514
RESEARCH REPORT
Community Based Physiotherapy in the
Trent Region: A Survey
Joanna C Seymour
Kathleen M Kerr
Key Words
Community, physiotherapy, survey, physiotherapy services,
community care.
Summary
A survey was carried out to investigate community based physio-
therapists employed by Trent Regional Health Authority.
Questionnaires were distributed to 150 community based phys-
iotherapists employed by Trent RHA, of which 97 (65%) were
returned. Informationwas obtained on personal details, geograph-
ical location and distribution, transport, referral mechanisms,
treatment, patient details, equipment, educational background,
assistant availability and interdisciplinary communication.
The majority of therapists had been recruited during the past
five years, and had been qualified for 11-15 years. The most
common venue for treatment was the patient’s own home,
resulting in an average of 16% of the working day spent in transit.
Most referrals came from GPs, but therapists were often dissat-
isfied with the information given in the referral documentation.
Conditions referred for community based physiotherapy included
strokes and other neurological problems, mobility cases, the
elderly, soft tissue injuries, rheumatologicalconditions, trauma and
orthopaedics, and back and neck problems. A majority (68.4%) of
respondents stated that they were not involved in any formal
health education/health promotion activities.
There was general satisfaction with access to equipment, with
in-service training, and with the links with other community based
professionals. Areas for further investigation include case-load
analysis, referral documentation, administrative support, use of
assistants, provision of paediatric physiotherapy, and the poten-
tial for health education/health promotion strategies.
Introduction
Community based physiotherapy services evolved
from a growing dissatisfaction with hospital care
of frail and elderly people, children and those with
progressive disease processes. For such people it
was believed that intervention at home was more
appropriate (RCGP/CSP, 1990). The underlying
philosophy of community based physiotherapy is
that therapists treat patients in the most appro-
priate venue outside the hospital setting, which
may be their homes, o r general practice clinics
(Partridge, 1982).
The aim of community based physiotherapy is to
achieve and maintain the optimum level of phys-
ical ability and independence within the clients’
own environment (Gleeson et al, 1989). Thus, the
therapists should be experienced clinicians with
widespread knowledge, have a wide array of
skills, and be capable of adapting and modifying
intervention to the specific community environ-
ment.
Physiotherapy, September 1996, vol82, no 9
From the early 1970s the transition from hospital
based physiotherapy care into community
settings has been gradual (Forster and Young,
1990), and in comparison t o the allied health
professions (social work, health visiting,
chiropody and occupational therapy) the devel-
opment of community based physiotherapy has
been remarkably slow (Burnard, 1988). By 1980,
75% of Health Districts had some form of commu-
nity based physiotherapy provision, and by 1984,
this had increased t o 95% (Burnard, 1988).
However, such provision appears to have been
limited in extent, emphasised by the evidence that
in 1991, 90% of all registered physiotherapists
played no part in the delivery of community based
physiotherapy (Partridge, 1987; Peat, 1991).
With the instigation of the government commu-
nity care legislation, and the recognition of how
physiotherapy might facilitate the implementa-
tion of community care, there has been general
acceptance that the role of community based
physiotherapists has become more diverse, with
their skills in greater demand (CSP, 1987). Thus
there is a need to analyse current service provi-
sion before refinements to existing services or
developments are made (Burnard, 1988).
The organisational difficulties of transporting
patients to hospital for treatment are documented
by Glossop and Smith (1979, cited Burnard,
1988); typical problems include delays, late
arrivals, and long journeys. These problems
have been shown t o have detrimental effects on
the effectiveness of treatment, and when this
is considered along with the cost of ambulance
transport, the advantages of a domiciliary service
become clear, However, community based physio-
therapists also face transport problems, as
approximately 8%of their working day is spent in
transit (Burnard, 1988>,resulting in the loss of
patient contact time. Space for carrying equip-
ment is limited, and rush hour city driving,
parking difficulties and traffic delays lead to
cumulative psychological stress (Frazer, 1980).
Referral misunderstandings may occur, the
majority of which arise as a result of poor commu-
nication between referring general practitioners
and physiotherapists (RCGPESP, 1990). It has
been documented that referrals to community
based physiotherapists are brief and lacking

in specific o r essential details (Scaffardi, 1989).
To counteract this, a RCGP/CSP working party
suggested that referrals should contain not only
the usual database material required at assess-
ment, but also supplementary information such
as X-ray reports, current investigation reports,
and other carers involved. This should be supple-
mented further by physiotherapists having direct
access t o practice medical records, and regular
contact with GPs and primary healthcare teams.
Indeed, Gleeson et al (1989) emphasised the
necessity for multidisciplinary liaison within
the community field, suggesting that continual
support from allied professionals helps t o alle-
viate the feelings of isolation which maybe felt
by community based physiotherapists (Furnell
and Furnell, 1978, cited Gleeson et a l , 1989; see
also Forster and Young, 1990).
It was initially proposed that ‘care in the commu-
nity’ would benefit frail and elderly people, for
whom travel to hospital might prove detrimental.
However, it has been documented that this
service might benefit a much wider range of
patients, namely those with acute respiratory
exacerbations (Partridge, 19871, stroke patients
needing rehabilitation (Gleesonet al, 19891,young
people with spina bifida and hydrocephalus
(following ‘special school’ care, CSP, 1987), and
patients with acute musculoskeletal problems
(Hackett et al, 1987).
However, although the needs, requirements and
provisions of the community care ideology have
been recognised, the lack of resources and funding
prevents the full implementation of the service
(Hunter, 1992), and this may result in groups of
patients who might benefit from the service
‘missing out’. Furthermore, Hackett et a1 (1987)
suggested that inadequate provision of adminis-
trative support, to deal with telephone calls and
appointments, diverted the physiotherapists’ time
from patient contact to administration, and that
inadequate funding for therapeutic equipment
could limit the effectiveness of some treatments.
Time and resources may be saved by encouraging
some clients t o develop responsibility for their
own health care, perhaps reducing deterioration
of function and avoiding hospital admission
(RCGP and CSP, 1990; Lammont and Langford,
1980, cited Chesson and Sutherland, 19941, and
releasing time for therapists to treat more acute
and demanding cases. This demands development
of a health education and advisory role, which
may be extended beyond more traditional thera-
peutic boundaries to encompass sports/leisure
centres and community based cardiac rehabilita-
tion (Lane, 1990). Further constructive use of
physiotherapists’ time may be facilitated by the
effective use of physiotherapy assistants for basic
515
treatments under the overall supervision of a
community based physiotherapist (ACPC, 1992),
although Stone (1987) warned that this should
be carefully monitored, to avoid the situation in
which assistants might ‘behave like pseudo-
professionals, and attempt skills and techniques
for which they are not qualified’.
There has been a considerable increase in interest
in community based practice since the Commu-
nity Care Act of 1990, and its full implementation
in 1993. The literature puts forward several
suggestions for effective practice, and individual
studies have identified where weaknesses in the
system exist. However, there is little definitive
information available on the actualities of current
provision of community based physiotherapy.
Consequently, this study aims to investigate the
overall picture of the provision of community
based physiotherapy in one health Region, encom-
passing administration, transport, and delivery
of the service.
Method
This study aimed t o investigate the provision of
community based physiotherapy within the Trent
Regional Health Authority (RHA), using the
perspectives and opinions of those delivering the
service, namely the community physiotherapists
themselves.
Design
A survey design in the form of a questionnaire
was used to obtain the data.
Populatiodsample
There was no available list of community based
physiotherapists in the Region; an interview with
the District physiotherapist of the Nottingham
Community NHS Trust identified managers/
superintendents of community based services in
the following locations within the RHA: Leicester-
shire, Sheffield, North Derbyshire, Rotherham,
Doncaster, Chesterfield, Worksop, South
Derbyshire. These managers/superintendents
were approached to request contact addresses of
individual community based physiotherapists
within each locality. From this information, a
population of 150 community based physiothera-
pists within the Trent RHA was established.
Questionnaire
Development
A semi-structured interview with the District
physiotherapist of the Nottingham Community
NHS Trust, in addition to a comprehensive review
of the literature, revealed various topics requiring
further investigation. Consequently, a question-
naire was constructed containing questions under
the following topics: personal details, geographical
Physiotherapy, September 1996, vol82, no 9
516

location and distribution, transport, referral premises’ (these include GP surgeries, health
mechanisms, treatment, patient details, equip- centres and community trust hospitals).
ment, educational background, assistant avail-
It was found that the larger the catchment area,
ability, and interdisciplinary communication.
the greater the number of community based
Four pilot questionnaires were distributed t o physiotherapists employed.
community based physiotherapists in a different
RHA, who did not participate in the study. Three Transport
were returned, and from subsequent evaluation, Almost 90% of community physiotherapists in the
some minor clarifications were made. Trent Region required the use of a car for service
provision; the average amount of time spent in
Distribution transit during the working day (excluding trav-
The final version of the questionnaire was dist- elling from home to and from the work base) was
ributed through managers/superintendents of 16% (fig 2). Perhaps not surprisingly, the propor-
community based physiotherapist services and 25
by mail to the 150 identified community based
physiotherapists. In each case an anonymity code
was issued, and confidentiality was assured. a,
Q
20
E
Analysis a
+ 15
0
Collected data were combined and collated in a,
tables related to topic areas in the questionnaire. m
m
The collated data were analysed using descriptive F 10
a,
statistics. 2
a,
a 5
Results
The 150 questionnaires distributed yielded a 0
5-10 11-12 14 16 20 25 33 75
return rate of 97 (65%),with a final completion
rate of 89 (59%). Percentage of day
Fig 2: Percentage of working day spent in transit
Sample
From the population of community based physio- tion of time spent in transit was greater in
therapists in this study, 92.1% were female, 54% relation to the size of the geographical catchment
were aged between 31-40, and the majority had area. Therapists working in a catchment area of
been qualified for 11-15 years. The majority of less than 20 square miles spent less than 10% of
this sample (64.4%)had been recruited as commu- their working day in transit, while those working
nity based physiotherapists within the last five in areas of over 30 square miles spent between
years (fig 1). 16% and 33% of their day travelling. Further-
100 more, those therapists spending a greater
proportion of their time in transit treated fewer
patients.

’c

a,
40
m
m
c

5 20
b
a
0
1975 1980 1985 1988 1990 1993
Year began work in the community
Fig 1: Recruitment of community physiotherapists in Trent General practitioners Other physiotherapists
Region
Social services District or community
nurses
Treatment Venue
Consultants Other
The patients’ homes were the most commonly
cited venues for treatment (75.2%),with 39.3% Fig 3: Main source of referrals to community based physio-
of treatments taking place a t community ‘site therapists - figures are percentages

Physiotherapy, September 1996, vol 82, no 9


Referrals
The majority of referrals t o community physio-
therapists came from GPs (fig 3). These were
made by letter, telephone or by using referral
cards, and were sent either directly to the commu-
nity based physiotherapist (44.4%), or t o a
receptionist/secretary (36.1%).In 72.5% of cases,
respondents indicated that it was the responsi-
bility of the community based physiotherapists
t o arrange subsequent appointments for clients.
The time span between receipt of the referral and
the first consultation ranged from between two
and five days (40.4%)to between five and ten days
(37.1%). This varied with the acutenesshrgency
for treatment of the referred condition, and did
not appear t o be related to the length of waiting
lists, as 82.2% of the respondents claimed to have
fewer than 20 clients on a current waiting list.
In 80%of referrals, the patient’s forenames, dates
of birth and addresses were included. However,
the inclusion of other items of information - the
name of the patient’s GPs (26.7%), past medical
histories (85.2%),drug histories (74.4%),investi-
gationdreports (77.3%), domiciliary access
(59.8%),social circumstances (68.4%),patients’
telephone numbers (67.4%) and the referring
agents’ names and contacts (44.8%)- was incon-
sistent and some details were often absent.
Treatment
When the number of treatment sessions available
to each patient was investigated, 66.3% of respon-
dents stated that there was no imposed limit
t o the number of treatment sessions a patient
might receive. However, 19.2% responded that
the number of treatment sessions was limited,
usually to fewer than ten, and that this restriction
was imposed by the fundholding GP. This last
statistic is of concern, and has implications for
the autonomy of physiotherapy practice in the
community, if decisions on treatment duration are
being made not by physiotherapists on clinical
grounds, but by GPs, on what we must assume are
financial grounds.
The frequency of treatment sessions varied from
once per day, to once every three to six months.
The most common frequency of treatment per
patient was once per week (57.6%).Factors which
dictated treatment frequency were the presenting
condition (91.0%), the therapist’s caseload
(75.3%), social situation (20.2%),patient location
(12.4%) and understaffing (11.2%).
A majority of therapists (57.3%) carried out
between six and ten treatment sessions per day.
Those therapists who worked predominantly in
patients’ homes carried out fewer treatment
sessions per day (six to ten) than those working in
517
community site premises (11to 15). Furthermore,
63.2% of treatments carried out in patients’
homes tended to be of longer duration (over thirty
minutes) when compared to treatments carried
out on community site premises, in which 88.4%
took less than thirty minutes.
Pathological Conditions
Pathological conditions appearing t o benefit
from community based physiotherapy included
strokes and other neurological problems, mobil-
ity problems, elderly people with a variety of prob-
lems, soft tissue injuries, rheumatological
conditions, trauma and orthopaedics, and back
and neck problems.
Orthopaedic (88.7%),rheumatological (85.6%),
neurological (92.9%), and respiratory problems
(go%),strokes (loo%), mobility problems (100%)
and the elderly were almost exclusively treated at
home, with soft tissue injuries (73.3%),shoulder
(69.2%)and back and neck problems (41.6%)more
commonly receiving physiotherapy treatments
at the community site premises.
Only 32.6% of respondents stated that they
offered out-patient clinics, and 43.8% disclosed
that they were not involved in the provision of any
group treatment sessions o r clinics within the
community, indicating that there was little
provision in the community by physiotherapists
of cardiac rehabilitation or ante- or post-natal
classes, or back schools. Furthermore, 68.4% indi-
cated that they did not deliver any formal health
promotionhealth education in the community.
Patients
There appeared t o be a relatively equal male:
female ratio of patients receiving community
based physiotherapy, with the majority of
patients being over 50 years of age; very few
patients were under 18 years old.
Support Network
Physiotherapy assistants were available to 49.4%
of community based physiotherapists, and in
these circumstances, 86% utilised their services,
particularly to help with orthopaedic and mobility
cases, and with stroke patients and older people.
The majority of therapists claimed that they had
access to almost any piece of equipment required,
although the use of traction tables and high/low
plinths was limited to therapists practising at
community site premises. The local health
authorityhrust was the main financial provider of
physiotherapeutic equipment. GPs were more
likely to contribute finance for equipment used on
their own community site premises, than for
equipment used in the patients’ own homes.
Physiotherapy, September 1996, vol82, no 9
518
Range of equipment transported by community based
physiotherapistsin Trent Region
Equipment Physiotherapists
No % Although larger geographical areas within the
Ultrasound 65 73
Interferential 27 30.3
TENS 39 43.8
PSWD 3 3.4
Soft collars 17 19.1
Tubigrip 6 6.7
Wrist brace 6 6.7
HoVcold packs 4 4.5
Mobility aids 33 37.1
Weights 1 1.1
Other 23 25.8
None 7 7
The table shows the usage of therapeutic equip-
ment, and indicates that the portable ultrasound
machine was the most commonly transported.
In-service training was a regular feature in 96.5%
of responses, occurring on average once per
month. The majority of therapists (77.5%) did
not feel isolated while working in the community,
as most had some form of regular contact with
various allied community based professionals.
However, there was no formal arrangement for
multi-disciplinary case conferences, which tended
to occur irregularly and on an informal basis.
Discussion
The development of the Trent RHA community
based physiotherapy service has been influenced
by the community care legislation. Before the
community care proposals of 1988, only 30% of the
current workforce was employed in the commu-
nity setting, with a further 50% being recruited
during the transitional period between the
proposal and the legislation of 1993; a further 20%
has been employed since 1993. In addition t o
reflecting the change in thinking on the benefits
of community based health care as opposed to
hospital based practice, this growth also reflects
the change in allocation of financial resources
since the early 1980s (Partridge, 1987). The vast
majority of community based physiotherapists in
this Region are employed directly by Trent
RHA, rather than indirectly through the general
practice budget, which may indicate t h a t GPs
offer contracts t o private practitioners for their
services, and do not employ physiotherapists
within their practices.
The most common venues for treatment were
patients’ homes, supporting the view expressed in
previous research that patients have greater
rehabilitation potential and are more relaxed and
co-operative in their own surroundings. Further-
more, the negative physical and psychological
effects and the huge financial implications of
Physiotherapy, September 1996, vol 82, no 9
transporting patients to hospital are avoided
(CSP, 1987; Forster and Young, 1990).
However, this also has implications for therapists.
Region are assigned a greater number of commu-
nity based physiotherapists, the amount of
therapist time spent in transit was considerable.
The majority of respondents in this study spent
between 16% and 25% of their working day
in transit, considerably greater than the 8%
mentioned by Burnard (19881, who quoted results
from a study carried out in Brent in 1986, but
suggested that it was not an atypical example; it
has been suggested that to spend more than 25%
of the working day in this mode results in service
counter-productivity (personal communication).
Although most of the therapists in the present
study were below this limit, it still represents a
loss of potential patient/therapist contact time,
and might also contribute t o increased stress
levels, particularly if it involves urban driving
(Fraser, 1980). Some of these problems might be
resolved by more efficient allocation of physio-
therapy resources, by assigning therapists to
smaller locations as suggested by Gleeson et 02,
1989); this was reinforced in the present study,
which found that within smaller geographical
locations (20 square miles), only 5% to 10% of the
working day was spent in transit. This of course
depends on adequate financial provision, but
should provide a more efficient service.
The majority of referrals (over 70%)to community
based physiotherapy were from GPs, supporting
the findings from previous studies (ACPC, 1992;
Walker, 1991). These referrals were usually sent
directly t o therapists; the findings from the
present study emphasised the importance of
administrative support when dealing with
referrals, as lack of support of this nature
also has potential t o reduce patientltherapist
contact time. Over 35% of respondents in this
study had no administrative support, suggesting
inefficient use of therapists’ time.
Referral documentation was found lacking in
several areas of information (for example, drug
history, past medical history, results of investiga-
tions, domiciliary access and social history). The
inadequacies in referral information from GPs
found in this study concurs with previous studies
(Scaffardi, 1989; RCGP-CSP, 1990), and is a cause
for concern, not only that having to obtain infor-
mation previously available is time-consuming
and should be unnecessary, but in the community
setting, lack of knowledge of previous medical
and/or social history could place the therapist in
an untenable, or potentially dangerous position.
Almost half of the sample claimed that their

patients received their first consultation within
five days of receiving the referral documentation,
compared with a similar claim from only 32% of
hospital based physiotherapists. Similarly, a
significant majority of the respondents in the
present study had waiting lists of fewer than 20
clients, perhaps demonstrating efficient caseload
management. The amount of treatment (in terms
of the number of sessions) given to patients was
unlimited in two-thirds of the sample, with the
therapists making the decision on a basis of need.
However, in those situations in which the alloca-
tion of treatment sessions was limited, almost
half were dictated by pre-set contracts with
fundholding GPs, the decisions apparently being
made on financial rather than clinical grounds.
Perhaps not surprisingly, more treatment
sessions per day were carried out when the phys-
iotherapists worked from a fixed community base
(for example, a community health centre) than
when they operated a domiciliary service. This
may be explained in part by the time spent in
transit between domiciliary visits, and between
the community base and the domiciliary setting.
Furthermore, the nature of conditionsiproblems
encountered by the community physiothera-
pist often dictates the venue in which the
patient/client is treated. Elderly patients, often
presenting with more complex problems, which
are more time-consuming t o treat, are usually
treated a t home, whereas musculoskeletal
problems are more commonly treated at a health
centre.
The community based physiotherapist seems in
an ideal situation to become actively involved in
health education activities aimed at primary and
secondary prevention (for example, cardiac reha-
bilitation, back schools, post-natal classes). It is
therefore disappointing that only a third of the
community based physiotherapists surveyed in
this study actively participated in health educa-
tiodhealth promotion activities, supporting the
views expressed by Walker (1991) that commu-
nity based practice does not adequately address
these issues. This may reflect the perceptions of
the physiotherapists of their role in the manage-
ment of specific problems presenting in their
patients, rather than addressing the wider issues
encompassed by health education and health
promotion. This is reinforced by the range of
conditions commonly cited as those treated by
community based physiotherapists, namely
neurological dysfunction (including stroke),
rheumatological problems, and musculoskeletal
conditions (including orthopaedics and trauma,
and back and neck problems).
As community based physiotherapists often spend
the majority of their time working alone (that is,
519
not with other therapists), access to resources
is a potential problem. Almost half (49.4%) of
the subjects of the present study had access to
physiotherapy assistants, a valuable resource,
particularly in the domiciliary setting when
patients’ mobility is a prime issue; in the present
study, 75% of physiotherapists whose caseload
comprised predominantly mobility problems
used assistants. However, a high percentage of
assistants played an administrative role, or trans-
ported equipment, which is not the most effective
use of this valuable resource, although it might be
argued that i t releases physiotherapists from
performing these tasks. This has been recognised
by other researchers (Stone, 1987; ACPC, 19921,
who believe that the role of physiotherapy assis-
tants in the community should be more clearly
defined, to enable this resource to be used to the
full. Access to therapeutic equipment was thought
to be satisfactory, with the majority of therapists
having access to any piece of equipment that was
required. The RHA was the greatest provider of
equipment, particularly that which is used in the
patients’ own homes; GPs were more likely to
provide equipment which would stay ‘on site’, and
t o contribute to the resources of the centre.
Working ‘solo’,while promoting self-sufficiency
and autonomy, can also lead to feelings of isola-
tion (Furnell and Furnell, 1978, cited by Gleeson
et al, 1989). This can be counteracted by having
mechanisms in place to promote regular meetings
of community based practitioners. The ACPC
(1992) and CSP (1987) have advocated regular
staff in-service training in the community
environment, which has a dual purpose as
an educational forum, and as means of
providing social and psychological support
when problems can be shared and discussed.
More than 96% of subjects in this study were
involved in a regular in-service training pro-
gramme, confirming sound standards of practice,
and explaining why few therapists expressed feel-
ings of isolation.
Conclusion
Community based physiotherapy services in the
Trent RHA are still in a developmental stage,
but this survey has highlighted some positive
elements of the service.
Therapists working in the community setting are
experienced practitioners, who are running a n
efficient service, and treating a wide range of
conditions in patients of both sexes and a variety
of ages. Resources in terms of equipment appear
to be adequate, and access to assistants is reason-
able, although it seems that more efficient use
could be made of this resource. There is a sound
Physiotherapy, September 1996, vol82, no 9
520
~ ~ ~~ ~~~~ ~~

support network, linked to a well established in-
service training programme. Negative issues
which have emerged include poor quality of
referral documentation, the amount of time spent
in transit, and the missed opportunity for commu-
nity based physiotherapists t o become involved
in the wider issues of health educatiodhealth
promotion.
Areas identified for further investigation include
caseload analysis, referral documentation, admin-
istrative support, use of assistants, provision of
paediatric physiotherapy, and the potential
for implementation of health educatiodhealth
promotion strategies.
Authors
Joanna Seymour BSc MCSP is a physiotherapist at the Royal
Hallamshire Hospital, Sheffield. This report is of a study carried
out as part of her undergraduate degree course at the Univer-
sity of Nottingham School of Physiotherapy.
Kate Kerr PhD BA MCSP DipHealthEd is a lecturer in the Univer-
sity of Nottingham School of Physiotherapy.
This article was received on March 26, 1996, and accepted on
July 5, 1996.
Address for Correspondence
Dr K M Kerr, University of Nottingham, School of Physiotherapy,
Hucknall Road, Nottingham NG5 1PG.
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These papers are all available free of charge (though a stamped addressed envelope is
appreciated) from the Professional Affairs Department, CSP, 14 Bedford Row. London
WC1 R 4ED. Please state clearly which paper is required.
PA1 : Reports for Legal Purposes PA14:Quality Assurance in Health Care PA26: Standards of Business Conduct
PA2: Access to Health Records - A glossary of terms PA28: Patterns of Health Care Delivery:
PA3: Use of NHS Facilities for Private PA15: Quality Assurance - Conducting a Managed care information for
Practice consumer satisfaction survey chartered physiotherapists
PA4: Equipment Safety and Product PA16: References for Quality Assurance PA29:Clinical Physiotherapy Specialist
Liability (Consumer Protection Act and Standard Setting Posts in Out-patient clinics:
1987) PA17:The Patient’s Charter Guidance for members
PA5: Patients Seeking Treatment in the PA18: Quality Assurance: References for PA30: Rationing of Physiotherapy
Public and Private Sectors audit Services
PA6: The Delegation of Tasks to PA19: Pelvic Floor and Vaginal Assess- PA31:Use of Injections by
Physiotherapy Assistants and ment: Guidance for course tutors Physiotherapists:
Other Support Workers and postgraduate physiotherapists Interim guide
PA7: Thinking of Private Practice PA20:General Principles of Record PA32:Chartered Physiotherapists and
PA8: Patient Handling Training Keeping Insurance
PA9: Manual Handling of Inanimate PA21: Physiotherapists Working Outside PA33: Medical Devices Agency
Loads Trainina the Scope of Physiotherapy PA34: New NHS Complaints
PA10: Working in theunited Kingdom Practice Procedure
PA11: Facilitating Exchanges PA23: Specialisms and Specialists PA35:Treatment Involving Manual
PA12: Going Abroad - Questions to ask PA24: Licensing of Acupuncture Handling
PA13: Joint Statement of Working PA25 Use of Lasers by Chartered
Together in Psychophysical Physiotherapists in Private
Preparation for Childbirth Practice - The legal position

Physiotherapy, September 1996, vol82, no 9