Elsevier

Physiotherapy

Volume 86, Issue 8, August 2000, Pages 397-400
Physiotherapy

Forum
Role Overlap and Professional Boundaries: Future Implications for Physiotherapy and Occupational Therapy in the NHS: Forum

https://doi.org/10.1016/S0031-9406(05)60828-0Get rights and content

Summary

Traditional assumptions about professional roles and structure in the modernising National Health Service are being challenged.

The changing nature of healthcare, the increase in the older population, and staffing implications are all key issues affecting the future of occupational therapy and physiotherapy as future separate professions. These complex changes are potentially threatening for these professions as they currently exist. It will, therefore, be necessary to find solutions to these issues if the healthcare labour force is to be responsive to meet the challenges ahead in the changing NHS.

Role overlap, role confusion, fragmentation of therapy services, shared learning and a melding of the core skills and philosophies of occupational therapy and physiotherapy are the drivers for change and modernisation discussed in this paper.

The paper offers the suggestion that occupational therapy and physiotherapy undergraduate education programmes should be combined. It also recommends that a creative, independent and comprehensive review of future workforce planning should be undertaken and states that the real way forward is towards the creation of highly skilled rehabilitation therapists who would be truly responsive to the needs of service users.

Section snippets

Introduction and Background

Traditional assumptions about professional roles in the rapidly changing National Health Service (NHS) are being challenged. The British Prime Minister, Tony Blair, recently affirmed that modernisation is high on the political agenda.

The removal of professional boundaries is a main focus for the government's new NHS. Action Committees have been formed to modernise and change the NHS by evaluating current practice and skill mix, questioning the assumptions of yesterday and formulating policy for

Changes in Healthcare Delivery

The shift of healthcare services into the primary care setting, increasing numbers of older people, the rise in chronic diseases and the philosophy of a more client-centred service are the drivers of changing physio-therapy and occupational therapy roles in this new millennium. As a result of these issues, there will be a greater demand for healthcare and an increasing need for therapists.

The move to form primary care groups and primary care trusts, that have the responsibility for

The Professions of Occupational Therapy and Physiotherapy

Archetypal professions involve autonomous practice, an exclusive knowledge base, service to the public, self-regulation of standards and occupational control of rewards.

Both occupational therapy and physio-therapy have claimed professional status over many years. Both have established training courses at degree level, have licence to practise and public recognition.

By its very nature, the healthcare labour force is an interdependent one. Doyal and Cameron et al (2000) discuss how different

Undergraduate Education

In the United Kingdom both occupational therapists and physiotherapists are currently educated at undergraduate level in universities. There are 29 university-based physiotherapy courses for undergraduate students and 27 for occupational therapy. There are many common areas in undergraduate training such as teaching of the basic sciences including anatomy, physiology and behavioural sciences. Both professional groups are taught skills such as problem solving, clinical reasoning and

Physiotherapy and Occupational Therapy Roles

Occupational therapists, with their in-depth knowledge of mental health issues, are involved to a greater extent than physio-therapists in psychotherapy, small-group work and counselling skills for users of the mental health services. They have a greater input into behavioural programmes than physiotherapists and they have a considerable role in providing advice to users about strategies to cope functionally at home. They have considerable expertise in cognitive assessment techniques.

Conclusion

Occupational therapy and physiotherapy job roles are similar and there is current role confusion and overlap. Physiotherapists are becoming more aware of the ‘care and support' philosophy rather than their traditional ‘cure' philosophy (Richardson, 1999) and as a result the two professions, already close, may overlap further. Service users need adequate numbers of trained therapists to provide them with the effective, high quality rehabilitation service that they deserve. Doyal and Cameron et al

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1

Susan Smith MA MCSP is a senior lecturer in physiotherapy

2

Pennie Roberts MCSP is group head (physiotherapy) at Leeds Metropolitan University.

3

Dr Simon Balmer MPH MFPHM is a consultant in public health medicine, Tees Health Authority.

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