What Is an Extended Scope Physiotherapist?

You may have seen a physiotherapist at your GP surgery instead of a doctor, or been sent to a physiotherapist at the hospital before seeing a surgeon. Those are usually senior physiotherapists with extra training. Here is what the titles mean and why it can matter to you.

The short answer

An extended scope physiotherapist, often shortened to ESP, is an experienced physiotherapist who has trained to do some of the work that used to need a doctor. That usually means assessing and diagnosing complex back, joint and muscle problems, asking for X-rays, scans and blood tests, and deciding who needs to see a surgeon and who does not.

In the NHS, many ESPs work in orthopaedic clinics. Patients waiting to see a consultant about a back, knee or shoulder are often seen by an ESP first, and a good number of them find they do not need surgery at all.

What is a first contact practitioner?

A first contact practitioner does a similar job in GP surgeries. If you ring your surgery about back pain or a painful joint, you may be booked straight in with one instead of a GP. They can diagnose the problem, give advice and exercises, and refer you on if needed.

Both roles are for physiotherapists with years of experience behind them and extra postgraduate training. They are not job titles you get straight out of university.

What extra can they do?

• Diagnose — working out what is really causing the pain, including spotting the less common problems that need a doctor
• Ask for tests — X-rays, scans and blood tests, within the rules of the service they work in
• Refer — to a surgeon, a pain team or a specialist, when that is the right next step
• Injections — some are trained to give steroid injections into joints and soft tissues
• Prescribing — some have gone on to qualify as independent prescribers, and this is shown on the HCPC register

Not every ESP does all of these. It depends on their training and on the service they work in.

Why does it matter for home physiotherapy?

Most of the time, a physiotherapist's job at home is treatment and exercise, and any good physiotherapist can do that well. Where an ESP background helps is with the problems that have not followed the usual path:

• Back or neck pain that has gone on for months and not responded to treatment
• Pain that does not add up, or keeps moving around
• Deciding whether a joint really needs a surgeon's opinion
• Knowing which warning signs mean you should see a doctor quickly

It also means a clear, honest answer about what is going on, and a straight referral back to your GP if something needs medical attention.

Warning signs to act on straight away

Whoever you see, some symptoms with back pain need urgent medical help, not physiotherapy. Call 999 or go to A&E if you have back pain with any of these:

• Numbness around your bottom or genitals
• Difficulty passing urine, or losing control of your bladder or bowels
• Weakness or numbness in both legs

These can be signs of cauda equina syndrome, which needs treatment within hours.

How to check someone's background

Search their name on the HCPC register, which will show their registration and any prescribing rights. Then simply ask on the phone: what their NHS role is, and how much of their work is with problems like yours.

Home visits across Bedfordshire

Ibrahim Ali works in the NHS as an extended scope practitioner and first contact practitioner, and visits people at home across Bedford, Kempston, Luton, Dunstable, Leighton Buzzard, Ampthill, Biggleswade and across Bedfordshire with his colleague Vinay Allam.

About Ibrahim and Vinay

Ibrahim Ali (HCPC PH61934) and Vinay Allam (HCPC PH129593) of Physio Experts provide home visit physiotherapy across Bedford, Kempston, Luton, Dunstable, Leighton Buzzard, Ampthill, Biggleswade and across Bedfordshire. Ibrahim has been a physiotherapist for over 30 years, 23 of them in the NHS, where he works as an extended scope practitioner; he holds a Doctor of Physiotherapy degree and a master's in neurological physiotherapy. Vinay is an NHS musculoskeletal physiotherapist with extra training in sports injuries and dizziness and balance problems.

Read their profile or call 0330 133 2125.

Please mention Mobile Physiotherapist.co.uk when you call.