Roland Craps describes how a momentous change in professional representation in Belgium took place on World Physical Therapy Day 2009.
There are 27,000 physiotherapists registered in Belgium, around 17,500 of them working in private practice settings. For historical reasons – the different language communities in Belgium, different entry levels of education – not one but eleven scattered professional associations grew up to represent them. The two largest have been the Association des Kinésithérapeutes de Belgique (AKB) with 3000 members; and the National Cartel with more than 2000 members.
This split hasn’t served the profession well in the past. Both manpower and finances were used inefficiently. New and very complex government system of regulation was introduced in Belgium in 2002, and both associations invested much energy, time and money dealing separately with the same professional and regulation issues.
Physical therapy in Belgium has one of the highest educational levels in Europe. But most physical therapists resented the constant bickering between the different professional associations. Universities and higher education institutes were reluctant to cooperate with these two bodies because they had to make a “political” choice between them.
The Belgian government was demanding more quality, better communication, respect for budgets, and more interdisciplinary collaboration, and was prepared to support a joint effort to realise those objectives. There was other pressure, relating to our international status. WCPT allows only one member organisation per country, but each organisation in Belgium represented only a small proportion of the profession. Collaboration became imperative.
Then, one day in August 2007, I was sitting in a restaurant with Luc Lemense, then the president of the National Cartel (now the first elected President of the new association). I was Secretary General of the AKB at the time. We were discussing a quality-improvement project before a meeting between the two associations and delegates from the universities, and he said: “We should really put all this together.” I answered spontaneously: “Why don’t we? What are we waiting for?”
So we did. In the following weeks and months, Luc Lemense and my colleague Luc Vermeeren started negotiations between both organisations and this enthusiastic leading team got a mandate from the two executive boards to realise the merger.
We started the process of merging in July 2008 and proceeded step by step. Problems were isolated and solutions found, and in the process mutual respect started to grow. On 8th September this year - on World Physical Therapy Day - we signed the Articles of Association for the new umbrella association. We called it “Axxon – Physical Therapy in Belgium“.
The name Axxon refers to the extension of a neuron, an axon, the primary element of transmission of information within the neural system. The association wishes to be a similarly dynamic stronghold for all physical therapists. The double xx indicates that the organisation is there for every colleague, in every practice situation. Axxon stands for a united organisation of physical therapists, guaranteeing quality and standing close by their patients.
The next steps are about to be implemented. Because Belgium has two communities, the association has two wings: a Flemish (northern) part and a French-speaking (southern) part. Axxon will work at a national level – through national representatives – and at regional level, but there will also be local groups of physiotherapists known as circles. These groups, and also special interest groups, will lay the foundations of a future quality promotion project that will result in an accreditation system based on continuing professional development.
The complete merger of the two associations is due to be completed by January 2010. There is still much work to be done. Associations with specific interests will be invited to join, and follow our common goal: to bring all physical therapists together.
Our main targets are achieving direct access, creating a system of evaluating continuous learning and setting up a quality register for physical therapists. Working in health promotion and prevention is an additional goal, as well as raising the fees in private practice and health institutions.
The new association is already making its mark. It has joined a consortium of medical doctors, pharmacists and nurses to participate in and provide input to Belgium’s electronic prescription project “Recipe-e”.
The government provided financial support for Axxon and gave it a mandate to develop a quality improvement system. Government officials and social security representatives expressed their admiration and respect for our merger: a first in Belgian health care. Other health professionals showed admiration, even some jealousy. Some medical doctors' organisations are trying to follow our example.
Axxon, Physical Therapy in Belgium, has a tremendous task ahead. But unity gives strength, and we are convinced that our fellow physical therapists will join us in our common effort to improve the quality of physical therapy in Belgium, for the practitioner and for the patient.
Roland Craps is Treasurer and head of international relations for Axxon, Physical Therapy in Belgium, and 2nd Vice-Chair of the WCPT’s European Region.