At the policy summit, from left to right: Jonathan Warren, President of the New Zealand Society of Physiotherapy; John Barnes, CEO of the American Physical Therapy Association; Michael Brennan, CEO of the Canadian Physiotherapy Association.
At the policy summit, from left to right: Jonathan Warren, President of the New Zealand Society of Physiotherapy; John Barnes, CEO of the American Physical Therapy Association; Michael Brennan, CEO of the Canadian Physiotherapy Association.

Policy summit agreed on the benefits of direct access

A meeting co-sponsored by WCPT attracted 160 physical therapists from around the world. They heard that direct patient access and self-referral to physical therapy improves public health.

At the international policy summit on direct access and scope of practice in physical therapy, held in Washington DC, USA in October, professional representatives from 18 countries supported the findings of research which demonstrates that patient self-referral to physical therapy results in better health outcomes, more timely care, higher patient satisfaction and lower costs. Direct access, also known as self-referral, allows patients to access physical therapists without referral from a doctor.

The summit, jointly hosted by WCPT, American Physical Therapy Association (APTA) and Canadian Physiotherapy Association (CPA), included focused symposia, panel discussions and breakout sessions.

The opening keynote speaker was Marilyn Moffat, WCPT President. “Physical therapists are able to act as first contact practitioners, and patients may seek direct services without referral from another health care professional,” she said. “The results of this wide body of research are clear: patients benefit from self-referral and direct access. Where these services don't already exist, we should encourage legislators and health administrators to consider these findings.”

The event revealed enormous disparities from country to country in the field of direct access. “What was quite apparent early in the summit was that the ability of Australians to get access to physiotherapy was excellent by world standards,” says Jonathon Kruger, Policy Manager at the Australian Physiotherapy Association, who spoke at the event. “This to a large extent is due to the fact that we have had primary contact status (direct access without referral from a medical practitioner) for over 30 years.”

The situation in Israel is very different. “In Israel, we have just obtained direct access,” says Nirit Rotem of the Israeli Physiotherapy Society, who was one of the speakers. “As a small organisation it was informative and important to learn from other organisations’ experiences, learn of possible barriers in implementation and get ideas of how to overcome them. I think it will also help us in setting future goals.”

The section of the meeting on scope of practice again revealed the challenge presented by global variations – there was some discussion about where extended scope and specialisation ended, and advanced scope began.

A party of five UK physiotherapists attended, including speaker Ruth ten Hove from the Chartered Society of Physiotherapy. “Finding agreement around shared goals was challenging,” she said. “In some countries physiotherapists are at the beginning of their journey to develop autonomous practice. In the UK there is more flexibility for the development of practice.”

She said there was heated debate during the summit about the recognition of advanced practice across the world – including financial remuneration, credentialing and terminology of title. “In the UK we seem to have a particularly confused situation, with over 50 job titles used for describing physiotherapists working with an advanced scope. If we are confused how are the patients?”

The response to the meeting was positive. “The most valuable element of the meeting for me was the ability to network with other physiotherapists working in the policy and advocacy field and to realise that the commonality of the issues that we face is far greater than the differences,” said Jonathon Kruger. “There is a great opportunity for increased collaboration in the policy development and advocacy fields and I would like to see the world community work towards this outcome.”

Emma Stokes from the Irish Society of Chartered Physiotherapists and a member of WCPT’s Executive Committee, who was another speaker, said the summit was an “excellent opportunity to have a global conversation about the two topics. It was reassuring that common problems or challenges emerge in very different health systems and professional organisations, and the summit provided an opportunity to gain an understanding of the many ways in which these have been considered by different WCPT member organisations.”

“From an Irish perspective, there was overwhelming support from those at the meeting over our problems with the issue of the protection of title in Ireland, where direct access is available. Irish legislation protects just the title of physiotherapy, not physical therapy. There are a number of individuals who are not qualified as chartered physiotherapists calling themselves physical therapists. A number of colleagues expressed concern at the summit and followed up with letters urging the protection of both titles, which is essential for our ongoing work in trying to persuade the regulatory authority and the Minister for Health to protect both titles.”

The issues raised at the conference will now be followed up. As WCPT News went to press, WCPT was holding a teleconference with the APTA and CPA to review the outcome and steps forward. WCPT’s European Region will be holding a one-day workshop on direct access before the region’s General Meeting in May and consideration is being given as to how the theme may also have profile at WCPT’s 2011 Congress in Amsterdam.

Marilyn Moffat, WCPT President, said: “I believe we need to continue these conversations, particularly in the areas of assuring retention of our scope of practice and iincorporating into our practice the all-important aspects of prevention, wellness, and promotion of health. We need to be in the forefront of health practitioners helping to combat the ever-increasing lifestyle-related disease of obesity, diabetes, and cardiovascular and pulmonary diseases."

"These kinds of summits on key professional issues, organised by WCPT in collaboration with other organisations, are a great way to build understanding and coordinated action on international policy.”

WCPT has a Declaration of Principle on Autonomy which states "Patients/clients should have direct access to physical therapist services". It can be found at Further updates will be provided as next steps are agreed.