A shortage of NHS physio roles is leaving patients in pain as waiting lists rise

The increasing number of people waiting for physiotherapy treatment is causing problems in other parts of the NHS and damaging the UK economy, leading doctors have warned.

The waiting lists for treatment of musculoskeletal complaints (MSK), such as back, neck and knee pain, have grown by 27% since January last year. The Chartered Society of Physiotherapy (CSP) said the number of physiotherapy posts in the NHS was not keeping pace with demand from Britain’s aging and increasingly obese population.

The CSP said Britain needs a 7% increase in NHS physiotherapy positions every year to meet rising demand. Musculoskeletal conditions that are left untreated can become more complex and lead to mental health problems or the need for surgery, as well as time off work.

The latest figures from the NHS community health service show that 323,965 people were waiting for musculoskeletal treatment in March, a year-on-year increase of 33,257 or 11%, and 27% more than the 254,521 people waiting in January 2023.

Rishi Sunak last month accused Britain of having a “culture of disease”, with 2.8 million working-age people classified as economically inactive. Ministers have focused on rising mental health problems, claiming doctors are ‘over-medicalising’ conditions, while also putting forward a plan to cut benefits for 420,000 sick and disabled people.

However, according to the Health Foundation, more and more people are living with chronic pain. Google searches about pain reached their highest ever level in Britain earlier this year, while searches for lower back pain reached their highest ever level in March.

Sara Hazzard, the assistant director of the CSP and co-chair of the Community Rehabilitation Alliance, said there were plenty of people wanting to become physiotherapists but there was a shortage of NHS positions.

“Messages aren’t being made where people need them, so people can’t make appointments,” she said.

“And because they can’t get that treatment, people ‘snowball’ – their mental health suffers because they’re in pain, and then it snowballs into other problems.

“So instead of people getting what they need to get back to work, they end up being off work. If people don’t work for a year, it is very difficult for them to get back to work.”

There were also knock-on effects on other NHS services, Hazzard said. Untreated aches and pains can develop into conditions that require surgery, creating even more waiting lists for knee or hip replacements. “We are at a point where we have to recognize that rehabilitation is just as important as medicine and surgery, because that is the answer for a large group of people.”

Freedom of information requests by the CSP reveal that unmet physiotherapy needs could have wider implications. In the North East and North Cumbria Integrated Care Service, the number of 111 calls received about back pain was 52,431 in 2019. This rose to 73,660 in 2020, when people were inactive at home for long periods of time and in lockdown. The number of calls fell in 2021 and 2022, but then rose sharply to 71,427 last year.

The picture was similar in Sussex, where the south-east coast ambulance service dealt with 45,677 back pain calls in 2019, but more than 97,000 in 2021 and 70,595 last year. The Sussex MSK Partnership organized a two-day special event last year where people on the waiting list could see physios at a leisure centre.

Some patients have gone to great lengths to get treatment. Vic Paterson was a frontline police officer in Cambridgeshire eight years ago and slowly developed excruciating back pain, possibly from wearing heavy body armor.

She realized she had a problem when she went out into her yard one evening to look at the International Space Station overhead. “I realized I couldn’t look up,” she said. “I tried to raise my head and it really hurt. I just came in and cried because of the pain and realizing it was a problem.

Paterson was lucky enough to gain access to a police rehabilitation center and was able to move her neck after two weeks. She was sent away with advice to get fortnightly massages but was unable to afford the £40 fee.

“My husband and I found out that it would be cheaper for us to get training,” she said. “Seven years later, neither of us are police officers.” Instead they run State 11, a soft tissue therapy clinic in Spalding, Lincolnshire.

Esther Fox is a clinically specialized physiotherapist with a PhD in this subject. She started her career in the NHS in 2003 but then moved into private practice and is now the clinical lead at Mount Kelly Physiotherapy Center in Devon.

“When I first started working in physiotherapy in 2003, we had a great physiotherapy offering and the services were very good,” she says. “I used to see people once a week. You could often see people. You could do a lot of manual therapy. That disappeared when I left the NHS in 2010, fourteen years ago, and as time went on it diminished significantly.”