Tuesday, June 9, 2009


The Chartered Society of Physiotherapy was founded
in 1894, under the name of the Society of Trained
Masseuses. This section will not attempt to relate the
history of the profession except in the context of
developing autonomy. However, more about the early
days of the profession can be found in
Dr Jean Barclay's fascinating book In Good Hands
(Butterworth-Heinemann, 1994).
For many years, doctors governed the profession.
One of the first rules of professional conduct stated 'no
massage to be undertaken except under medical direction'
(Barclay 1994). Even in the 1960s doctors were
asserting that they must take full responsibility for
patients in their charge and 'professional and technical
staff have no right to challenge his views; only he is
equipped to decide how best to get the patients fit
again' (Barclay 1994). It is hard to believe now that it
took more than 80 years to escape the paternalism of
doctors, to whom physiotherapists were dependent for
referrals. The first breakthrough came in the early
1970s, when a report by the Remedial Professions
Committee, chaired by Professor Sir Ronald Tunbridge,
included a statement that while the doctor should
retain responsibility for prescribing treatment, more
scope in application and duration should be given to
The McMillan report (DHSS 1973) went further, by
recommending that therapists should be allowed to
decide the nature and duration of treatment, although
doctors would remain responsible for the patient's welfare.
There was recognition that doctors who referred
patients would not be skilled in the detailed application
of particular techniques, and that the therapist would
therefore be able to operate more effectively if given
greater responsibility and freedom.
Eventually, a Health Circular called Relationship
between the Medical and Remedial Professions was
issued (DHSS 1977). This acknowledged the therapist's
competence and responsibility for deciding on the
nature of the treatment to be given. It recognised the
ability of the physiotherapist to determine the most appropriate intervention for a patient, based on knowledge
over and above that which it would be reasonable
to expect a doctor to possess. It also recognised the
close relationship between therapist and patient, and
the importance of the therapist interpreting and
adjusting treatment according to immediate patient
Autonomy was only achieved by being able to
demonstrate competence to make appropriate decisions,
building up the trust of doctors and those paying
for physiotherapy services. The need to acquire skills of
assessment and analysis became a key component of
student programmes from the 1970s. Today, qualifying
programmes stress even further the development of
skills, knowledge and attributes required for
autonomous practice.