements

18

want to be able to use their acquisition of knowledge,

References

18

skills

and attributes from qualifying

programmes to

SAMPLE

benefit people, in whatever specialty or with whichever

patient group they wish to work once qualified

for example, elite athletes, older people, people with

developmental or acquired conditions, people with

mental health problems. This chapter will help readers

understand how they can

make

benefiting patients

a reality in the context of the expectations of society

for the provision of high-quality, safe and effective

care.

1

While earlier editions of Tidy’s Physiotherapy may

The professional body for physiotherapists, the

have been popular for their prescriptive descriptions

Chartered Society of Physiotherapy (CSP), provides a

of what physiotherapists should do in particular situa-

framework for the curriculum of physiotherapy educa-

tions or for specific conditions, this edition demands

tion and approves those physiotherapy programmes

more from the reader. No two patients are quite the

that meet the requirements of the framework on behalf

same; each requires the skills of the physiotherapist to

of the profession.

carry out a full and accurate assessment, taking account

The CSP also publishes rules of professional conduct

of the individuality of the patient, and then to use clini-

and standards of physiotherapy practice derived from

cal reasoning to problem-solve and offer appropriate

within the profession, which are in harmony with those

options for treatment, on which the patient will make

of the HPC. Anyone on the HPC physiotherapist regis-

a decision. A professional is required to have the matu-

ter may call themselves a physiotherapist; only those

rity to take full responsibility for the privilege of auton-

who are members of the CSP may call themselves a

omy. This will be by maintaining a competence to

chartered physiotherapist.

practise through career-long learning and through

The breadth of activity and resources that the CSP

self-evaluation, as well as through the evaluation of

undertakes and provides seek to establish a level of excel-

present practice; by keeping up to date with the most

lence for the profession. Its education and professional

effective interventions; and by maintaining the trust of

activity is centred on leading and supporting members’

patients by doing good. Readers should realise that

delivery of high-quality, evidence-based patient care. This

while this approach is more challenging, it will also

FINAL

activity emanates from its status as the professional body

be more rewarding.

for physiotherapy in the UK and therefore as the primary

holder and shaper of physiotherapy practice. The CSP

CHARACTERISTICS OF BEING

works on behalf of the profession to protect the chartered

status of physiotherapists’ standing, which is one denot-

A PROFESSIONAL

NOT

ing excellence. It is worth noting that the relationship with

Becoming a professional requires an acceptance, often

-

the HPC is one of registrant; with the CSP it is one of

implied, of certain responsibilities, in return for certain

membership.

ELSEVIER

privileges. These responsibilities require certain beha-

While the principles of professionalism should be

viours and attitudes of individuals in whom profes-

aspired to by physiotherapists anywhere in the world,

sional trust is placed. Broadly, professionalism requires

the existence and/or role of regulators and professional

these attributes:

OF

bodies and the way these characteristics are manifested

may vary, depending on political, social and financial

▪ a motivation to deliver service to others

factors.

▪ adherence to a moral and ethical code of practice

▪ striving for excellence, maintaining an awareness of

Belonging to an organisation that sets

limitations and scope of practice

standards and ideals of behaviour

▪ the empowerment of others (Hodkinson 1995 and

CONTENT

Medical Professionalism Project 2002, both cited in

The Rules of Professional Conduct (the Rules) were

CSP 2005b).

endorsed at the very first council meeting of the CSP

To practise in the

profession of

physiotherapy

in

in 1895

(Barclay 1994)

and have been revised and

updated at intervals since. The Rules define the profes-

the UK, registration

with the statutory regulator

is

sional behaviour expected of chartered physiothera-

required. The Health Professions Council (HPC) sets

pists. The current Rules set out a number of principles,

standards of professional training,

performance and

the basis for all of which is to safeguard patients (CSP

conductPROPERTYfor thirteen professions, including physiother-

2002a).

They include

requirements that chartered

apy (HPC 2006). It keeps a register of health profes-

physiotherapists should:

sionals that meet its standards, and it takes action if

SAMPLE

▪ respect the dignity and individual sensibilities of

registered health professionals do not meet those stan-

dards. It was created by the Health Professions Order

every patient

2001 (HPC 2002). Only those registered with the HPC

▪ work safely and competently

may call themselves a physiotherapist/physical thera-

▪ ensure the confidentiality of patient information

pist (HPC 2006). It is the duty of registrants to keep

▪ report circumstances that might otherwise put

up to date with the processes and requirements decreed

patients at risk

by the Regulator; this is particularly important currently

▪ not exploit patients

because of the changing attitudes to, and legislation of,

▪ act in a way that reflects credit on the profession and

healthcare professions in recent times.

does not cause offence to patients.

▪ involving patients in decision-making

practise of its members, except those described in the

▪ being fully abreast of the evidence of effectiveness

next paragraph. The HPC considers all complaints of

in order to inform patients and offer the most effec-

this nature.

tive interventions

The Society

does however, handle complaints or

▪ evaluating their practice and measuring a patient’s

consider matters of fitness to practise concerning mem-

health gain as a result of treatment.

bers of the Society who are not regulated by the HPC.

This reflects the increasing expectations of the public to

(This includes physiotherapist’s physiotherapy treat-

be active partners in their healthcare, the expectations

ment of animals, students and the CSP’s associate

of clinical governance to provide more effective care,

members (CSP 2006).)

FINAL

and the growing demands of funders of services, as

Possessing knowledge and skills not shared

well as patients, to be able to demonstrate the benefits

by others

or ‘added value’ of physiotherapy. All these will be dis-

cussed later in the chapter.

Any profession possesses a range of specific knowledge

Standards of Physiotherapy Practice is written in a way

and skills that are either unique, or more significantly

that offers a broad statement of intent (the Standard

NOT

developed than in other professions. The World Congress

statement), which is followed by a number of measur-

-

for Physical Therapy (WCPT) has described the nature of

able statements about expected performance or activity

physiotherapy as ‘providing services to people and popu-

ELSEVIER

by the physiotherapist, student or assistant (known as

lations to develop, maintain and restore maximum move-

‘criteria’). For example, Core Standard 2 states ‘Patients

ment and functional ability throughout the lifespan’

are given relevant information about the proposed

(WCPT 1999).

physiotherapy

procedure,

taking into account

their

It adds, in a detailed description, that physical ther-

OF

apy is ‘concerned with identifying and maximising

age, emotional state and cognitive ability, to allow

informed consent.’ The criteria for this standard include

movement potential, within the spheres of promotion,

the following:

prevention, treatment and rehabilitation’ (ibid, p28).

▪ The patient’s consent is obtained before starting any

WCPT identifies the interaction between ‘physical

therapist, patients or clients, families and care givers,

examination/treatment.

CONTENTin a process of assessing movement potential and in

▪ Treatment

options, including

significant

benefits,

establishing agreed upon goals and objectives’ as cru-

risks and side-effects, are discussed with the patient.

cial and acknowledges that

this requires knowledge

▪ The patient

is

given

the

opportunity

to

ask

and skills unique to physical therapists (ibid, p28).

questions.

In the UK,

one approach

to conceptualising phy-

▪ The patient is informed of the right to decline phys-

siotherapy has been to focus on three core elements: mas-

iotherapy

at

any

stage

without that prejudicing

sage, exercise and electrophysical modalities (CSP 2002a).

future care.

For physiotherapy, the roots of the profession can be

PROPERTY

▪ The patient’s consent to the treatment plan is docu-

found in massage, the founders of the profession having

mented in the patient’s record.

been a group of nurses who carried out massage. The sig-

SAMPLE

nificance of therapeutic touching of patients still sets

These measurable criteria allow performance to be

assessed against them, through clinical audit, described

physiotherapy aside from other professions. Physiothera-

in more detail later.

pists continue to use massage therapeutically as well as a

The content of this standard and accompanying

wide range of other manual techniques such as manipu-

criteria set out the specific actions required in order to

lation and reflex therapy. Therapeutic handling under-

conform, in this case, to an aspect of Rule 2 of Rules of

pins many aspects of rehabilitation, requiring the

Professional Conduct: ‘Chartered physiotherapists shall

touching of patients to facilitate movement.

respect and uphold the rights, dignity and individual

Another description of the profession’s knowledge

sensibilities of every patient,’ which includes guidance

and skills can be found in the Curriculum Framework