I recently met with a Kim Gibson, Chair of the Physiotherapy Board of Australia. The Physiotherapt Board of Australia and AHPRA work in partnership to deliver the National Registration and Accreditation Scheme in Australia to regulate all Australian physiotherapists through protection of title rather than regulation of practice scope. I have also had the pleasure of meeting with and discussing these topics with Damon Newrick from the Physiotherapy Board of New Zealand and members of the Australian Physiotherapy Association Advanced Practice Network.
I equate theAustralian and New Zealand Boards to to the UKs HCPC. Discussions drift towards two opposing views of regulation. One view highlights that the majority of physiotherpaists will not be called to prove the quantity or quality of CPD and ongoing learning processes. This can allow poor practice to remain hidden and therefore can put patients at risk. This is the view I heard discussed on the recent Health Matters podcast with Sandra Harding and Sarah Tribe and to which I listened with interest. This view is also discussed within the Reforming Clinical Governance chapter of the MSK Reform Manifesto.
The opposing view is that the risk level to the public from physiotherapy is minimal with the majority of our intervention being education and movement based therefore the risk of serious harm to the public is minimal. This view suggests the bigger risk may be an overburdening of the profession which could have mental health impacts for staff and a wider societal impact if professionals feel this process is too burdensome and therefore leave the profession for periods of time or early.
In this view, regulation is a minimal requirement for safe practice and should not be too specifically tied to credentialing or educational credit structures. Within this approach credentialing is seperate to regualtion and it is credentialing processes which demonstrate a clinicians’ advanced level within a profession, unless Advanced (or Specialist as in NZ) becomes a regulated title.
I have been fortunte to hear Dr Richard Collier present his work with HEE on a number of occasions and we have discussed the potential difficulties in regulating advanced pracitce in the UK. My understanding from our discussions is that The Academy, which is being developed as a credentialing body for Advanced Clinical Practitioners, will provide a voluntary register for Advanced Clinical Practice but that this is not linked to a move to regulate Advanced Practice through The Academy or through HCPC.
The Academy would credential a level of practice rather than specific roles and this level of practice is often talked about as being at Level 7, in terms of an MSc or equivilent. It is reassuring to see this is mirrored in the educational achievements of advanced practice physiotherapists in other countries such as Australia and New Zealand.
The supporting documentation being released from the various UK organisations advocate strongly for the 4 pillars of advanced practice. However, this is not a model I have seen strongly replicated during my Fellowship interviews and discussions. In Queensland, practitioners working in Advanced Practice MSK settings are credentialed through a peer learning process which is purely clinically focused. In Victoria, practitioners working in these same settings work through a competency based portfolio framework supported by self-learning modules, this framework is again purely clinical.
My observation is that there are similarities between the regulation of Physiotherapy in these specific countries. All regulators explain that risk in our profession is low and therefore a light touch method is taken to regulation which should be the minimal standard of practice expected by a qualified physiotherapist. However, there are inconsistencies in how we manage accreditation of all qualified physiotherapists and very mixed approaches to the accreditation or recognition of clinicians with advanced skills or working in advanced practice environments.
It again comes back to terminology, we need to be mindful about whether we are talking about regulation, credentialing or governance.