How To Avoid Lengthy Treatment Delays By Understanding The Great Divide In Physiotherapy

Physiotherapy – A Brief History

The beginnings of Physiotherapy date back to the late 1894 when four nurses formed the Society of Trained Masseuses. A Royal Charter was awarded in 1920, in recognition of the profession’s high education and professional standards. It evolved over the following years until it became the Chartered Society of Physiotherapy (CSP) in 1944.

The CSP has been the controlling body for physiotherapy since 1944 and they work to the guidelines as dictated by NICE (The National Institute for Health & Care Excellence – a government body).  The CSP is predominantly geared towards the needs of the NHS and this is where the great divide has it’s origins.

Physiotherapy Within The NHS Today

The NHS is a massive entity and has to constantly make difficult decisions on how and where to best spend the budget it is provided by the government. The lack of a sufficient budget has been a permanent factor in our lifetime, and as we all know, it is without fail subject to political football every election.

In recent years the NHS has moved towards ‘hand off’ physiotherapy. You will get a good diagnostic assessment if a face to face appointment is granted. However, hands-off exercises seems to be the normal ‘treatment’. Follow up appointments, if really needed, are 15 to 20 minutes and are spaced 8 or more weeks apart.

Perception Is Reality

Understandably, the general public will think of the NHS first if they perceive they need some physiotherapy. After all, they have already paid for it in their taxes, so there is no extra cost. This of course ignores the fact that wherever you go, there is a time commitment which could mean time off work or even taking holiday. I reality, nothing is free.

If an individual has no former experience of physiotherapy, their perception of what physiotherapy is will be governed totally by their NHS experience and their perception, in the words of most of our clients coming from the NHS, and there are a lot of them, is it’s a waste of time.

Now this is not good for the profession of physiotherapy, because all physiotherapists, whether they work in the NHS or not, are highly trained to provide excellent diagnostics and effective hands-on treatment.

Long term, this is not good for the physiotherapy profession


The issue is not the physiotherapist, it’s the environment they choose to work in. And if that’s in the NHS, then the shift is towards ‘hands-off and in reality, how can you effectively treat if it’s ‘hands off’?

The real risk is that many will have their first and last physiotherapy appointment in the NHS. From their perception, this lacked any real benefit, and consequently, they will post physiotherapy to the dustbin for the rest of their lives and seek out alternatives like chiropractic and osteopathy.

Long term, this is bad news for the physiotherapy profession.

An Alternative Perception – An Alternative Reality

Many physiotherapists choose to work in the private sector because they are primarily motivated to make a real and positive difference to a client’s life. In reality, they know they can only do that by being allowed to give as much treatment as is needed. That means sufficient time to be effective and the ability to follow up as frequently and as often as is really needed.

Skills Availability

As written above, the CSP has to work within NICE guidelines and this sometimes causes problems that can be avoided in private clinics.  As an example, a few years ago, NICE awarded acupuncture the gold standard for treating back pain. Then they made a complete U turn and said it was ineffective. The impact of this decision was that acupuncture was categorised by many in the NHS as quackery. Some of our part time staff, who also worked full time in the NHS, reported they were banned from using acupuncture, which they found very frustrating as they were using acupuncture very effectively in our clinic at exactly the same time.

Some years later, NICE performed their second U turn and approved acupuncture for back pain again. Without doubt many patients in the interim, who could have been helped from suffering severe pain, were probably left to taking pain killers and talked to about how to manage their pain.

Now compare this to what happened in our clinic. We had massive experience in using not only acupuncture, but also much more advanced techniques, and we had achieved substantial success in helping people get out of pain and be more mobile. Thus when NICE stated acupuncture as being ineffective, we simply ignored it because we knew it was incorrect and carried on helping clients, day in day out. Many clients even traveled from abroad for our skills in this period and that simply would not have happened if our treatments didn’t work.


It may come as a surprise to many, but private clinics tend to invest much more heavily than the NHS into technology which can really help clients in pain. We don’t have the restrictions of conforming to NICE dictates, and thus we have the freedom to look more broadly and move much faster. We also employ evidence based decision making and take account of clinical experience and client preferences.

We know this because when we employ physiotherapists from the NHS, we have to train them in new skills and new technology which they have never seen before.

What Does This Mean For You

Not surprisingly, we have many clients who start with us and then go to the NHS thinking they will get the same intensity and breadth of treatment as we provide, only to return weeks or months later expressing their frustrations of how little, if any, treatment they received.

Their perception was that physiotherapy was based on what we provided, and it seemed logical to go to the NHS and get the same thing for free. The reality was they experienced the great divide between private and NHS physiotherapy.

We doubt that future clients new to us will be any different. The truth is clients just don’t believe us when we try to explain the differences.

You, however, are only getting this blog because you have already been to our clinic and hopefully you will thus better comprehend the great divide. That may not stop you from wanting to try the free option first.  If you do decide to give it a go, hopefully it will work for you as you will get a good diagnostic assessment, but the chances are you will end up waiting weeks to get an exercise prescription.

Your Choice

Ultimately it’s your choice what you do. We can only advise as best we can and if you are in pain now, that would be to get to a private clinic as you will get out of pain a lot faster.

If you are in pain, we can help.

Call 01889 881488 now. Erica, Jean or Charlotte will be happy to help.