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Representatives' Conference
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Representatives’ Conference Professional practice, management, education and regulatory topics were debated during the first half of the 1992 Annual Representatives’Conference reported here. The meeting was held in the Royal Concert Hall, Glasgow, on October 8 and 9. Paul Lynch was chairman, with Fiona Jenkins and Natalie Beswetherick as vice-chairmen. Patricia Phillips, chairman of Council, reported on Council’s response to motions passed at the previous conference. In the motions listed below, C Indicates a composite motion. Those not listed were not debated because of lack of time. The second part of the conference will be reported in next month’s issue.
Professional Practice 1. The CSP should actively support its members who are asked to participate In sklll mix exercises, in order to malntaln professional standing and prevent the profession from becoming obsolete. Birmingham Branch
Allson Keeling, from BirminghamBranch, said that while skill mix exercises might be used to improve service delivery there was real concern that, as resources became tighter, they could be used primarily as a means of cutting costs. Physiotherapists provided unique skills of clinical judgement and decision-making. In the light of the high profile that health care assistants have, the CSP should be actively promoting the unique skills of chartered physiotherapists, she said. If not, she feared that in some instances physiotherapists would be phased out and disappear. Sue Jackson, ACPM, said it was only by taking part in these exercises that it was possible to influence the outcome, and the ACPM urged the CSP to support its members to enable them to participate. An internal seminar on skill mix had been organised by the CSP to produce briefing and course material, said David Fleming, CSP director of industrial relations. The intention was to run regional workshops on the issue and eventually to providedetailed briefing packs and papers on skill mix, and a lobbyingdocument. The CSP was aware that there were going to be many problems with skill mix but a start had been made to provide the kind of services being called for in the motion. The motion was carried by a very large majority. 2. Wlth Increasing number of selfgoverning trusts more emphasis is being placed on cllnlcal audit. The Society should strongly urge members to seek training and funding from the trusts and that we, the profession, retain control of the evaluatlon of our own service. Scottish stewards
More emphasis was being placed on clinical audit, said Karen Bruce for Scottish stewards. Put simply, she explained, physiotherapists’examination, treatment plan and outcome were the core
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elements of audit. Members had heard about external agencies offering to evaluatetheir service, but she said: ‘We are the most ably qualified people around to account for what physiotherapistsdo and what physiotherapypractice achieves.’ By utilising audit the profession would be able to prove why and when a physiotherapist was more cost-effective than a partiallyskilled helper. She said the profession had worked hard to ensure that physiotherapistswere highlyskilled clinicians. The profession had to seize the opportunity to prove how effective and efficient their service was and it was important to do so now before other organisations evaluated physiotherapists’ jobs and input and replaced them with someone from a Youth Training Scheme. Wendy Whlte, of Scottish stewards, said members kad to be assertive in demanding adequate training to evaluate and promote the service they provide. Sue Jackson, ACPM, urged support for the motion. She said the profession should be encouraging full clinical audit by looking at the whole progress of the patients from their time of injury or trauma in order to assess the best outcome. She said it should be looking not just at trusts but at the Department of Health and the regions for funding. Jennie Collins, chairman of the CSP Professional Practice Committee, spoke of the work going on in the profession with the standards of practice, which could be modified and used for clinical audit. She urged members to participate in the workshops around the country on clinical audit. The motion was carried by a large mqority.
3. The Chartered Society should establish a working party to determine the criteria for the use of the term ‘specialist’ within the profession. OCPPP The motion, said Jean Kelly of OCPPP, was about re-starting the debate on what was meant by the use of the term ‘specialist’, now and in the future, and whether the CSP should look at developing a recognised route to the status of specialist. She said the motion was
not seeking to restrict professional development, to pigeon-hole anyone or to fossilise the profession in a fixed moment in time. But the term needed clarification and she asked the profession to look at the issue again. Speaking against the motion, Nina Melvllle, ACPIN, said she appreciated the importance of specialisation and the development of clinical skills to a high standard. But she asked: ‘Do we wish to see a profession divided entirely into small Blite groups?’ Theresa Ball, MACP, said it would be easier to explain the role and value of specialists to other professions if they were officially recognised by the CSP. There was, she said, a need for generalists and specialists in the professionbut it was vital for the CSP to recognise specialists. The motion was narrowly lost. 4. Employers should be able to requlre a physiotherapist to be a member of the appropriate Clinical Interest Group, If they are prepared to pay the fee. ACPRC Clinical Interest Groups had changed ovpr the years, said Frances West, ACPRC. She outlined the three main benefits from CIG membership - access to research, to continuing education and to standards and guide lines to good practice. Managers, she said, should show their respect for ClGs by expecting specialists to be members. Fiona Hawklns, North West stewards, said ClGs had survived on the sheer hard work and commitment of their members and asked whether they would want people to come along just because their manager said they should. If the motion was agreed, she said, it would be an infringement of liberty. Sue Jackson, ACPM, agreed with everything the proposer said but could not support the motion. More needed to be done by the ClGs to ensure more local recruitment, with local meetings and local participation. Wendy Whlte, of Scottish stewards, also speaking against the motion, said she would not want people attending a group who did not want to be there, ‘a noninterested member of a special interest group’. The motion was lost overwhelmingly.
Scrutineers The following people volunteered to act as scrutineers for the Conference: Charles McLeod, Susan Rumbold, Erica Nix, Caroline Smith, Jane Featherstone Witty.
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847 5. The CSP should encourage physiotherapy managers to retain a specialist cllnlcal workload, albeit on a part-time or consultancy basis. ACPM
Maggle Downton, ACPM, called on the CSP to encourage all physiotherapy managers to retain a clinical caseload to ensure that professional expertise was not wasted. This would enable managers to retain credibility with staff and colleagues, to keep in touch with professional issues, and to maintain first-hand knowledge of staff and patient perspectives. When not involved clinically, she said, managers could become more remote from the practice of physiotherapy. It was important, she said, for physiotherapists to have some clinical involvement so that scarce and expensive clinical expertise was not lost.
The CSP should support the introduction of a higher clinical grading structure so that physiotherapists could continue to progress in their careers and retain their specialist skills, while taking on an everincreasing management role. Anne Walker, physiotherapy consultant with Exeter Health Authority, pointed out the vulnerability of physiotherapy managers who have not kept on a specialist clinical caseload and she urged them to retain some clinical expertise. Sandra Hlcken, of West Midlands stewards, said managers needed to be fulltime managers and while they needed to have a clinical background she suggested they could draw on the knowledge and expertise of their colleagues. The motion was lost, with 87 for and 90 against.
Physiotherapistsand GPs 7. The CSP should strongly campaign against GP fundholders specifying phydothempy tteatment modalltles, and thus thmatenlng professional autonomy. AACR Cumbria Branch Sue Garner of AACP said physiotherapists were best placed to know the range of modalities available and GPs needed to be aware of this. She said physiotherapists had been looking at ways to speed up throughput, without sacrificing quality, decrease waiting lists in physiotherapy departments. Chris Mercer, South West Thames and Kingston Branch, said he agreed with the basic sentiment of the motion. But, he said, it was a matter of communicationbetween physiotherapistsand other professionals. Linda Andrews, Cumbria Branch, speaking in favour of the motion, pointed out that fundholding GPs would be referring patients to physiotherapists and it was important to have clear and direct communication between the two professions. It was time physiotherapists realised they had gained professionalautonomy, through a process of education and negotiation, said Maggie Downton, ACPM. The same must be done with GP fundholders. She referred to the ‘contacting’ and ‘marketing’
processes which could be used in an effective way and said she could not support the motion in the way it was presented. The motion was carried. 8. This conference believes that direct employment of physlotheraplsts by GPs Is likely to cause severe fragmentation of the services currently provided by the local hospital or community units. Therefore the CSP should actively campaign against such direct employment of Individual physiotherapists. National Group of Regional Stewards, Northern stewards
Claire Strlckland, for the National Group of Regional Stewards, said there were major disadvantages to all involved in the direct employment of physiotherapists by GPs. Among these were the problem of isolation without professional back-up from colleagues. She asked delegates to consider the situation where a GP wanted to change a physiotherapist’s hours of work. ‘What bargaining power will you have?’ she asked. The disadvantages had to be viewed against the benefits of contracting physiotherapist services. Sally Harris, Northern stewards, strongly
Key to Acronyms AACP ACPIH ACPIN ACPM ACPOG ACPOPC ACPRC ACPSIEP APCP ATCSP HACP MACP OCPPP
Acupuncture Association of Chartered Physiotherapists Association of Chartered Physiotherapistsin Independent Hospitals Association of Chartered Physiotherapistswith an Interest in Neurology Association of Chartered Physiotherapistsin Management Association of Chartered Physiotherapistsin Obstetrics and Gynaecology Association of Chartered Physiotherapistsin Oncology and Palliative Care Association of Chartered Physiotherapistsin Respiratory Care Association of Chartered Physiotherapistswith a Special Interest in Elderly People Association of Paediatric Chartered Physiotherapists Association of Teachers of the Chartered Society of Physiotherapy Hydrotherapy Association of Chartered Physiotherapists Manipulation Association of Chartered Physiotherapists Organisation of Chartered Physiotherapistsin Private Practice
supported the motion. Apart from fragmentation of the physiotherapy service, other issues to consider were professional isolation, unfavourable conditions of service, maybe absence of a contract, lack of professional development, and poor support of equipment and servicing. Given the pitfalls, the obvious and best option would be to provide the service to the GP via the local authority physiotherapy department. Giving a personal view, Frances West said there had been no mention of where the patient wanted to have physiotherapy. She said there was a danger of losing physiotherapy in a GP practice and doctors might revert to the osteopaths they used to use. She told the conference: ‘Surely we should campaign that the GPs have physiotherapists. . . and then go on and sort out how they get them.’ Catherine Barrett, North East Thames stewards, warned that GPs might be tempted to employ newly-qualifiedphysiotherapists, without general rotation experience, because they were cheaper. She said she supported the motion to maintain standards and protect patient care in both the long and short term. Wendy White, Scottish stewards, said the motion was not about physiotherapists working in GP practices but about their direct employment by GPs. The motion was carried by a large majority. Motions 6 & 9 were taken at the end of the meeting.
Support Workers 11. Conference believes the title ‘physlotherapy helper’ should be changed to ‘physiotherapy assistant’, as the former Is out-dated and does not reflect the status of the post. Derby Branch
The motion was simple, unpretentious and direct, said Bill Wilson of Derby Branch. He said the Branch believedthat the term ‘helper’ was not fitting. Physiotherapists recognised the work and value of helpers, but others did not. He gave two examples of what patients thought about helpers: that they were unpaid voluntary workers, or schoolchildren on day release. The title ‘helper’ held no esteem, did not sound worthy and had no sense of pride. It should be changed. Elizabeth Sanderson, Argyle and Dumbarton, said the term ‘helper’ did not imply any skill, yet helpers did have skills. She urged members to support the motion, to show helpers that they were valued by staff and patients. Linda Relder, Dorset Branch, warned that a physiotherapy assistant could be easily turned around to become an assistant physiotherapist. She urged delegates to be careful because the title could be misconstrued. Expressing a personal view, Ronnie Paul of Colchester said: ‘We must retain the difference between qualified professionals and unqualified helpers and the patients must realise the difference as well.’ The motion was lost.
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12. The CSP must set clear standards for physlotherapy workers, with respect to the training and dutles, In order to pmtect patlent care and the professional role of the chartered physiotherapist. Trent stewards, Edinburgh Branch, South Yorkshire Branch Amendment by North East Thames stewards: Delete ‘support workers’ and insert ‘helpers!
Helpers needed to have standards set SO that they did not take on modalities of physiotherapy for which they were neither trained nor insured, Paul Stanton of Leicester told the conference. Speaking to the amendment, he said it was imperative that the CSp set down,
monitored and regularly updated national guide lines on the training and duties of helpers, to preserve and protect the role of physiotherapists and in the interest of the patients in their care. Janette Lees, South Yorkshire Branch, urged support for the motion to protect patient care and the professional role of chartered physiotherapists. Jane Langley, CSP senior professional affairs officer, said that because helpers did have such a wide range of activities it was difficult to set standards, but the CSP had set criteria (CSP guide line 15) for physiotherapists to decide what helpers can and cannot do. The motion was carried unanimously.
Service Management 13. The CSP should striw to ensure that physlotherapy servlces are organlsed by physlotheraplsts, and not devolved to consultants or buslness managers. Chiltern Branch
Only physiotherapists were able to understand the total needs of a client group across organisational and geographical boundaries, Pauline Austln, Chiltern Branch, told the conference. Physiotherapy services managed by physiotherapists would provide the best use of resources, staffing and equipment, reduce duplication and overlap, and promote high professional standards. Non-physiotherapist managers, she said, would not have the interests of the profession at heart,, and research, development and training would not be seen by others as important. Physiotherapists were best placed to offer an efficient, effective and equitable service. ‘We understand physiotherapy,’ she said. Maggle Downton, ACPM, supported the sentiments of the motion. But Jackie Wrlght, Norfolk, took issue with the view that consultants and business managers did not know about the work of physiotherapists. They could be the best people to be managers. ‘We should be open to allow other people in if they are better than we are,’ she said. Speaking personally, Paul Lynch said that as he was employed under the title of ‘physiotherapy business manager’, he was in danger of supporting a motion that would do him out of a job. He suggested that the words ‘non-physiotherapist’ be inserted before ‘business managers’. For Scottish stewards, Wendy White, speaking to the amended motion, said it was important to be managed by physiotherapists. The amended motion, which referred to ‘non-physiotherapist business managers; was carried. 14. The CSP should actlveiy encourage the formation of paramedlcai directorates wlthln the NHS to ensure the long-term Integrity of the profession. Grampian Branch Amended by Stockport Branch: Delete ‘paramedical’ and insert ‘clinical therapy’.
Anne Qulrk, Grampian Branch, said physiotherapists made up a small number of hospital staff, with little influence on current changes taking place. What chance would they have if they became part of clinical directorates? Clinical directorates would lead inevitably to fragmentation. She asked how sick leave, holidays and oncall would be organised within the clinical directorates. While recognisingthat there was a need to work together as a team with other health-care colleagues, she pointed out that they also had to work together as physiotherapists. It was vital, she said, for the profession to collaborate with paramedical colleagues, forming free-standing and autonomous directorates. From London, Brenda Samuel8 said there were other models of providing physiothempyservices. As an example she used the trust where she worked, which had service units of which she was the head, with equal status as consultants. Ronnie Paul, North East Thames stewards, said rather than aiming for clinical therapy directorates, the first goal should be an independent physiotherapy directorate. Maggle Downton, ACPM, said the thrust of the motion had been to maintain the integrity of services and enable physiotherapists to work together with their paramedical and clinical colleagues.
The motion was narrowly lost. 15. The CSP should devise a natlonal scale for the recordlng of physlotherapy input to patlent care In order to enable managers to cost the service and purchasers to make accurate comparlsons. APCP Michele Lee, APCP, told delegates that recording the amount of physiotherapy input to patient care was becoming an established practice and that records were being used more and more to cost services. But she said each physiotherapy service was using its own costing system and recording method, preventing a true comparison for purchasers. Having one system for everyone to use was, she said, vital to allow for a uniform costing
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procedure. In addition it would allow managers to budget their services efficiently and demonstrate the quality of their service. Maggle Downton, ACPM, said it was important in any discussion of a national scale, not to penalise people in the short term. She added that it was also important to work from the patient perspective upwards. The motion was carried. Motion 16 was not moved because there was no proposer. 17. The CSP Is urged to Issue gulde lines on the dangers and problems of accepting charitable donations for the purchase of basic essential equipment, which should be provided by health authority fundlng. Scottish stewards
The motion was a sign of the times, said its proposer Kay Burnett of Scottish stewards. Physiotherapistswere supporting sponsorship for basic pieces of equipment that were the tools of their trade. It was, she admitted, an emotive issue. Nearly loo/, of the health service budget was propped up by charitable donations. In the current climate, she said, with businesses going bankrupt and increased unemployment, donations were probably coming from peoplewho could least afford it. How long, she asked, before there was no authority budget at all? There had been many sponsorship events for hospital equipment but as yet no one had seen the Armed Forces seeking sponsorship for Centurion tanks. Wendy White, Scottish stewards, said there had been some reservations about the motion because members felt it was difficult to refuse charitable donations. But, she went on, donations in the past had been used for ’little extras’, whereas now they were being used for basic equipment. In the last year at her hospital there had been a sponsored walk to raise money for syringe pumps, fund-raising for an intensive care bed, and numerous cake and candy stalls to raise money for wheelchairs. Llnda Relder of Dorset Branch took issue with the view that donations were being used for basic equipment. She believed fund-raising was for additional equipment. In response to her question:
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‘Are we really begging for our pieces of ultrasound and electrical equipment?’, the audience responded with cries of ‘Yes’. However, she urged them to think of their patients and to be sure that the equipment they sought was ‘basic, essential, necessary and useful’. Gall Green, West Yorkshire Branch, said
she worked in the charitable sector where every penny and pound was raised by the community. How long was it going to be before they were not only having to raise money for traction beds, but to have cracks in the wall mended? The motion was carried unanimously.
Education 20C. Slnce cllnlcal education of physiotherapy students Is vltal to patlent care and professional standards, and could be at risk if professional structures are fragmented, Conference believes there is a need for (a) stringent nationwide standards for cllnlcai supervisors; (b) Improved remuneration arrangements for supervisors; (c) specific funding for placements. Edinburgh Branch, East Essex Branch, Yorkshire stewards Amendment by the Agenda Committee: Delete all after ‘Conference’ and insert ‘believes that there is a need for (a) stringent nationwide standards for the training of clinical supervisors and for the monitoring of clinical placements and (b) specific funding for placements’. Speaking on the amended motion, Lindsay Masterton, Edinburgh Branch, warned delegates that the vital exchange of ideas and techniques throughout the profession might be curtailed as hospitals competed for business. Clinicians could find it increasingly difficult to supervise students because of the pressures of patient throughput and performancerelated targets. Funding for placements had moved from the Department for Education to the Department of Health. To
21C. The CSP should promote a poilcy of shared appointments of ‘senior lecturerlcllnlcal physlotheraplst’ bemeen larger departments and units of physiotherapy education, to facilitate greater academlc development at the workplace while allowing academlc staff to retain specialist skills. ACPM, Glasgow Branch ACPM representative Sue Jackson said that if the motion was adopted, schools would benefit from current clinical input. She pointed out that it was also important for students to be taught about physiotherapy in the current health-care environment and they should be aware of how health-care was provided. The joint appointment would facilitate this, she said. It would also bring research skills into the clinical establishment. Having a member of the teaching staff in a clinical establishment would reinforce the importance of clinical placement being an educational experience for students. Lydia Gliiham of APOPC gave a personal view. She said she left physiotherapy teaching after 20 years. The hospital-based course had moved to an educational establishment and while she supported this, she found it became
counterbalance the problems invoked by fragmentation of professional structures, she urged members to support the motion. East Essex Branch representative Helen Back said the profession needed to ensure that at least basic, practical, clinical skills had been obtained before qualification. In a short placement, adequate funding was essential to ensure the clinician was able to give the best possible supervision. Placements needed monitoring, she said. She told of a newly-qualified physiotherapist who had never assessed a patient with a back or a neck problem during training. Susanne Neville for ATCSP said the role of the clinician was fundamental to the education of students. She suggested specific and fair funding should be made available. Nikkl Conn, student representative to Council, reminded delegates that clinical education was an integral and vital part of physiotherapy training. She urged standardisation in assessment technique and in the training of clinical supervisors. If there was a specific funding allocation, she said the professionwould not be facing the prospect of producing incompetent physiotherapists. The motion was carried unanimously.
increasingly difficult to retain meaningful contact with patients of her own. She missed having a personal caseload. She believed that some shared appointments could bridge the gap between academic and clinical components of physiotherapy education. She said she strongly supported the motion with the proviso that the sharing element of these posts was carefully and fairly constructed. Susanne Nevlile, ATCSI? also giving a personal view, said she was worried about the practicalities. She thought it was more important to forge closer links between the education institution and the clinical areas. Giseia Creed, Glasgow Branch, accepted that there would be difficulties. She said there had been informal moves to forge these links and she urged the CSP to bring more formality into these arrangements. Moira Banks, ACPIN, said the practical problems were not insurmountable. She said ACPIN felt strongly that this kind of innovation would be nothing but helpful to both branches of the profession.
22. In view of the shortage of physiotherapists, and In order that the professionshould reflect the community in which it works, the CSP should actively promote the profession to ethnic minorities, dlsabied people, and men. North West Thames stewards Physiotherapy, said Kerry Wyatt, North West Thames stewards, was dominated by white, middle-class females. She said she was surprised and appalled looking at the recent entry statistics into physiotherapy to see the small percentage made up by ethnic minorities. According to the latest figures, 3.5% of places were taken up by black applicants. She asked why men were not attracted to the profession, or was it that the profession was not promoted to them? She also asked why people with conditions like eczema, psoriasis, hearing impairment or low back pain, could not join the profession. She urged the CSP to escalate the pace of the work being done on equal opportunities and to continue to research all aspects of the profession, including promotion to a spread of the population which truly reflected society. David Perkins, Gwynedd, said he was not entirely against the motion but that it was rather poorly worded, with some wrong assumptions. He agreed with the call for more men to join the profession and suggested this would happen if the salary levels were better. He believed that the need was for more and larger physiotherapy schools. Personally, he said, he was not happy with the part about ethnic minorities. Everyone belonged to an ethnic group. Stephanie Kitchener, Royal Free Hospital Trust, giving a personal view, said she had some reservations about the motion but in the main supported it. Physiotherapists ought to reflect the population as a whole. To have a larger spread in the population could only help. She said the CSP and individuals needed to look at their attitudes to disability. Research had shown that physiotherapists’attitudes to disability were based on general population stereotypes. She said the feeling seemed to be that it was all right as long as it was not in their profession. Christine Potter, Chichester, said that to promote the profession to any one sector of the community smacked of positive discrimination which the profession should not condone. It was more important to get the right people for the job, irrespectiveof colour, sex or disability. Patricia Auty, HACP, speaking personally, said that actively promoting the profession to men, disabled people and ethnic minorities would be an excellent objective, with or without a shortage of physiotherapists. The motion was narrowly lost. [A letter from Mrs Auty is published in this Journal.1
The motion was carried by a very large majority.
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Post-registration Study 25. The CSP should encourage centres of higher education and training hospitals to run refresher courses for physiotherapists wishing to return to work, particularly for those who wish to return part-time. ACPIH Alan Lyons, ACPIH, spoke of the problems of recruiting staff. Colleagueswho had left physiotherapy to have a family said they found the prospect of returning to work daunting. The vacancies that existed could be filled by giving stronger encouragement to those wishing to return to the profession full-time and part-time, he said. Sue Jackson, ACPM, pointed out that people returning to work had widely different needs and courses needed to be individually packaged.
The motion was carried by a very large majority.
physiotherapy for women’s health. She urged the CSP to make obstetrics a compulsory placement for students. Pat McCoy, recent chairman of the Curriculum Review Group, said the CSP was not a provider or a dictator and it could not say that obstetrics and gynaecology must be compulsory. Nanette Holroyd of Scottish stewards said that physiotherapists were uniquely placed to promote women’s health but that without the compulsory placement and the post-registration rotational experience, the interest to specialise would not be generated. Chris Mercer of London, said physiotherapists were given a good, broad overview in pre-registrationeducation and this should be built in post-registration experience. The motion was lost, with 80 votes for and 87 against.
26. The CSP should address the lack of adequate clinical training opportunities at both pre- and post-registration levels for physiotherapists to specialise In the promotion of women’s health, particularly in Obstetrics. ACPOG
Debbie Shannon of ACPOG said that in some schools an obstetrics placement was no longer necessary. If a subject as important as obstetrics was no longer compulsory, she said, then it called into question the whole pre-registration programme. She believed there was a lack of appreciation of the major benefits of
The motion was carriedby a /age majority. 31. Due to the possible future State registration of osteopaths we feel that the CSP should have an open debate on the Implications to our profession of this move. North Western stewards
Ethical and Regulatory 29C. The CSP and CPSM should use their powers to ensure that EC and other overseas qualified physiotherapists have clinical experience and training, and academic knowledge, which fully meet UK standards before full membership and State registration are granted, using ‘top-up’ placements If necessary. Birmingham Branch, West Midlands stewards, East Anglian stewards, Mersey stewards Instead of the almost blanket system of registration, Samantha Hallowell, Birmingham Branch, suggested it would be better if the Council for Professions Supplementary to Medicine (CPSM) had more exacting criteria. This could highlight particular areas of weakness in a physiotherapist’s training and appropriate additional training could be provided. The profession should be asking why in America, Germany and Australia all overseas physiotherapists had to take examinations before they were accepted as eligible to practise. Kay Edwards, West Midlands stewards, said that in today’s climate the profession needed to ensure those coming in from foreign countries were as qualified and skilled. Sandra Hicken, West Midlands stewards, urged delegates to give Council a mandate to highlight the problems raised in the motion. Maggle Downton, ACPM, pointed
30. The CSP should provide physiotherapy managers with guide lines to ensure the positive Integration of ovenwas physiotheraplsts which does not result In additional stress on other physiotherapy staff. West Midlands stewards Janice Moss, representing West Midland stewards, highlighted the problems that arose when overseas physiotherapists were asked to work in a specialty which they had not covered in their course. Some Dutch physiotherapists, she said, had minimal respiratory work in their training and would therefore have problems in intensive therapy units or on-call duty. Senior colleagues had to give extra time teaching and training to ensure competence which caused stress and could lead to resentment. There were problems with language and recordkeeping. She urged the CSP to issue managers with guide lines to use when interviewing and employing overseas physiotherapists. Supporting the motion, Kevin Foreman of Liverpool Branch, speaking personally, said it was very important to encourage physiotherapists to come to the UK but it was also necessary to give them help and support wherl they were here.
out that the CPSM had stated that the crieterion for registrationwas competence at a basic grade level. If membersaccepted this and were prepared to work on the cultural changes and top-up training, then they could look at the positive benefits of having overseas members working within their department. Toby Simon, Secretary of the CSP, said there had to be some degree of mutual trust within the EC. The CSP was pressing for a revision of the PSM Act to ensure it gave more appropriate powers to the PhysiotherapistsBoard to look at courses outside the EC. Christine Potter, Chichester Branch, said she believed she was not alone in experiencing some of the problems of dealing with someone from another country. It was important to ensure clinical standards were met, and urged members to support the motion. The Yorkshire Board representative to Council, Sue Rumbold, said the CSP and CPSM had set up a joint authority to screen applicants from EC countries. The motion was carried by a very large majority.
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A call for an open debate on the impact of possible State registration for osteopaths was made on behalf of North west stewards by Fiona Hawklns. She believed State registration of osteopaths would greatly affect the physiotherapy profession. She said she knew she could be accused of being protectionistor resistant to change. She suggested members gave it much thought before ‘embracing it with open arms’. The biggest problem would be in how osteopaths would be employed in the NHS. Would they be competing within the same hospital or trust, contracted in as specialists or would they be directly employed by GPs? There were many issues to be discussed and questions to be answered and it was important to have an open debate. While supporting the motion, Theresa Ball, MCSP, said one of the main arguments used by chiropractors and osteopaths was that physiotherapists were Jacks of all trades and specialists of none. Manipulationwas highly skilled and specialised and needed to be recognised by the CSP if physiotherapists were to win their argument. The chairman of Council, Trlcia Phillips, said the Society was consulted on the proposed legislation. The CSP took a realistic view, knowing that osteopaths were in competition with chartered physiotherapists, particularly in private practice. The view was taken that State registration would give protection for patients that certain qualifications would be recognised and others would not. The motion was carried unanimously.
Representatives’ Conference Professional practice, management, education and regulatory topics were debated during the first half of the 1992 Annual Representatives’Conference reported here. The meeting was held in the Royal Concert Hall, Glasgow, on October 8 and 9. Paul Lynch was chairman, with Fiona Jenkins and Natalie Beswetherick as vice-chairmen. Patricia Phillips, chairman of Council, reported on Council’s response to motions passed at the previous conference. In the motions listed below, C Indicates a composite motion. Those not listed were not debated because of lack of time. The second part of the conference will be reported in next month’s issue.
Professional Practice 1. The CSP should actively support its members who are asked to participate In sklll mix exercises, in order to malntaln professional standing and prevent the profession from becoming obsolete. Birmingham Branch
Allson Keeling, from BirminghamBranch, said that while skill mix exercises might be used to improve service delivery there was real concern that, as resources became tighter, they could be used primarily as a means of cutting costs. Physiotherapists provided unique skills of clinical judgement and decision-making. In the light of the high profile that health care assistants have, the CSP should be actively promoting the unique skills of chartered physiotherapists, she said. If not, she feared that in some instances physiotherapists would be phased out and disappear. Sue Jackson, ACPM, said it was only by taking part in these exercises that it was possible to influence the outcome, and the ACPM urged the CSP to support its members to enable them to participate. An internal seminar on skill mix had been organised by the CSP to produce briefing and course material, said David Fleming, CSP director of industrial relations. The intention was to run regional workshops on the issue and eventually to providedetailed briefing packs and papers on skill mix, and a lobbyingdocument. The CSP was aware that there were going to be many problems with skill mix but a start had been made to provide the kind of services being called for in the motion. The motion was carried by a very large majority. 2. Wlth Increasing number of selfgoverning trusts more emphasis is being placed on cllnlcal audit. The Society should strongly urge members to seek training and funding from the trusts and that we, the profession, retain control of the evaluatlon of our own service. Scottish stewards
More emphasis was being placed on clinical audit, said Karen Bruce for Scottish stewards. Put simply, she explained, physiotherapists’examination, treatment plan and outcome were the core
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elements of audit. Members had heard about external agencies offering to evaluatetheir service, but she said: ‘We are the most ably qualified people around to account for what physiotherapistsdo and what physiotherapypractice achieves.’ By utilising audit the profession would be able to prove why and when a physiotherapist was more cost-effective than a partiallyskilled helper. She said the profession had worked hard to ensure that physiotherapistswere highlyskilled clinicians. The profession had to seize the opportunity to prove how effective and efficient their service was and it was important to do so now before other organisations evaluated physiotherapists’ jobs and input and replaced them with someone from a Youth Training Scheme. Wendy Whlte, of Scottish stewards, said members kad to be assertive in demanding adequate training to evaluate and promote the service they provide. Sue Jackson, ACPM, urged support for the motion. She said the profession should be encouraging full clinical audit by looking at the whole progress of the patients from their time of injury or trauma in order to assess the best outcome. She said it should be looking not just at trusts but at the Department of Health and the regions for funding. Jennie Collins, chairman of the CSP Professional Practice Committee, spoke of the work going on in the profession with the standards of practice, which could be modified and used for clinical audit. She urged members to participate in the workshops around the country on clinical audit. The motion was carried by a large mqority.
3. The Chartered Society should establish a working party to determine the criteria for the use of the term ‘specialist’ within the profession. OCPPP The motion, said Jean Kelly of OCPPP, was about re-starting the debate on what was meant by the use of the term ‘specialist’, now and in the future, and whether the CSP should look at developing a recognised route to the status of specialist. She said the motion was
not seeking to restrict professional development, to pigeon-hole anyone or to fossilise the profession in a fixed moment in time. But the term needed clarification and she asked the profession to look at the issue again. Speaking against the motion, Nina Melvllle, ACPIN, said she appreciated the importance of specialisation and the development of clinical skills to a high standard. But she asked: ‘Do we wish to see a profession divided entirely into small Blite groups?’ Theresa Ball, MACP, said it would be easier to explain the role and value of specialists to other professions if they were officially recognised by the CSP. There was, she said, a need for generalists and specialists in the professionbut it was vital for the CSP to recognise specialists. The motion was narrowly lost. 4. Employers should be able to requlre a physiotherapist to be a member of the appropriate Clinical Interest Group, If they are prepared to pay the fee. ACPRC Clinical Interest Groups had changed ovpr the years, said Frances West, ACPRC. She outlined the three main benefits from CIG membership - access to research, to continuing education and to standards and guide lines to good practice. Managers, she said, should show their respect for ClGs by expecting specialists to be members. Fiona Hawklns, North West stewards, said ClGs had survived on the sheer hard work and commitment of their members and asked whether they would want people to come along just because their manager said they should. If the motion was agreed, she said, it would be an infringement of liberty. Sue Jackson, ACPM, agreed with everything the proposer said but could not support the motion. More needed to be done by the ClGs to ensure more local recruitment, with local meetings and local participation. Wendy Whlte, of Scottish stewards, also speaking against the motion, said she would not want people attending a group who did not want to be there, ‘a noninterested member of a special interest group’. The motion was lost overwhelmingly.
Scrutineers The following people volunteered to act as scrutineers for the Conference: Charles McLeod, Susan Rumbold, Erica Nix, Caroline Smith, Jane Featherstone Witty.
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847 5. The CSP should encourage physiotherapy managers to retain a specialist cllnlcal workload, albeit on a part-time or consultancy basis. ACPM
Maggle Downton, ACPM, called on the CSP to encourage all physiotherapy managers to retain a clinical caseload to ensure that professional expertise was not wasted. This would enable managers to retain credibility with staff and colleagues, to keep in touch with professional issues, and to maintain first-hand knowledge of staff and patient perspectives. When not involved clinically, she said, managers could become more remote from the practice of physiotherapy. It was important, she said, for physiotherapists to have some clinical involvement so that scarce and expensive clinical expertise was not lost.
The CSP should support the introduction of a higher clinical grading structure so that physiotherapists could continue to progress in their careers and retain their specialist skills, while taking on an everincreasing management role. Anne Walker, physiotherapy consultant with Exeter Health Authority, pointed out the vulnerability of physiotherapy managers who have not kept on a specialist clinical caseload and she urged them to retain some clinical expertise. Sandra Hlcken, of West Midlands stewards, said managers needed to be fulltime managers and while they needed to have a clinical background she suggested they could draw on the knowledge and expertise of their colleagues. The motion was lost, with 87 for and 90 against.
Physiotherapistsand GPs 7. The CSP should strongly campaign against GP fundholders specifying phydothempy tteatment modalltles, and thus thmatenlng professional autonomy. AACR Cumbria Branch Sue Garner of AACP said physiotherapists were best placed to know the range of modalities available and GPs needed to be aware of this. She said physiotherapists had been looking at ways to speed up throughput, without sacrificing quality, decrease waiting lists in physiotherapy departments. Chris Mercer, South West Thames and Kingston Branch, said he agreed with the basic sentiment of the motion. But, he said, it was a matter of communicationbetween physiotherapistsand other professionals. Linda Andrews, Cumbria Branch, speaking in favour of the motion, pointed out that fundholding GPs would be referring patients to physiotherapists and it was important to have clear and direct communication between the two professions. It was time physiotherapists realised they had gained professionalautonomy, through a process of education and negotiation, said Maggie Downton, ACPM. The same must be done with GP fundholders. She referred to the ‘contacting’ and ‘marketing’
processes which could be used in an effective way and said she could not support the motion in the way it was presented. The motion was carried. 8. This conference believes that direct employment of physlotheraplsts by GPs Is likely to cause severe fragmentation of the services currently provided by the local hospital or community units. Therefore the CSP should actively campaign against such direct employment of Individual physiotherapists. National Group of Regional Stewards, Northern stewards
Claire Strlckland, for the National Group of Regional Stewards, said there were major disadvantages to all involved in the direct employment of physiotherapists by GPs. Among these were the problem of isolation without professional back-up from colleagues. She asked delegates to consider the situation where a GP wanted to change a physiotherapist’s hours of work. ‘What bargaining power will you have?’ she asked. The disadvantages had to be viewed against the benefits of contracting physiotherapist services. Sally Harris, Northern stewards, strongly
Key to Acronyms AACP ACPIH ACPIN ACPM ACPOG ACPOPC ACPRC ACPSIEP APCP ATCSP HACP MACP OCPPP
Acupuncture Association of Chartered Physiotherapists Association of Chartered Physiotherapistsin Independent Hospitals Association of Chartered Physiotherapistswith an Interest in Neurology Association of Chartered Physiotherapistsin Management Association of Chartered Physiotherapistsin Obstetrics and Gynaecology Association of Chartered Physiotherapistsin Oncology and Palliative Care Association of Chartered Physiotherapistsin Respiratory Care Association of Chartered Physiotherapistswith a Special Interest in Elderly People Association of Paediatric Chartered Physiotherapists Association of Teachers of the Chartered Society of Physiotherapy Hydrotherapy Association of Chartered Physiotherapists Manipulation Association of Chartered Physiotherapists Organisation of Chartered Physiotherapistsin Private Practice
supported the motion. Apart from fragmentation of the physiotherapy service, other issues to consider were professional isolation, unfavourable conditions of service, maybe absence of a contract, lack of professional development, and poor support of equipment and servicing. Given the pitfalls, the obvious and best option would be to provide the service to the GP via the local authority physiotherapy department. Giving a personal view, Frances West said there had been no mention of where the patient wanted to have physiotherapy. She said there was a danger of losing physiotherapy in a GP practice and doctors might revert to the osteopaths they used to use. She told the conference: ‘Surely we should campaign that the GPs have physiotherapists. . . and then go on and sort out how they get them.’ Catherine Barrett, North East Thames stewards, warned that GPs might be tempted to employ newly-qualifiedphysiotherapists, without general rotation experience, because they were cheaper. She said she supported the motion to maintain standards and protect patient care in both the long and short term. Wendy White, Scottish stewards, said the motion was not about physiotherapists working in GP practices but about their direct employment by GPs. The motion was carried by a large majority. Motions 6 & 9 were taken at the end of the meeting.
Support Workers 11. Conference believes the title ‘physlotherapy helper’ should be changed to ‘physiotherapy assistant’, as the former Is out-dated and does not reflect the status of the post. Derby Branch
The motion was simple, unpretentious and direct, said Bill Wilson of Derby Branch. He said the Branch believedthat the term ‘helper’ was not fitting. Physiotherapists recognised the work and value of helpers, but others did not. He gave two examples of what patients thought about helpers: that they were unpaid voluntary workers, or schoolchildren on day release. The title ‘helper’ held no esteem, did not sound worthy and had no sense of pride. It should be changed. Elizabeth Sanderson, Argyle and Dumbarton, said the term ‘helper’ did not imply any skill, yet helpers did have skills. She urged members to support the motion, to show helpers that they were valued by staff and patients. Linda Relder, Dorset Branch, warned that a physiotherapy assistant could be easily turned around to become an assistant physiotherapist. She urged delegates to be careful because the title could be misconstrued. Expressing a personal view, Ronnie Paul of Colchester said: ‘We must retain the difference between qualified professionals and unqualified helpers and the patients must realise the difference as well.’ The motion was lost.
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12. The CSP must set clear standards for physlotherapy workers, with respect to the training and dutles, In order to pmtect patlent care and the professional role of the chartered physiotherapist. Trent stewards, Edinburgh Branch, South Yorkshire Branch Amendment by North East Thames stewards: Delete ‘support workers’ and insert ‘helpers!
Helpers needed to have standards set SO that they did not take on modalities of physiotherapy for which they were neither trained nor insured, Paul Stanton of Leicester told the conference. Speaking to the amendment, he said it was imperative that the CSp set down,
monitored and regularly updated national guide lines on the training and duties of helpers, to preserve and protect the role of physiotherapists and in the interest of the patients in their care. Janette Lees, South Yorkshire Branch, urged support for the motion to protect patient care and the professional role of chartered physiotherapists. Jane Langley, CSP senior professional affairs officer, said that because helpers did have such a wide range of activities it was difficult to set standards, but the CSP had set criteria (CSP guide line 15) for physiotherapists to decide what helpers can and cannot do. The motion was carried unanimously.
Service Management 13. The CSP should striw to ensure that physlotherapy servlces are organlsed by physlotheraplsts, and not devolved to consultants or buslness managers. Chiltern Branch
Only physiotherapists were able to understand the total needs of a client group across organisational and geographical boundaries, Pauline Austln, Chiltern Branch, told the conference. Physiotherapy services managed by physiotherapists would provide the best use of resources, staffing and equipment, reduce duplication and overlap, and promote high professional standards. Non-physiotherapist managers, she said, would not have the interests of the profession at heart,, and research, development and training would not be seen by others as important. Physiotherapists were best placed to offer an efficient, effective and equitable service. ‘We understand physiotherapy,’ she said. Maggle Downton, ACPM, supported the sentiments of the motion. But Jackie Wrlght, Norfolk, took issue with the view that consultants and business managers did not know about the work of physiotherapists. They could be the best people to be managers. ‘We should be open to allow other people in if they are better than we are,’ she said. Speaking personally, Paul Lynch said that as he was employed under the title of ‘physiotherapy business manager’, he was in danger of supporting a motion that would do him out of a job. He suggested that the words ‘non-physiotherapist’ be inserted before ‘business managers’. For Scottish stewards, Wendy White, speaking to the amended motion, said it was important to be managed by physiotherapists. The amended motion, which referred to ‘non-physiotherapist business managers; was carried. 14. The CSP should actlveiy encourage the formation of paramedlcai directorates wlthln the NHS to ensure the long-term Integrity of the profession. Grampian Branch Amended by Stockport Branch: Delete ‘paramedical’ and insert ‘clinical therapy’.
Anne Qulrk, Grampian Branch, said physiotherapists made up a small number of hospital staff, with little influence on current changes taking place. What chance would they have if they became part of clinical directorates? Clinical directorates would lead inevitably to fragmentation. She asked how sick leave, holidays and oncall would be organised within the clinical directorates. While recognisingthat there was a need to work together as a team with other health-care colleagues, she pointed out that they also had to work together as physiotherapists. It was vital, she said, for the profession to collaborate with paramedical colleagues, forming free-standing and autonomous directorates. From London, Brenda Samuel8 said there were other models of providing physiothempyservices. As an example she used the trust where she worked, which had service units of which she was the head, with equal status as consultants. Ronnie Paul, North East Thames stewards, said rather than aiming for clinical therapy directorates, the first goal should be an independent physiotherapy directorate. Maggle Downton, ACPM, said the thrust of the motion had been to maintain the integrity of services and enable physiotherapists to work together with their paramedical and clinical colleagues.
The motion was narrowly lost. 15. The CSP should devise a natlonal scale for the recordlng of physlotherapy input to patlent care In order to enable managers to cost the service and purchasers to make accurate comparlsons. APCP Michele Lee, APCP, told delegates that recording the amount of physiotherapy input to patient care was becoming an established practice and that records were being used more and more to cost services. But she said each physiotherapy service was using its own costing system and recording method, preventing a true comparison for purchasers. Having one system for everyone to use was, she said, vital to allow for a uniform costing
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procedure. In addition it would allow managers to budget their services efficiently and demonstrate the quality of their service. Maggle Downton, ACPM, said it was important in any discussion of a national scale, not to penalise people in the short term. She added that it was also important to work from the patient perspective upwards. The motion was carried. Motion 16 was not moved because there was no proposer. 17. The CSP Is urged to Issue gulde lines on the dangers and problems of accepting charitable donations for the purchase of basic essential equipment, which should be provided by health authority fundlng. Scottish stewards
The motion was a sign of the times, said its proposer Kay Burnett of Scottish stewards. Physiotherapistswere supporting sponsorship for basic pieces of equipment that were the tools of their trade. It was, she admitted, an emotive issue. Nearly loo/, of the health service budget was propped up by charitable donations. In the current climate, she said, with businesses going bankrupt and increased unemployment, donations were probably coming from peoplewho could least afford it. How long, she asked, before there was no authority budget at all? There had been many sponsorship events for hospital equipment but as yet no one had seen the Armed Forces seeking sponsorship for Centurion tanks. Wendy White, Scottish stewards, said there had been some reservations about the motion because members felt it was difficult to refuse charitable donations. But, she went on, donations in the past had been used for ’little extras’, whereas now they were being used for basic equipment. In the last year at her hospital there had been a sponsored walk to raise money for syringe pumps, fund-raising for an intensive care bed, and numerous cake and candy stalls to raise money for wheelchairs. Llnda Relder of Dorset Branch took issue with the view that donations were being used for basic equipment. She believed fund-raising was for additional equipment. In response to her question:
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‘Are we really begging for our pieces of ultrasound and electrical equipment?’, the audience responded with cries of ‘Yes’. However, she urged them to think of their patients and to be sure that the equipment they sought was ‘basic, essential, necessary and useful’. Gall Green, West Yorkshire Branch, said
she worked in the charitable sector where every penny and pound was raised by the community. How long was it going to be before they were not only having to raise money for traction beds, but to have cracks in the wall mended? The motion was carried unanimously.
Education 20C. Slnce cllnlcal education of physiotherapy students Is vltal to patlent care and professional standards, and could be at risk if professional structures are fragmented, Conference believes there is a need for (a) stringent nationwide standards for cllnlcai supervisors; (b) Improved remuneration arrangements for supervisors; (c) specific funding for placements. Edinburgh Branch, East Essex Branch, Yorkshire stewards Amendment by the Agenda Committee: Delete all after ‘Conference’ and insert ‘believes that there is a need for (a) stringent nationwide standards for the training of clinical supervisors and for the monitoring of clinical placements and (b) specific funding for placements’. Speaking on the amended motion, Lindsay Masterton, Edinburgh Branch, warned delegates that the vital exchange of ideas and techniques throughout the profession might be curtailed as hospitals competed for business. Clinicians could find it increasingly difficult to supervise students because of the pressures of patient throughput and performancerelated targets. Funding for placements had moved from the Department for Education to the Department of Health. To
21C. The CSP should promote a poilcy of shared appointments of ‘senior lecturerlcllnlcal physlotheraplst’ bemeen larger departments and units of physiotherapy education, to facilitate greater academlc development at the workplace while allowing academlc staff to retain specialist skills. ACPM, Glasgow Branch ACPM representative Sue Jackson said that if the motion was adopted, schools would benefit from current clinical input. She pointed out that it was also important for students to be taught about physiotherapy in the current health-care environment and they should be aware of how health-care was provided. The joint appointment would facilitate this, she said. It would also bring research skills into the clinical establishment. Having a member of the teaching staff in a clinical establishment would reinforce the importance of clinical placement being an educational experience for students. Lydia Gliiham of APOPC gave a personal view. She said she left physiotherapy teaching after 20 years. The hospital-based course had moved to an educational establishment and while she supported this, she found it became
counterbalance the problems invoked by fragmentation of professional structures, she urged members to support the motion. East Essex Branch representative Helen Back said the profession needed to ensure that at least basic, practical, clinical skills had been obtained before qualification. In a short placement, adequate funding was essential to ensure the clinician was able to give the best possible supervision. Placements needed monitoring, she said. She told of a newly-qualified physiotherapist who had never assessed a patient with a back or a neck problem during training. Susanne Neville for ATCSP said the role of the clinician was fundamental to the education of students. She suggested specific and fair funding should be made available. Nikkl Conn, student representative to Council, reminded delegates that clinical education was an integral and vital part of physiotherapy training. She urged standardisation in assessment technique and in the training of clinical supervisors. If there was a specific funding allocation, she said the professionwould not be facing the prospect of producing incompetent physiotherapists. The motion was carried unanimously.
increasingly difficult to retain meaningful contact with patients of her own. She missed having a personal caseload. She believed that some shared appointments could bridge the gap between academic and clinical components of physiotherapy education. She said she strongly supported the motion with the proviso that the sharing element of these posts was carefully and fairly constructed. Susanne Nevlile, ATCSI? also giving a personal view, said she was worried about the practicalities. She thought it was more important to forge closer links between the education institution and the clinical areas. Giseia Creed, Glasgow Branch, accepted that there would be difficulties. She said there had been informal moves to forge these links and she urged the CSP to bring more formality into these arrangements. Moira Banks, ACPIN, said the practical problems were not insurmountable. She said ACPIN felt strongly that this kind of innovation would be nothing but helpful to both branches of the profession.
22. In view of the shortage of physiotherapists, and In order that the professionshould reflect the community in which it works, the CSP should actively promote the profession to ethnic minorities, dlsabied people, and men. North West Thames stewards Physiotherapy, said Kerry Wyatt, North West Thames stewards, was dominated by white, middle-class females. She said she was surprised and appalled looking at the recent entry statistics into physiotherapy to see the small percentage made up by ethnic minorities. According to the latest figures, 3.5% of places were taken up by black applicants. She asked why men were not attracted to the profession, or was it that the profession was not promoted to them? She also asked why people with conditions like eczema, psoriasis, hearing impairment or low back pain, could not join the profession. She urged the CSP to escalate the pace of the work being done on equal opportunities and to continue to research all aspects of the profession, including promotion to a spread of the population which truly reflected society. David Perkins, Gwynedd, said he was not entirely against the motion but that it was rather poorly worded, with some wrong assumptions. He agreed with the call for more men to join the profession and suggested this would happen if the salary levels were better. He believed that the need was for more and larger physiotherapy schools. Personally, he said, he was not happy with the part about ethnic minorities. Everyone belonged to an ethnic group. Stephanie Kitchener, Royal Free Hospital Trust, giving a personal view, said she had some reservations about the motion but in the main supported it. Physiotherapists ought to reflect the population as a whole. To have a larger spread in the population could only help. She said the CSP and individuals needed to look at their attitudes to disability. Research had shown that physiotherapists’attitudes to disability were based on general population stereotypes. She said the feeling seemed to be that it was all right as long as it was not in their profession. Christine Potter, Chichester, said that to promote the profession to any one sector of the community smacked of positive discrimination which the profession should not condone. It was more important to get the right people for the job, irrespectiveof colour, sex or disability. Patricia Auty, HACP, speaking personally, said that actively promoting the profession to men, disabled people and ethnic minorities would be an excellent objective, with or without a shortage of physiotherapists. The motion was narrowly lost. [A letter from Mrs Auty is published in this Journal.1
The motion was carried by a very large majority.
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Post-registration Study 25. The CSP should encourage centres of higher education and training hospitals to run refresher courses for physiotherapists wishing to return to work, particularly for those who wish to return part-time. ACPIH Alan Lyons, ACPIH, spoke of the problems of recruiting staff. Colleagueswho had left physiotherapy to have a family said they found the prospect of returning to work daunting. The vacancies that existed could be filled by giving stronger encouragement to those wishing to return to the profession full-time and part-time, he said. Sue Jackson, ACPM, pointed out that people returning to work had widely different needs and courses needed to be individually packaged.
The motion was carried by a very large majority.
physiotherapy for women’s health. She urged the CSP to make obstetrics a compulsory placement for students. Pat McCoy, recent chairman of the Curriculum Review Group, said the CSP was not a provider or a dictator and it could not say that obstetrics and gynaecology must be compulsory. Nanette Holroyd of Scottish stewards said that physiotherapists were uniquely placed to promote women’s health but that without the compulsory placement and the post-registration rotational experience, the interest to specialise would not be generated. Chris Mercer of London, said physiotherapists were given a good, broad overview in pre-registrationeducation and this should be built in post-registration experience. The motion was lost, with 80 votes for and 87 against.
26. The CSP should address the lack of adequate clinical training opportunities at both pre- and post-registration levels for physiotherapists to specialise In the promotion of women’s health, particularly in Obstetrics. ACPOG
Debbie Shannon of ACPOG said that in some schools an obstetrics placement was no longer necessary. If a subject as important as obstetrics was no longer compulsory, she said, then it called into question the whole pre-registration programme. She believed there was a lack of appreciation of the major benefits of
The motion was carriedby a /age majority. 31. Due to the possible future State registration of osteopaths we feel that the CSP should have an open debate on the Implications to our profession of this move. North Western stewards
Ethical and Regulatory 29C. The CSP and CPSM should use their powers to ensure that EC and other overseas qualified physiotherapists have clinical experience and training, and academic knowledge, which fully meet UK standards before full membership and State registration are granted, using ‘top-up’ placements If necessary. Birmingham Branch, West Midlands stewards, East Anglian stewards, Mersey stewards Instead of the almost blanket system of registration, Samantha Hallowell, Birmingham Branch, suggested it would be better if the Council for Professions Supplementary to Medicine (CPSM) had more exacting criteria. This could highlight particular areas of weakness in a physiotherapist’s training and appropriate additional training could be provided. The profession should be asking why in America, Germany and Australia all overseas physiotherapists had to take examinations before they were accepted as eligible to practise. Kay Edwards, West Midlands stewards, said that in today’s climate the profession needed to ensure those coming in from foreign countries were as qualified and skilled. Sandra Hicken, West Midlands stewards, urged delegates to give Council a mandate to highlight the problems raised in the motion. Maggle Downton, ACPM, pointed
30. The CSP should provide physiotherapy managers with guide lines to ensure the positive Integration of ovenwas physiotheraplsts which does not result In additional stress on other physiotherapy staff. West Midlands stewards Janice Moss, representing West Midland stewards, highlighted the problems that arose when overseas physiotherapists were asked to work in a specialty which they had not covered in their course. Some Dutch physiotherapists, she said, had minimal respiratory work in their training and would therefore have problems in intensive therapy units or on-call duty. Senior colleagues had to give extra time teaching and training to ensure competence which caused stress and could lead to resentment. There were problems with language and recordkeeping. She urged the CSP to issue managers with guide lines to use when interviewing and employing overseas physiotherapists. Supporting the motion, Kevin Foreman of Liverpool Branch, speaking personally, said it was very important to encourage physiotherapists to come to the UK but it was also necessary to give them help and support wherl they were here.
out that the CPSM had stated that the crieterion for registrationwas competence at a basic grade level. If membersaccepted this and were prepared to work on the cultural changes and top-up training, then they could look at the positive benefits of having overseas members working within their department. Toby Simon, Secretary of the CSP, said there had to be some degree of mutual trust within the EC. The CSP was pressing for a revision of the PSM Act to ensure it gave more appropriate powers to the PhysiotherapistsBoard to look at courses outside the EC. Christine Potter, Chichester Branch, said she believed she was not alone in experiencing some of the problems of dealing with someone from another country. It was important to ensure clinical standards were met, and urged members to support the motion. The Yorkshire Board representative to Council, Sue Rumbold, said the CSP and CPSM had set up a joint authority to screen applicants from EC countries. The motion was carried by a very large majority.
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A call for an open debate on the impact of possible State registration for osteopaths was made on behalf of North west stewards by Fiona Hawklns. She believed State registration of osteopaths would greatly affect the physiotherapy profession. She said she knew she could be accused of being protectionistor resistant to change. She suggested members gave it much thought before ‘embracing it with open arms’. The biggest problem would be in how osteopaths would be employed in the NHS. Would they be competing within the same hospital or trust, contracted in as specialists or would they be directly employed by GPs? There were many issues to be discussed and questions to be answered and it was important to have an open debate. While supporting the motion, Theresa Ball, MCSP, said one of the main arguments used by chiropractors and osteopaths was that physiotherapists were Jacks of all trades and specialists of none. Manipulationwas highly skilled and specialised and needed to be recognised by the CSP if physiotherapists were to win their argument. The chairman of Council, Trlcia Phillips, said the Society was consulted on the proposed legislation. The CSP took a realistic view, knowing that osteopaths were in competition with chartered physiotherapists, particularly in private practice. The view was taken that State registration would give protection for patients that certain qualifications would be recognised and others would not. The motion was carried unanimously.