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Protection of Title Campaign: Your questions answered
457
Protection of Title Campaign: Your questions answered Some key questions have emerged over the last few weeks about the Society’s campaign for protection of title. This article attempts to answer them so that members are fully au fait with the complex issues involved. It should be read in conjunction with the recent article on ‘grandfathers’ in the April 1994 edition of Physiotherapy, page 263.
Q: Would the Society prefer a review of the 1960 Professions Supplementary to Medicine Act or a private member’s Bill on protection of title?
Wouldn’t that still leave thousands of people able to register?
A: Most definitely the former. There are many issues that demand a review of the Act over and above that of protection of title. This has been Council policy for many years and has been discussed in many fora - with other professions involved, with the Council for the Professions Supplementary to Medicine (CPSM) and with the Department of Health.
Given the caveats already mentioned, that is extremely unlikely. We have been trying to establish exactly how many people work as ’physiotherapists’ in addition to chartered physiotherapists but have not yet arrived at a definitive answer. Certainly using the normal advertising media, such as Yellow Pages, Thompson’s directories, local papers and so on as evidence, there are not thousands.
Why then is the Society going for protection of title now?
Would those people (the so-called ‘grandfathers’) be able to register for ever?
Because 10-15 years of discussion and negotiation have not led to a review of the Act and more recently, Government advice has been that change will only come via private members’ legislation, similar to that for the osteopaths and chiropractors. Having said that, campaigning so far has put pressure on the Government, and we await its deliberations on a review of the Act. We have also, in the meantime, won the support of the CPSM for protection of title legislation through a major revision of the PSM Act.
No. The ‘grandfather’ process would be a one-off activity, covering probably a two-year period. After that, registration would be proscribed except for people with particular qualifications. This is the case with the Osteopaths Act and would be for physiotherapists as well.
Why are we bothering about public protection? Surely the CSP’s function is to defend its members. It is certainly the Society’s primary function to defend, promote, support and speak out for chartered physiotherapists; there can be no doubt about that. However, right from the Society’s inception in 1894, high standards of practice have been central to the profession and rules of professional conduct have been in place to ensure, inter a h , public protection. The dual functions of the Society are inextricably linked.
Isn’t the title of ‘chartered physiotherapist’ already protected? Yes it is, and has been since the granting of the Royal Charter in 1920. But with so many people calling themselves physiotherapists, a much broader protection of title is now required in order to safeguard both the public and the good name of physiotherapy. The General Physiotherapy Council (GPC), for which our campaign is calling, would provide such protection. Members can be reassured, however, that until there is any new legislation, the Society will campaign vigorously for chartered physiotherapists. After all, the campaign car sticker says ’Is your physiotherapist chartered?’
Wouldn’t a change in the law mean that anyone calling themselves a physiotherapist now would be eligible for registration under the General Physiotherapy Council (GPC)? No. The first thing to say is that, before State registration came in, the same fears were expressed; yet, when it happened in 1962, there was no swamping of the CPSM by non-chartered physiotherapists. Secondly, only those practising physiotherapy as their main job for, say, five out of the six years prior to the introduction of a GPC would be eligible to register. That rules out all those people who give first-aid ‘physiotherapy’ to a local sports team at a weekend, for example. Thirdly, the whole point about a GPC is that it would set standards for the profession. Only those it considered suitably qualified would be able to register. That is a tremendous safeguard.
How would the profession benefit from bringing in ‘grandfathers’? In several ways. These people exist now and call themselves physiotherapists. Under a new GPC, only those registered would be able to call themselves physiotherapists, so the present situation in which unqualified ‘physiotherapists’ harm or do not help people, thereby encouraging them to seek treatment elsewhere - with osteopaths and chiropractors for example would be a thing of the past. As a result the status of the profession would be uplifted. If the ‘grandfathers’ weren’t subsequently considered to be practising at a suitable standard, the GPC would be able, publicly, to strike them from the register. The public would be very clear that the physiotherapy profession takes high standards seriously.
Will all those who register automatically become chartered? Absolutely not. Eligibility for the GPC does not mean automatic membership of the CSP. The Society has always and will always maintain the right to accept (and reject) people for membership. Nothing will change in this respect.
Will protection of title protect physiotherapy techniques? No. To enshrine such limitations in legislation would be unfair and render it unlikely to be passed. After all, had osteopaths and chiropractors sought similar limitations on manipulation skills in their Bills, physiotherapists would not now be able to use manipulation. Equally, physiotherapy has not stood still for 100 years and will not for the next 100 years. Members now use acupuncture, reflextherapy and so on. Physiotherapy skills could not be protected by legal ‘brick walls’ without hugely reducing the scope of practice of the profession.
Isn’t the campaign a bit late? It is certainly late but not too late. The issue has been around for some 80-odd years but, in the past, the ‘grandfather’ issue has always put off the Council of the day from pursuing the substantive issue with government, even though governments have in the past been sympathetic. Members’ justified concerns about unqualified physiotherapists today would not exist had the history been different. If the issue is not pursued today, or if the Society fails in its quest, the chartered physiotherapists of the next century may well be scornful of today’s members of the profession for letting them down.
Physiotherapy, July 1994, vol80, no 7
458
Where would the ‘grandfathers’ work? All of them at present work in private practice, so it is likely they would want to continue to do so. Once registered, they would however become eligible for employment in the NHS, so some may apply. Whether they get a job or not would depend on the post in question and the person making the appointment - almost certainly a chartered physiotherapist. Remember: Registration will only put people on the jobs market; it won’t guarantee them a job - and that will be true of chartered physiotherapists as well as anyone else on the register.
Would those institutions which currently claim to train physiotherapists but are not recognised as such be put out of business by a change in the law? Not necessarily. If the registration body decided their courses were acceptable, they would continue to train physiotherapists - in which case there would be no problem. If the GPC decided they were unacceptable, they would not be able to train physiotherapists - which would also be satisfactory.
Even if it succeeds, won’t the Society still have to campaign for chartered physiotherapists to differentiate between us and non-chartered physiotherapists? Council will have to decide. We will, after all, have removed unqualified physiotherapists from physiotherapy practice, and all people falsely calling themselves suitably qualified. At one level, it therefore would be a waste of resources to continue to campaign. Council may decided that promoting physiotherapy is enough. At another level, Council may decide that it still wants to distinguish between chartered and non-chartered physiotherapists, or that having a royal charter is meritorious enough to warrant campaigning; it implies recognition, historical importance, etc.
If the campaign is successful, would the need for a CSP still exist?
Shouldn’t this issue be put to members in a ballot?
Absolutely! The registration body would not take on board the Society’s many functions, any more than the CPSM does today. There would still need to be a professional body speaking out for chartered physiotherapists, setting standards, promoting continued professional development and research, and so on. A GPC would not and could not do that.
Successive Annual Representative Conferences (and their forebears) have called for protection of title; successive Councils have called for protection of title; many members have in the recent and distant past been highly critical of the Society for not pursuing or achieving protection of title - this has been particularly true of private practitioners. A member writing in In Touch last year, for example, declared: ‘We have no protected title - and please no one respond with the retort that only CSP members are chartered. To Joe Public, a physiotherapist is a physiotherapist; that is the title that people remember.’
Only if you believe that earlier leaders of the profession were right to reject government support for protection of title, and that future generations of physiotherapists will not condemn today’s leaders for throwing away an opportunity. Campaigning for protection of title does not mean that the Society has no time for anything else. Far from it. CSP staff and members continue to work hard on other issues and on general PR and marketing activity.
Finally, isn’t it all a waste of time?
Annual Representative Conference 1993 Motions Update Council has agreed that July’s Journal should contain an update on the action taken with the resolutions passed at last year’s Annual Representative Conference, and these are set out below. Initial responses were published in January’s Journal and the two sets of responses need to be read together. 1. The CSP is actively involved in discussions on the future arrangements for physiotherapy education. It is consulted on the ‘balance sheet’ exercise which takes a forward look at workforce requirements and has persuaded the Health Department to retain the Joint National Manpower inquiry on staffing. Numbers entering courses in 1994 are expected to stay at broadly the same level aS 1993, which saw a substantial increase. The Society will continue to press Regions for the numbers to reflect the needs of patients. So far, however, physiotherapy has fared far better than any of the other professions covered by Working Paper 10 arrangements. 3. The Education Department continues to monitor student entry figures in relation to regional employment statistics. The CSP recognises the importance of making students aware of industrial relations issues. The briefing packs for first- a@ final-year students have been updated, and that for finalists contains advice about contracts of employment. IR staff continue to visit schools regularly on request, and answer individual queries. 5. The Education Committee has agreed that a publicity campaign should be mounted in support of rotational structures. The text of a campaign leaflet drawing on the Society’s policy for the first two qualifying years was considered at the June meeting of the committee.
9. A recent editorial in Physiotherapy raised a number of questions about how the involvement of members in the CSP can best be facilitated, and invited comments. The need for a continuing debate is well recognised. 13. The presentation to the Queen gave the Society some good public relations opportunities. Press releases were sent to local
Physiotherapy, July 1994, vol80, no 7
and regional media in the places from which the physiotherapists came and to various national media. The result was several radio interviews and newspaper articles in the regions, and references to the presentation in the Daily Telegraph, The Times and The Independent. The Society administers a wide range of bursaries and awards for members, and has recently been successful in securing funding from the Hospital Saving Association for further awards (See Physiotherapy, June, page 401). 15. It has been agreed to undertake a review of the CSP’s current relationships with SlGs and funding arrangements will form part of this. 16. The outcome of the current pilot scheme is awaited in order to allow conclusions to be drawn on whether a permanent scheme should be introduced. 18. Papers presented to the Policy and Resources Committee have examined issues such as the use of information technology to distribute material to the media, the effectivecess of the Society’s parliamentary relations, the Society’s public relations network, and the information services provided to members by the Public Relations and other departments. These issues are still under review. Otherwise, PR targets are linked to the strategies of the three key functions. A particular target this year has been and is physiotherapy purchasers; either directly or indirectly, they have been subject to news stories, briefing packs, leaflets, feature articles and advertisements. 20. So far this year, the PR Department has issued new publications on ‘Physiotherapy and strokes’ and ‘Physiotherapy and incontinence’. Planned for later in the year are ’Physiotherapy
Protection of Title Campaign: Your questions answered Some key questions have emerged over the last few weeks about the Society’s campaign for protection of title. This article attempts to answer them so that members are fully au fait with the complex issues involved. It should be read in conjunction with the recent article on ‘grandfathers’ in the April 1994 edition of Physiotherapy, page 263.
Q: Would the Society prefer a review of the 1960 Professions Supplementary to Medicine Act or a private member’s Bill on protection of title?
Wouldn’t that still leave thousands of people able to register?
A: Most definitely the former. There are many issues that demand a review of the Act over and above that of protection of title. This has been Council policy for many years and has been discussed in many fora - with other professions involved, with the Council for the Professions Supplementary to Medicine (CPSM) and with the Department of Health.
Given the caveats already mentioned, that is extremely unlikely. We have been trying to establish exactly how many people work as ’physiotherapists’ in addition to chartered physiotherapists but have not yet arrived at a definitive answer. Certainly using the normal advertising media, such as Yellow Pages, Thompson’s directories, local papers and so on as evidence, there are not thousands.
Why then is the Society going for protection of title now?
Would those people (the so-called ‘grandfathers’) be able to register for ever?
Because 10-15 years of discussion and negotiation have not led to a review of the Act and more recently, Government advice has been that change will only come via private members’ legislation, similar to that for the osteopaths and chiropractors. Having said that, campaigning so far has put pressure on the Government, and we await its deliberations on a review of the Act. We have also, in the meantime, won the support of the CPSM for protection of title legislation through a major revision of the PSM Act.
No. The ‘grandfather’ process would be a one-off activity, covering probably a two-year period. After that, registration would be proscribed except for people with particular qualifications. This is the case with the Osteopaths Act and would be for physiotherapists as well.
Why are we bothering about public protection? Surely the CSP’s function is to defend its members. It is certainly the Society’s primary function to defend, promote, support and speak out for chartered physiotherapists; there can be no doubt about that. However, right from the Society’s inception in 1894, high standards of practice have been central to the profession and rules of professional conduct have been in place to ensure, inter a h , public protection. The dual functions of the Society are inextricably linked.
Isn’t the title of ‘chartered physiotherapist’ already protected? Yes it is, and has been since the granting of the Royal Charter in 1920. But with so many people calling themselves physiotherapists, a much broader protection of title is now required in order to safeguard both the public and the good name of physiotherapy. The General Physiotherapy Council (GPC), for which our campaign is calling, would provide such protection. Members can be reassured, however, that until there is any new legislation, the Society will campaign vigorously for chartered physiotherapists. After all, the campaign car sticker says ’Is your physiotherapist chartered?’
Wouldn’t a change in the law mean that anyone calling themselves a physiotherapist now would be eligible for registration under the General Physiotherapy Council (GPC)? No. The first thing to say is that, before State registration came in, the same fears were expressed; yet, when it happened in 1962, there was no swamping of the CPSM by non-chartered physiotherapists. Secondly, only those practising physiotherapy as their main job for, say, five out of the six years prior to the introduction of a GPC would be eligible to register. That rules out all those people who give first-aid ‘physiotherapy’ to a local sports team at a weekend, for example. Thirdly, the whole point about a GPC is that it would set standards for the profession. Only those it considered suitably qualified would be able to register. That is a tremendous safeguard.
How would the profession benefit from bringing in ‘grandfathers’? In several ways. These people exist now and call themselves physiotherapists. Under a new GPC, only those registered would be able to call themselves physiotherapists, so the present situation in which unqualified ‘physiotherapists’ harm or do not help people, thereby encouraging them to seek treatment elsewhere - with osteopaths and chiropractors for example would be a thing of the past. As a result the status of the profession would be uplifted. If the ‘grandfathers’ weren’t subsequently considered to be practising at a suitable standard, the GPC would be able, publicly, to strike them from the register. The public would be very clear that the physiotherapy profession takes high standards seriously.
Will all those who register automatically become chartered? Absolutely not. Eligibility for the GPC does not mean automatic membership of the CSP. The Society has always and will always maintain the right to accept (and reject) people for membership. Nothing will change in this respect.
Will protection of title protect physiotherapy techniques? No. To enshrine such limitations in legislation would be unfair and render it unlikely to be passed. After all, had osteopaths and chiropractors sought similar limitations on manipulation skills in their Bills, physiotherapists would not now be able to use manipulation. Equally, physiotherapy has not stood still for 100 years and will not for the next 100 years. Members now use acupuncture, reflextherapy and so on. Physiotherapy skills could not be protected by legal ‘brick walls’ without hugely reducing the scope of practice of the profession.
Isn’t the campaign a bit late? It is certainly late but not too late. The issue has been around for some 80-odd years but, in the past, the ‘grandfather’ issue has always put off the Council of the day from pursuing the substantive issue with government, even though governments have in the past been sympathetic. Members’ justified concerns about unqualified physiotherapists today would not exist had the history been different. If the issue is not pursued today, or if the Society fails in its quest, the chartered physiotherapists of the next century may well be scornful of today’s members of the profession for letting them down.
Physiotherapy, July 1994, vol80, no 7
458
Where would the ‘grandfathers’ work? All of them at present work in private practice, so it is likely they would want to continue to do so. Once registered, they would however become eligible for employment in the NHS, so some may apply. Whether they get a job or not would depend on the post in question and the person making the appointment - almost certainly a chartered physiotherapist. Remember: Registration will only put people on the jobs market; it won’t guarantee them a job - and that will be true of chartered physiotherapists as well as anyone else on the register.
Would those institutions which currently claim to train physiotherapists but are not recognised as such be put out of business by a change in the law? Not necessarily. If the registration body decided their courses were acceptable, they would continue to train physiotherapists - in which case there would be no problem. If the GPC decided they were unacceptable, they would not be able to train physiotherapists - which would also be satisfactory.
Even if it succeeds, won’t the Society still have to campaign for chartered physiotherapists to differentiate between us and non-chartered physiotherapists? Council will have to decide. We will, after all, have removed unqualified physiotherapists from physiotherapy practice, and all people falsely calling themselves suitably qualified. At one level, it therefore would be a waste of resources to continue to campaign. Council may decided that promoting physiotherapy is enough. At another level, Council may decide that it still wants to distinguish between chartered and non-chartered physiotherapists, or that having a royal charter is meritorious enough to warrant campaigning; it implies recognition, historical importance, etc.
If the campaign is successful, would the need for a CSP still exist?
Shouldn’t this issue be put to members in a ballot?
Absolutely! The registration body would not take on board the Society’s many functions, any more than the CPSM does today. There would still need to be a professional body speaking out for chartered physiotherapists, setting standards, promoting continued professional development and research, and so on. A GPC would not and could not do that.
Successive Annual Representative Conferences (and their forebears) have called for protection of title; successive Councils have called for protection of title; many members have in the recent and distant past been highly critical of the Society for not pursuing or achieving protection of title - this has been particularly true of private practitioners. A member writing in In Touch last year, for example, declared: ‘We have no protected title - and please no one respond with the retort that only CSP members are chartered. To Joe Public, a physiotherapist is a physiotherapist; that is the title that people remember.’
Only if you believe that earlier leaders of the profession were right to reject government support for protection of title, and that future generations of physiotherapists will not condemn today’s leaders for throwing away an opportunity. Campaigning for protection of title does not mean that the Society has no time for anything else. Far from it. CSP staff and members continue to work hard on other issues and on general PR and marketing activity.
Finally, isn’t it all a waste of time?
Annual Representative Conference 1993 Motions Update Council has agreed that July’s Journal should contain an update on the action taken with the resolutions passed at last year’s Annual Representative Conference, and these are set out below. Initial responses were published in January’s Journal and the two sets of responses need to be read together. 1. The CSP is actively involved in discussions on the future arrangements for physiotherapy education. It is consulted on the ‘balance sheet’ exercise which takes a forward look at workforce requirements and has persuaded the Health Department to retain the Joint National Manpower inquiry on staffing. Numbers entering courses in 1994 are expected to stay at broadly the same level aS 1993, which saw a substantial increase. The Society will continue to press Regions for the numbers to reflect the needs of patients. So far, however, physiotherapy has fared far better than any of the other professions covered by Working Paper 10 arrangements. 3. The Education Department continues to monitor student entry figures in relation to regional employment statistics. The CSP recognises the importance of making students aware of industrial relations issues. The briefing packs for first- a@ final-year students have been updated, and that for finalists contains advice about contracts of employment. IR staff continue to visit schools regularly on request, and answer individual queries. 5. The Education Committee has agreed that a publicity campaign should be mounted in support of rotational structures. The text of a campaign leaflet drawing on the Society’s policy for the first two qualifying years was considered at the June meeting of the committee.
9. A recent editorial in Physiotherapy raised a number of questions about how the involvement of members in the CSP can best be facilitated, and invited comments. The need for a continuing debate is well recognised. 13. The presentation to the Queen gave the Society some good public relations opportunities. Press releases were sent to local
Physiotherapy, July 1994, vol80, no 7
and regional media in the places from which the physiotherapists came and to various national media. The result was several radio interviews and newspaper articles in the regions, and references to the presentation in the Daily Telegraph, The Times and The Independent. The Society administers a wide range of bursaries and awards for members, and has recently been successful in securing funding from the Hospital Saving Association for further awards (See Physiotherapy, June, page 401). 15. It has been agreed to undertake a review of the CSP’s current relationships with SlGs and funding arrangements will form part of this. 16. The outcome of the current pilot scheme is awaited in order to allow conclusions to be drawn on whether a permanent scheme should be introduced. 18. Papers presented to the Policy and Resources Committee have examined issues such as the use of information technology to distribute material to the media, the effectivecess of the Society’s parliamentary relations, the Society’s public relations network, and the information services provided to members by the Public Relations and other departments. These issues are still under review. Otherwise, PR targets are linked to the strategies of the three key functions. A particular target this year has been and is physiotherapy purchasers; either directly or indirectly, they have been subject to news stories, briefing packs, leaflets, feature articles and advertisements. 20. So far this year, the PR Department has issued new publications on ‘Physiotherapy and strokes’ and ‘Physiotherapy and incontinence’. Planned for later in the year are ’Physiotherapy