Physiotherapy private practice: raising standards across the UK

The University of Brighton’s development of data collection tools and research into private sector physiotherapy practice has led to the launch of the first UK Quality Assurance awards for private practitioners and clinics.

Patient experience in the physiotherapy private sector has always been extremely varied because of a lack of quality standards and benchmarking. Increasingly, patients are holding physiotherapy services accountable for the quality and equity of care provision. Yet, in order to demonstrate and account for the delivery and quality of their clinical services, practitioners need to be collecting data in a robust and consistent way. This includes patient demographics, clinical presentation, service delivery and outcomes of care. Now, the Quality Assured awards, managed by Physio First, the trade association for chartered physiotherapists in private practice, provide standardisation for the evaluation of patient outcomes across the sector.

Adopting QA standards enables practitioners to benchmark their practice, provide robust evaluation and tailor the marketing of their services. In April 2019, BUPA endorsed the QAC, recognising it as part of their commissioning process and by 2020, 811 practitioners and 55 clinics across the UK had worked towards the QA schemes.

The University of Brighton’s musculoskeletal research programme

Prior to 2005, the University of Brighton’s musculoskeletal research programme had developed a range of standardised data collection tools to facilitate data capture. This provided practitioners with an opportunity to show how their services are efficient, timely and equitable. This work led to an initial research programme with Physio First and the 3000 strong professional network of the Chartered Society of Physiotherapy. The research designed and implemented a number of condition-specific standardised data collection tools for use by their members. The research has improved the quality of services through a shorter but integrated standardised data collection system and the development of an accessible patient-reported outcomes measure.

A patient expectation study identified gaps between expectations and the delivery of care, which could be used to improve the quality of care leading to the Brighton musculoskeletal Patient Reported Outcome Measure (BmPROM), piloted in a private practice prior to extensive testing across five NHS trusts eventually being accepted as a reliable and valid measure to evaluate physiotherapy treatment.

Collaborative longitudinal research led by University of Brighton with Physio First (the trade organisation representing chartered physiotherapists in private practice in the UK) and a professional network of the Chartered Society of Physiotherapy (CSP) led to a significant increase in memberships for the organisation enabling them to provide a standardised and optimal service across the sector. These systematised data collection and guidance tools have affected affiliated clinics, health care providers and individual practitioners, by raising the standard of care across the UK.

Quality assurance schemes in musculoskeletal practice

The Quality Assurance schemes are the only independently analysed musculoskeletal data collection schemes in the UK and interest in them continues to grow rapidly. The ‘Quality in private Musculoskeletal Working Group’, a collective of stakeholders within musculoskeletal, including the main private medical insurers (for example Bupa) and the private hospital groups as well as representatives from the Chiropractic and Osteopathic professional bodies, have featured the schemes highly as a key reference point whist agreeing a common sector wide minimum data set.

Clinics can apply to University of Brighton for a QAC assessment. All musculoskeletal practitioners within the clinic are required to collect data. The minimum number of datasets required per clinic is calculated on a pro-rata basis for each staff member and their working hours over a 12-month period. In the contract process with physiotherapy providers in 2019, BUPA identified the Physio First Data for Impact and Quality Assured Clinic scheme as the only quality assurance schemes they would endorse.

These findings are also used by Physio First to direct all of their centrally run educational courses for members. The findings are being used with the organisation’s education strand to identify gaps in knowledge, provide webinars on data collection and implementation, and to enable practice principles to target in service training more effectively. Practitioners have reported that the process of collecting data in a standardised format improves the quality of the data and stimulates reflective practice on patient scores, treatments and outcomes that may not have occurred without the data recording process. Individual practices have reported that the use of the scheme to measure outcomes gives greater confidence in quality standards, while the quality assurance schemes are central to Physio First’s vision to champion evidence-based, cost effective private physiotherapy in a changing healthcare marketplace.