Physiotherapy at a crossroads

As our profession expands into new roles – prescribing medications, performing injections, ordering investigations, and triaging in primary care – physiotherapy is evolving rapidly. 

This evolution raises a thought-provoking question: are we, as a profession, moving in two different directions? One path broadens our scope to meet healthcare demands in new ways, while the other focuses on our traditional strengths in movement-based rehabilitation. Let’s explore this further. 

NHS demands

The NHS is facing immense pressures, challenged by limited resources and constant calls to do ‘more with less’. Physiotherapists within the NHS work tirelessly to meet the complex demands of this stretched healthcare system. 

With constrained funding, we’re encouraged to take on roles traditionally filled by other healthcare professionals, which allows for broad impact and opens new career growth opportunities. 

However, as our responsibilities expand, we must ask: are we focussing our energy on roles that, while critical to healthcare, may distance us from our core strengths of exercise and rehab?

Private practice

In private practice, traditional skills like hands-on treatment and targeted rehab remain central to physiotherapy. Patient demand for these services is high, as seen in the growing numbers of private physiotherapy practices across the UK. With long NHS waiting times, some patients may choose private care to gain timely access to the treatment they seek. 

More physios are moving into private practice, drawn by a desire to focus closely on rehabilitation expertise and build meaningful patient relationships. Physio First supports this shift. For many practitioners, private practice offers a fulfilling career path, allowing them to deliver care unrestrained by NHS limitations. Katie Knapton, chair of Physio First, describing a trend in UK physiotherapy

This contrast prompts us to consider whether we are seeing the emergence of two different approaches to physiotherapy – one shaped by the demands of the public sector and another aligned more closely with our foundational practices.

Finding balance

The diversity of where we work and how we practice highlights the broad impact physiotherapy has across settings. NHS physiotherapists play essential roles in a complex healthcare system, often managing large patient populations under challenging conditions. 

In contrast, private practice enables some practitioners to focus more deeply on function and rehabilitation. Both settings offer unique strengths and make invaluable contributions to patient care. 

This discussion is not about saying certain roles are ‘better’ or ‘worse’, but about understanding the potential development of different pathways within one unified profession. 

As a profession, we are at an important moment to ask: how can we maintain our unity while servicing different needs? 

If we continue to embrace diverse roles in the NHS, could we gradually shift from our rehabilitative identity? 

Or can we find a way to integrate both traditional and emerging roles, preserving the integrity of physiotherapy without creating separate identities? The decision is in our hands. Will we keep our profession whole, or let it split into two divergent paths?