Katie Knapton is a physiotherapist in private practice who is the chair of Physio First. In this topical article, she examines the implications of Fit for the future: 10 Year Health Plan for England, which the government unveiled earlier this month

The numbers don’t add up

Let’s talk about what the 10-Year Plan doesn’t mention: 3,000 newly qualified physiotherapists are chasing 20 advertised positions. See: bit.ly/3TIzRqV

While the Plan waxes lyrical about ‘neighbourhood health delivery models’ and ‘personalised genomics’, there’s a more basic question: who exactly is going to deliver this transformation?

A Plan built on wishful thinking

The Plan reads like someone’s created a shopping list for healthcare paradise without checking if the shops are actually open. (I hate shopping, by the way, but even I know that you check if the shop exists before making a list). The ‘three big shifts’ – hospital to community, analogue to digital, sickness to prevention – sound transformational. But we’re not starting from a blank slate.

Prevention is a lifetime away

Right now, we’re seeing patients who have chronicity, co-morbidities, and complex presentations. These aren’t problems you solve with digital tools and health coaches – they need skilled professionals who understand the intricate web of physical, psychological, and social factors that keep people stuck.

Yet thousands of qualified physiotherapists can’t get jobs.

Every one of those locked-out graduates represents 15 potential patient appointments per day. That’s 45,000 daily appointments sitting idle while 300,000 people await musculoskeletal (MSK) care – and that’s just one speciality. There’s a shortage of access to neuro, paediatric, and community physiotherapy too. Our members are providing this much-needed care across all these specialties. It’s not just wasteful – it’s absurd.

‘[Patients are ] tired of 10-minute appointments and exercise sheets. They want someone who actually listens and has time to help them properly’ [Katie Knapton]

The independent sector: the Plan’s ‘blind spot’

Here’s what really gets me: the Plan completely ignores the thousands of physiotherapists already working in the independent sector. These aren’t mythical creatures – they’re real professionals, right now, with capacity to help tackle those waiting lists.

But apparently, if you don’t have an NHS badge, you don’t exist in the planners’ universe. It’s like trying to solve traffic congestion while pretending half the roads don’t exist.

What the private sector gives is immediate access and convenience – we’re already based in the community. The Plan talks about moving care into communities, but we’re already there, delivering personalised, patient goal-driven care with time to actually talk to people, understand their lives, their work, their fears about their body.

Do you wonder why the self-pay market is growing?

It’s totally under the radar, but people are voting with their wallets. They’re tired of waiting. They’re tired of 10-minute appointments and exercise sheets. They want someone who actually listens and has time to help them properly.

Some people cannot afford not to seek private care – but they are the lucky ones, as they’re aware of what they need and can access it.

When strategy meets reality

The Chartered Society of Physiotherapy (CSP) is delighted to have rehabilitation mentioned in the Plan. [A link is provided below to the CSP’s initial response to the Plan]. But I’m not buying the celebration. Physiotherapy isn’t even specifically mentioned. Let that sink in. We’re celebrating vague references to ‘rehabilitation’ while our profession remains invisible in the actual document.

And let’s be honest – is there anything dramatically new to celebrate here? Maybe, but, in reality, probably not. There’s some work around the Pathways to Work Green Paper, but again, nothing new here. Our members have been providing evidence for over 20 years that proper physiotherapy input saves employers money and keeps people in work. We’ve heard promises about prevention, personalised care, and digital transformation before. The buzzwords change, but the fundamental problems remain.

‘Stop talking about “transformational reform” and start talking about “getting people back to work, back to sport, back to life”. That’s what physiotherapy actually does‘ [Katie Knapton]

And here’s what really gets to me: we’re still waiting for the CSP to revert their policy that physiotherapy should be free at the point of access. To be fair, it has been voted to be reviewed, but they’re celebrating vague mentions in a plan that can’t deliver, while we wait for them to acknowledge that the independent sector – where the majority of Physio First members work is self-pay patients seeking quality care – could be part of the solution.

Our professional body doesn’t even recognise about 30 per cent of CSP membership

The CSP doesn’t seem to have issues with insurer-paid or employer-paid physiotherapy, but it has a problem with self-pay – which is the majority of our members’ work. When nearly a third of the profession is delivering care that the professional body won’t acknowledge, how can we expect government planners to see us?

We’re celebrating vague mentions in a plan that simultaneously locks us out of jobs and ignores where we actually work. It’s like being invited to a party where the door is bolted shut.

Recognition without implementation is just window dressing. And clinging to outdated ideology while patients suffer is worse than window dressing – it’s negligent.

The real question

So, here’s what I want to know: when the 10-Year Plan inevitably fails to deliver on its promises, will anyone remember that we had thousands of qualified professionals ready to help, sitting on the sidelines?

Will anyone connect the dots between job freezes today and waiting list crises tomorrow?

A different approach

Instead of another government White Paper full of buzzwords, what if we tried something radical?

• Unfreeze the posts. We know economically this could be backed, but again, it needs quality input.  A novel concept, I know.

• Recognise that healthcare doesn’t stop at NHS boundaries. Independent sector professionals aren’t the enemy – they’re part of the solution. And the public needs to understand what quality physiotherapy actually looks like.

• Give people informed choice. Not just about where they go, but what they should expect. The Plan talks about choice, but ignoring the independent sector is not choice – it’s limiting options. Real physiotherapy is personalised, goal-driven care with time to listen. It’s not a production line of generic exercises – especially not for patients dealing with complex, chronic conditions that have developed over years or decades.

• Stop talking about ‘transformational reform’ and start talking about ‘getting people back to work, back to sport, back to life’. That’s what physiotherapy actually does – working with the complex reality of where patients are now, not where we wish they were. And there are 300,000 people waiting for exactly that.

The bottom line

The NHS 10-Year Plan might be ‘bursting with brilliant ideas’, but brilliance without workforce planning is just expensive daydreaming.

You can’t revolutionise healthcare by ignoring the people who deliver it. You can’t promise ‘personalised care’ while systematically excluding the sector that has time to personalise it.

And you certainly can’t do it by keeping 3,000 qualified professionals unemployed while 300,000 patients wait in pain for MSK care.

The Plan needs a reality check: and it needs one fast

But more than that, the public needs to understand what they’re missing. They deserve to know that physiotherapy isn’t just about following exercises on a sheet – it’s about having someone who listens, understands your goals and works with you to achieve them.

The growing self-pay market isn’t an accident. It’s a signal. People are choosing to pay privately because they want care that actually cares.

To follow Katie Knapton on X: @physiokatiek

To access an official executive summary of  Fit for the future: 10 Year Health Plan for England, visit: https://bit.ly/4lxetB1

To access an article titled Physiotherapy and rehab prominent in government’s 10-year plan for England that was published on the CSP website on 3 July, visit: bit.ly/44CX1Fq

Physio First is the UK-wide trade association for chartered physiotherapists in private practice and is a professional network of the CSP.

It welcomes members from all specialities of physiotherapy who are looking for business and clinical connection and support within a community of like-minded colleagues.  For more information, visit : www.physiofirst.org.uk