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Encouraging Facets of Academic Developments in the

Physiotherapy Profession-in the UK and Sri Lanka

by Bertie Samarasinghe-February 8, 2015
It was so gratifying to reflect on the academic achievements in
physiotherapy that I was prompted to write this article to update my
colleagues, relevant officials of the Health Ministry, professional organizers
lecturers, member of the Sri Lanka Society of Physiotherapy and readers.
1. Self Referral
Self-referral is a system of access that allows patients to refer themselves
to a physiotherapist directly, without having to see or be prompted by
another health-care practitioner. There is indisputable evidence that selfreferral to physiotherapy results in high level of service-user satisfaction,
lowers NHS costs and lower-levels of work absence. In 2009 the
government introduced plans to actively promote self-referral to
physiotherapy services in England.
* The patient completes a short self assessment questionnaire, which is
reviewed by a physiotherapist, and depending on their clinical need an
appointment is allocated accordingly.
* Tests have found that self-referral has a range of benefits for patients,
GPs and employers. It is associated with cost savings and reduces the
needs for health care intervention such as X-rays and prescribing and for
referral to orthopaedic specialists. It also lowers rates of sickness absence,
and motivates patients to manage their own health.
* Self-referral is popular with patients. It is a patients-centered approach

that ease of use, convenience, portability and would promote selfmanagement. Studies show that people who self-refer take few a days off
work and are about half are likely to be off for one month, compared with
those referred for physiotherapy by a GP.
* Self-referral to physiotherapy is efficient for other health care providers
too. It reduces cost, time and resources. A Patient often sees a GP several
times before being referred to a physiotherapists by that time their
condition may be more difficult to resolve. Evidence shows that early
intervention for lower back pain reduces its reoccurrence in the following
year by upto 40%. A proportion of people who would have normally had
seen their GP simply opt for a more direct route to solve their problems.
* The feedback from GPs in the self-preferral study was extremely
positive, with 91% in England wanting self-referral facility to continue.
Reasons for these include saving GP time and enhancing the patient
autonomy, enabling GP's to focus their resources in those with more
complex medical problems.
2. The Transformation of the 3 year Diploma Course to 4 years BSc Degree
(Hons) Course of the Chartered Society of Physiotherapy.
This took place in 1993. Most institutions in UK have three year Hons.
Degree courses. Scotland is the only country that still a four-year
undergraduate physiotherapy Degree course.
In Sri Lanka, the School of Physiotherapy was established in 1957, and a
two year Diploma Course in Physiotherapy was organized. I had the good
fortune to be attached to the academic staff for many years.
After nearly 50 years of fruitless and repeated representations to some
intransigent authorities requesting a four year BSc Degree Course in
physiotherapy in Sri Lanka, it was, at tong last, approved in 2006. In the
meanwhile, 14 countries around the world, including our nearest
neighbour, India, were already conducting 4 year BSc Degree Courses in
Physiotherapy! Our deep gratitude goes to the persistence and tenacity of
the leading members of the Sri Lanka Society of Physiotherapy, who
relentlessly fought over the years, till their justifiable demands were
conceded. Today we have three four-year BSc (Hons) Degree Courses
conducted at

a. The University of Peradeniya.
b. The Faculty of Medicine Colombo.
c. The Kotalawala Defence Academy, Ratmalana.
In order to upgrade the present two- year diploma holders in
Physiotherapy, Kelaniya University is finalizing a two- year External BSc
Degree Course in Physiotherapy, which is welcome news.
3. The legal rights to administer intra-articular and intra-muscular
injections by
physiotherapists.
Physiotherapy gained full professional autonomy in 1977, and rapidly
expanded the types of activity that members undertook. The concept of
"extended roles" emerged in the late 1980's/ early 1990's as hospitals
sought to tackle lengthy orthopedic surgeon waiting list by utilizing other
staff groups to triage (screen patients in the clinic to determine priority of
treatment) and encourage referrals and manage referrals. In 1994, the
CSP issued a statement that setout giving injections, requesting X-rays
and general acting as clinical assistance was considered outside the scope
of Physiotherapy practice and members were not covered by the CSP PLI
scheme to perform such activities. From this, the concept that "external
scope practice" was separate from physiotherapist emerged. However, as
the profession continued to evolve it was clearly identified that many
"extended scope activities" drew on physiotherapist skills. As we are
becoming more involved in managing all of the patient's care from
assessment, diagnosis treatment and discharge, in 1997, the CSP Council
decided to incorporate injection therapy formerly into the scope of
Physiotherapy practice.
4. The legal sanction to prescribe by Physiotherapists
Physiotherapist's were granted world's first independent prescribing rights
in August 2013.

Prescribing is an advanced practice activity only undertaken by specialist
Physiotherapist who have undergone additional education and training to
achieve and additional HCPC annotation to distinguish their prescribing
ability. Physiotherapist must only prescribed when medicines use enhances
the delivery of physiotherapy intervention, or supports the delivery of care
pathways that are managed by the physiotherapist. The scope of
prescribing practice for an individual physiotherapist is defined as :
The physiotherapist may prescribe any licensed medicine from the British
National Formulary, within the overarching frame work of human
movement performance and function. They may also mix medicine prior to
administration and may prescribe from a restricted list of controlled drugs
as set out in Regulations.
5. The authority to issue Medical Certificates by Physiotherapist to
patients. Physiotherapists are one of the allied health professionals who
are able to contribute to the AHP Advisory Fitness Work Report which was
developed in 2013. The AHP's Advisory Fitness for Work Report can be
used ;
* by AHP's to provide advice to employees on fitness for work and how to
return to work could be facilitated.
* by employees to provide evidence that their employer for sick pay
purposes (although employers may require an additional a statement of
fitness for work from a doctor in order to pay-sick-pay).
* by employees to give the employer a return to work discussion by
employers to agree appropriate modifications to environment to enable
them to work.
* by a doctor as a report on which to base the provision of a Statement of
Fitness for Work to the employee.
The aim of the article is
a. to help raise the profile of the profession in Sri Lanka.
b. that physiotherapy is innovative prove cost effective and deliver quality

care.
c. that physiotherapy can build resilience, keep people independent and
live long and well.
d. to inform and hopefully educate the readers on the benefits of
physiotherapy available to them through safe, compassionate and
professional hands.
e. to help face new challenges to professional development in Sri Lanka.
The writer is a Chartered Physiotherapist.
Posted by Thavam