Extended scopes now include limited prescribing rights and some invasive procedures like injecting, cannulation and bronchoscopy. We now also have new consultancy, advisory and leadership roles that are changing the nature of our practice.
And one of the most popular extensions that can be taken up by the whole profession has involved the drift towards public health medicine.
Physiotherapists and others are looking at the possibility of offering ‘wrap-around’ care where once they were specialists in discrete areas of practice, like cardiorespiratory, musculoskeletal and neurological physiotherapy.
Now, we are looking to use our access and skills to change people’s health behaviours: helping them to stop smoking, lose weight and do more exercise.
But there are real dangers in this approach that have not, as yet, been explored by the profession, as it tries to scale the rocky cliff face of traditional health care, to find the rarified air and green pastures in the New World of health promotion.
A few years ago, nurses began to take on the work of endoscopy that used to be the doctor’s domain. Practice nurses were trained up, and took over the responsibility for all of the preparation, hygiene, risk management and scoping of the patient.
Many saw this as a real sign that nursing was now respected as a scientifically-based practice, and one that had gained the clinical trust of doctors. But others, privately at least, thought otherwise.
Some asked whether doing endoscopies was really anything to do with nursing philosophy, arguing that doctors had simply passed over a role that they no longer wanted, because it was either too mundane or of limited clinical interest.
Rather than it being a sign of recognition, they argued, endoscopy was merely another episode in the long history of medical paternalism and patronage. Not something nurses should be welcoming.
The same questions might be asked about physiotherapists telling people to stop smoking and take more exercise.
It could be argued that you don’t need a three- or four-year degree and experience as a diagnostician of multiple comorbidities to take on this role, no matter how attractive it might be as a mechanism to secure public health funding.
Besides, a recent report in the Journal of Public Health has suggested that the routine health checks implemented into the NHS in 2013 have had limited impact but have been extermely costly – effectively stealing money from services that were already struggling for funding (Capewell et al, 2015).
While it is easy to see, and accept, the rhetoric that physiotherapists are perfectly placed to offer basic health promotion advice and support, we would be wise to ask more critical questions about this approach, before becoming a part of the army of health advisors that are now slowly replacing the therapists of old.
Capewell, S., McCartney, M., & Holland, W. (2015). Invited debate: NHS health checksa naked emperor? Journal of Public Health, 37(2), 187-192.