Creation of Crucial Advanced Physiotherapist Grade in Hospitals Will Dramatically Reduce Patient Waiting Lists By Tens Of Thousands

ISCP pre-budget submission calls for physiotherapists to be allowed refer for X-ray and the creation of an APP grade

The Irish Society of Physiotherapists (ISCP) in its pre-budget submission calls on Government to amend the legislation to allow physiotherapists refer patients for X-ray and create the official grade of Advanced Practice Physiotherapy (APP) grade, both of which will achieve significant cost savings to the health budget and in one instance resulted in over 40,000 patients on orthopaedic and rheumatology waiting lists being seen and discharged between 2018 and mid 2021. Ireland is an outlier in this regard with the Nordic countries, the UK, Holland and Australia already having this crucial role in place which will easily fit in with a significant ongoing skills gap and align with Slainte Care. The advanced role will easily assist in delivering patient centred care in acute, community and residential settings especially when the profession can point to areas like rheumatology waiting lists being recently reduced by 130% and a quarter of triage sites showing waiting times reduced to under 3 months from 84 months in the last 10 years.

The ISCP presented a comprehensive report to the Minister for Health, Department of Health (DoH) and the Health Service Executive (HSE) in March, which demonstrated the massive savings physiotherapists are consistently delivering for the Health Service Executive.

As a direct result of APP activity nationally

  • 125,852 new patients have been removed from orthopaedic and rheumatology waiting lists nationally by clinical specialist physiotherapists working with advance practice skills between 2012 and 2018 and a further 30,000 between 2019-2020.

  • Wait time for orthopaedic and rheumatology out-patients has reduced from 7 years to 18 months, and in one quarter of the triage sites in hospitals which assess, diagnose and manage Musculo-skeletal ailments independent of junior doctors and consultants the waiting lists are now reduced to 3 months over a 6 year period.

  • Waiting lists for Rheumatology appointments are 130% shorter

  • 70% reduction in wait time in an Emergency Department for patients seen by a physio for a bone or joint issue

  • €104,040 was saved at one hospital site over a 9 month period in respiratory medicine , with an average reduction in length of hospital stay of 2 nights compared to previous medical care

  • €24.50 for each APP triage appointment is saved over consultant appointments.

The ISCP welcomes the resourcing the HSE has put in place regarding physiotherapists, particularly its commitment to the National Musculoskeletal (MSK) Triage Initiative and the End to End Chronic Obstructive Pulmonary Disease (OPD) Model of Care, but these posts are hampered in their effectiveness by not utilising the full skills of physiotherapists. Allowing the current physiotherapists already in this initiative to refer for X-rays will eliminate the current loss of €108,000 annually in lost time whilst they wait for junior doctors to order x-rays. This will increase to 65 advanced posts after 2022 resulting in a saving of €234,000 annually creating 650 new patient slots per month in the National MSK Triage Initiative.

OPD waiting lists continue to grow exponentially and are worse than ever after the COVID-19 Pandemic. The answer to managing waiting lists lies not just in manpower resourcing but also in fully utilising the skills of current staff and delivering a multiprofessional workforce. This in turn will REDUCE

  1. the need for medical professionals to make referrals for investigations, thereby improving patient flow by over 13% or an additional 7,800 patient slots by the end of 2022.

  2. the need for multiple patient contacts along the pathway, thereby increasing timeliness and consistency in the management of certain conditions

  3. inappropriate demands on medical professionals and therefore improving access to medical care for those who need it,

  4. costs across the pathway whereby patients are seen by the right clinician at the right time

The ISCP calls on Government to implement the following recommendations:




Amend the legislation (SI256/2018) to enable physiotherapists working in advanced practice to refer to x-ray

Utilise the evidence* to amend the legislation whereby registered physiotherapists are included on the list of ‘referrers’ entitled to refer individuals for medical radiological/ ionising radiation procedures in Statutory Instrument (SI) 256/2018

*See report on Physiotherapists in Advanced Practice 2021 for the evidence


Establish Clinical Grade of Advanced Practice Physiotherapist

Recognise the evidence of the breadth and depth of work currently being performed physiotherapists by working in advance practice nationally, the increased autonomy and responsibility being shouldered by these practitioners and the concomitant benefits primarily to patients and also to the health service. The Department of Health should utilise this evidence to create the clinical grade of APP




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