The development of the Quality Assured Practitioner (QAP) Scheme in Private Physiotherapy Practice in the UK

Background: Quality assurance in health care has become a priority for health care providers. In the UK, Physiotherapists are required to renew their registration every two years and confirm they meet the standard set by the health professions regulator in the UK, the Health and Care Professions Council (HCPC). Within this standard is the requirement that physiotherapists must be able to assure the quality of their practice. Since 2005, Physio First (the Organisation for Chartered Physiotherapists in Private Practice in the UK) have worked in collaboration with the University of Brighton on the Data for Impact (DfI) project to provide private practitioners with the opportunity to participate in an online standardised data collection project gathering data for patients with musculoskeletal conditions. Although quality assurance has been set out in the HCPC standards, the issue has not yet been addressed in a formalised way on a national level. That, in addition with the increasing need for physiotherapists to evidence their quality within a competitive healthcare marketplace, has highlighted the need for an appropriate quality assurance scheme to be developed for private physiotherapists in the UK.

Purpose: To provide private physiotherapists a means of benchmarking their patient outcomes and demonstrating quality through the development of an ongoing Quality Assured Practitioner (QAP) scheme.
Methods: Draft standards for how quality would be defined and measured were proposed by Physio First. Discussions between Physio First and the University allowed for further development and refinement of the QAP scheme.

Results: Five criteria were agreed on as indicators of the QAP scheme including waiting time, change in outcome scores pre/post treatment, average number treatments, goal achievement at discharge, and outcome of referral on discharge. Descriptive statistical analyses of the national data was performed based on a non-weighted mean of practitioners who had collected 50+ data. Data for each of the criteria was normally distributed. The lower and/or upper limits were calculated for each criterion representing a value that is one standard deviation below and one standard deviation above the mean. Eligibility of QAP status would be based on practitioners meeting a minimum of three of the five criteria based on their data collected over a twelve month period. Data would be analysed independently by researchers at the University.
Conclusions: The development of the scheme provides private physiotherapists the opportunity to verify the quality of their own practice with objective evidence collected nationally through the DfI project. One of the main challenges of such initiatives is the selection of appropriate indicators of quality. Ongoing feedback from stakeholders of the scheme may be used to amend the criteria if the need arises. Further amendments in the form of introducing an online patient-reported outcome measure alongside the practitioner-reported outcomes will strengthen the scheme and alleviate bias.
Implications: The ability to demonstrate quality enables practitioners to effectively position themselves in an increasingly competitive marketplace. The scheme also serves to highlight to practitioners areas of focus for CPD and areas of improvement.