1. Sofia, 6 June, 2015 Roland Craps – 1st Vice-chairman of the ER-WCPT David Gorría – General Secretary of the ER-WCPT 7 th Congress of Bulgarian Association of Physiotherapists (BAPT).

2. Physiotherapists: Independent and autonomous professionals with the knowledge, skills and competences, prepared to have a key role in health systems taking their own decisions

3. 1.What we are talking about 2.Education 3.Scope of Practice 4.Putting it all together 5.Conclusions Content of the presentation

4. 1.What is this about? Physiotherapy and physiotherapists 2.What this is NOT about? 3.How are we seeing it at EU Level and by other health professionals ? We are a recognized profession. 1. What we are talking about

5. 1. PHYSIOTHERAPY AS AN INDEPENDENT AUTONOMOUS PROFESSION “Organized autonomy must be the first distinctive element of a profession. Self control of the own work makes the difference between an independent profession and a subordinate/auxiliary one” Eliot Freidson, 1978

6. 1. PHYSIOTHERAPY AS AN INDEPENDENT AUTONOMOUS PROFESSION Actions of individual physiotherapists are their own responsibility Physiotherapy programmes should deliver a curriculum that will enable PTs to attain the professional autonomy Clinical education is an essential element of the PT programmes

8. 1.1 DEFINITION OF PHYSIOTHERAPY PROVIDED TO THE EUROPEAN COMMISSION Physiotherapy provides services to individuals and populations in circumstances where movement and function are, or may be, threatened by ageing, injury, pain, diseases, disorders, conditions or environmental factors. Physiotherapy promotes the active participation in society through the development, maintenance and restoration of health, movement capacity, physical activity and functional ability throughout the lifespan.

9. 1.1 DEFINITION OF PHYSIOTHERAPY PROVIDED TO THE EUROPEAN COMMISSION Physiotherapy services are provided within all the spheres of health & well-being (e.g. health promotion, prevention, habilitation, rehabilitation and palliation) and encompass physical, psychological, emotional, and social factors. Physiotherapy involves the interaction of the physiotherapist with the patient/client including their family, care givers and relevant other health professionals, and communities, in a process that rests on the assessment of movement potential. Physiotherapy is a science-based health discipline.

10. 1.1 WHO PRACTICES PHYSIOTHERAPY? As agreed with the EU Commission: (DG Employment, ESCO project and provided to other DGs) Physiotherapy is only practiced by a: Physiotherapist or Advanced Physiotherapist

11. 1.1 Physiotherapist Physiotherapists promote the participation of persons in society by working independently to develop, maintain and/or restore their patients’/clients’ health, movement capability, physical activity and functional ability throughout the lifespan using evidence-based approaches that encompass physical, psychological, emotional, and social factors. Physiotherapists are autonomous health care professional who assesses, diagnoses, plans, treats and evaluates clients/patients and is responsible for his/her own actions. Physiotherapists have their own caseload of clients/patients with complex needs; and practice within complex and increasingly unpredictable contexts. Physiotherapists practice according to professional codes of practice and conduct. Physiotherapists have completed an education programme, or equivalent, which is recognised by the state to practice physiotherapy.

12. 1.1 Advanced Physiotherapist Advanced Physiotherapists, are Physiotherapists who have formally demonstrated an ability to apply advanced competences (knowledge, skills and attitudes) in a defined area within the scope recognised for physiotherapy. Advanced Physiotherapists have the skills to address complex decision- making processes and manage risk in unpredictable contexts. Advanced Physiotherapists may have completed an advanced programme of studies or be able to demonstrate the ability to work at an advanced level, focusing on a specific area of clinical practice, education, research, or professional management among others.

13. 1.2 What we are not We are not assistants or technicians working under supervision of physiotherapists We do not work within defined contexts using agreed treatment protocols and procedures We have the right to refuse to perform any intervention, on professional and safety ground, even if prescribed by a physician

14. 1.3 How are we seeing it at EU Level and by other health professionals? We are a recognized profession ! Besides our practical competences, explained later, we are also required at EU level to collaborate on: Directive on Recognition of Professional Qualifications; European Professional card – Focus group on Health Professionals Patients right on cross border. EU Health Strategies. European Skills / Competences and Occupations – Reference Group on Healthcare social services European Innovation Partnership on Active and healthy Ageing European Health Workforce EU Platform for Action on Diet, Physical Activity & Health. European Health Forum – EHF

15. 1.How is the Education at EU level ? 2.Purpose of clinical education – Why ? 2. Education

16. 2.1 Education at EU level Education for entry-level physiotherapists must be based on university or university-level studies, of a minimum of four years, independently validated and accredited as being at a standard that accords graduate full statutory and professional recognition. The first professional qualification should represent completion of a curriculum that qualifies the physiotherapists for practice as an independent professional. An integral component of the curriculum for the first professional qualification is direct clinical experience under the supervision of appropriately qualified physiotherapists.

17. 2.1 Education at EU level Clinical education will involve gradual access to responsibility as skill and experience grow. Basic physical therapy education should be conducted by physiotherapist teachers able to transfer knowledge and skills for the critical analysis of theories and methods of physiotherapy. Physiotherapists should be encouraged to undertake post-graduate education in physiotherapy or related fields for advanced professional development.

18. 2.2 PURPOSE OF CLINICAL EDUCATION To provide students with opportunities to integrate knowledge and skills at progressively higher levels of performance and responsibility To apply theories and scientific findings, learned in their academic study, and develop their skills through interaction with clients and practitioners To develop experience of inter-professional working To practice interpersonal skills and develop characteristics essential to productive working relationships

19. Clinical education produces clinicians COMPETENT SAFE CONFIDENT ADAPTABLE EVIDENCE BASED Autonomous practitioners MAKE INDEPENDENT JUDMENTS FREEDOM TO EXERCISE THEIR PROFESSIONAL JUDMENT AND DECISION MAKING WHITIN THE PT SCOPE OF PRACTICE

20. Physiotherapists have extended their scope of practice They have to have knowledge, skills and competence to undertake roles beyond their basic training Health promotion and disease prevention are integral to all treatment programmes 3. Scope of Practice

21. Physiotherapists can now: Aspirate Inject Treat with Acupuncture Can use Patient Group Directions in prescribing Have Supplementary Prescribing rights Independent Prescribing rights in UK since 2013 Diagnostic Ultrasound Imaging

22. Physiotherapists can now: Triage patients Manage self-referral programmes Request x-rays Request blood tests List patients for surgery Run outpatient follow up clinics instead of a medical Consultant 3. Scope of Practice

23. The scope of physical therapy practice is not limited to direct patient/client care, but also includes: public health strategies advocating for patients/clients and for health supervising and delegating to others leading managing teaching research developing and implementing health policy locally, nationally and internationally

24. 4. Putting it all together

25. SOCIAL DIMENSION OF PROFESSIONAL AUTONOMY “Is the critical result of the interaction between the economical and political power, and the occupational representation” Eliot Freidson, 1978 DIRECT ACCESS AS AN EXPRESION OF PROFESSIONAL AUTONOMY OF PTS

26. What is direct access and self-referral? Direct access and self referral means that patients are able to refer themselves to a physical therapist without having to see anyone else first, or without being told to refer themselves by another health professional. This can relate to telephone and face-to-face services, as well as those delivered via new media such as over the internet. Ref: http://www.wcpt.org/node/34062http://www.wcpt.org/node/34062 Direct Access

28. Patient Experience? I would prefer to make an appointment to see a physiotherapist without having to see my doctor first: 74% agreed or strongly agreed. 3% strongly disagreed. Physiotherapy can offer effective treatment for conditions such as back and neck, joint or soft tissue problems: 92% agreed or strongly agreed. Patients can learn a lot about how to manage their health problems themselves: 90% agreed or strongly agreed. Questionnaire results from self-referral pilot

29. The Changing Face of Healthcare Why Physiotherapists need to be involved Ever higher expectations Advances in treatments Demand driven by ageing Changing Health and Social Care demands Health in an information age Changing nature of disease

30. Health Promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being an individual or group must be able to identify and realise aspirations, satisfy needs and change/cope with the environment (Ottawa Charter 1986)

31. Taking Action

32. Active Aging “All parts of the body which have a function, if used in moderation and exercised in labours in which each is accustomed, become thereby healthy, well-developed and age more slowly, but if unused and left idle, they become liable to disease, defective in growth and age quickly” Hippocrates (460-370BC)

33. Physical inactivity is now identified as the fourth leading risk factor for global mortality Benefits of regular physical activity on primary and secondary prevention of several chronic diseases are well recognised and now widely established

34. Practice to be evidence based whenever possible Continuous Professional Development is an integral part of maintaining high quality practice and registration

35. Private practice as a liberal profession

36. 1. The need of a first cycle of studies to be of four years, at university level, for BSc in Physiotherapy, preserving Bulgarian Kinesitherapy School 2. The need to guarantee the autonomy of the profession and of the physiotherapists, throughout legislation that consolidates the regulation of the profession, the protection of the title of physiotherapist and a scope of practice as presented. 3. Legislation is needed to protect the public 4. The need of private practice and regulation 5. Development of a law for health professional organisations, such as BAPT – to check with them 5. Conclusions

37. PROFESIONAL AUTONOMY WILL BE FACILITATED BY Delivery of high quality clinical training programmes Work of representative organisations of physiotherapists –PROFESSIONAL ASOCIATIONS –WCPT and ER-WCPT CONVINCE THE AUTHORITIES OF THE VALUABLE AND RELIABLE WORK OF THE PHYSIOTHERAPISTS TO SOCIETY

38. Thank you!!!