PhysioUpdate 6th June 2023

An association that represents physiotherapists and other professionals involved in cardiovascular disease prevention has backed a bid to stamp out the bullying, harassment, discrimination and other ‘unacceptable’ and ‘unprofessional’ behaviours that plague the specialty.

The British Association for Cardiovascular Prevention and Rehabilitation (BACPR) – whose president elect, Heather Probert, is a physiotherapist – has endorsed a position statement that was published online in the journal Heart earlier this week (31 May).

Ms Probert also an active member of the Association of Chartered Physiotherapists in Cardiovascular Rehabilitation, which lists her as its co-chair on its website.

The statement, which has been endorsed by 18 other organisations affiliated with the British Cardiovascular Society (BCS), urges everyone based in a cardiology team to challenge examples of unprofessional behaviours in the workplace.

Bullying a long-standing issue

The statement voices concern over evidence suggesting that poor behaviours are rife in UK cardiology departments, and which could reflect longstanding cultural and practice issues, fuelled by traditional training programmes and unconscious biases.

Data from the General Medical Council trainee survey suggest that bullying in cardiology is almost double the average across all medical specialties: 12.3 per cent compared to 6.9 per cent.

Bullying accounts for half of all stress-related workplace illnesses, the statement points out and is associated with

• poorer performance
• a heightened risk of medical error
• lost productivity, burn-out and absenteeism

Inappropriate behaviour in cardiology departments has a detrimental ripple effect, including on the recruitment and retention of staff, patient care, and other bystanders, the statement suggests.  ‘As such, improving the culture and professional behaviours within UK cardiology departments is of paramount importance,’ it notes.

The statement sets out examples of inappropriate behaviour. These include bullying; sexist, racist, homophobic or belittling language; discrimination; harassment; providing or depriving individuals of opportunities based purely on personal characteristics; outbursts of uncontrolled anger; and unconstructive criticism of performance. 

Outdated misconceptions

There is a common and outdated misconception in the specialty that intimidation helps to ‘build character’, the statement notes. ‘This is an anachronistic and flawed concept: intimidating language or actions do not build character and have substantial negative impacts on those affected. Furthermore, role modelling and learnt behaviours lead to perpetuating the cycle of bullying.

‘While mistakes happen in medicine and may require frank feedback to aid learning, they are not an excuse for intimidating or belittling behaviour or language,’ it adds.

Departments and individuals should

• set out clear standards and expectations of behavioural norms from all members of the cardiovascular team 
• encourage the reporting of inappropriate behaviours
• ensure that clear policies, practices and procedures are in place for dealing with inappropriate behaviour, are reviewed, and included in induction and staff handbooks
• designate and train a behaviour lead with whom concerns can be raised  
• consider any episodes of inappropriate behaviour in the selection process for promotions and leadership roles
• make routine use of multi-source feedback where evidence of all behaviours can be raised
• provide mandatory training for all on workplace culture; how to give and receive structured feedback; unconscious bias; and cardiology-specific human factors

No-one should be discriminated against at work, bullied, harassed or undermined. In cardiology we have had this pervasive culture for far too long [John Greenwood, BCS]

The statement also makes recommendations for universities and national bodies, which are urged, for example, to develop positive organisational cultures and ensure that similar standards of behaviour are expected of members. They should also establish transparent cardiology reporting strategies for inappropriate behaviour 

‘As with clinical standards, professional societies have a role in developing a standard for appropriate behaviour and a responsibility to ensure that inappropriate behaviour is shown to be unacceptable,’ the statement adds. 

BCS president John Greenwood said: ‘No-one should be discriminated against at work, bullied, harassed or undermined. In cardiology we have had this pervasive culture for far too long.

'This statement and its practical recommendations represent a concerted effort to stop bullying in its tracks and put measures in place to stop it happening in the future.’

Professor Greenwood added that the statement would be aired at the BCS annual conference in Manchester (5-7 June).

To read the full version of the statement – titled Joint British Societies’ position statement on bullying, harassment and discrimination in cardiology doi 10.1136/heartjnl-2023-322445 – click 

Karen Middleton, the Chartered Society of Physiotherapy’s (CSP) chief executive, has voiced her ‘dismay’ over the government’s failure to publish a workforce plan for the health sector on time.

She has co-signed a letter that was sent today (31 May) to prime minister Rishi Sunak after it emerged that the plan’s publication was being delayed. The Guardian reported on 29 May that the plan had widely been expected to be published by now and that a senior NHS figure had claimed the minsters had delayed an announcement due to concerns over the ‘significant investment’ that would be required to implement the recommendations.

'Damaging' repercussions

The CSP joined forces with 39 organisations representing the health professions, patients, NHS staff and NHS organisations in signing the letter, which laments the ‘continuing delays’ that are making a bad workforce situation even worse. The CSP appears to have coordinated the action, and the address of its headquarters in London appears at the top of the letter addressed to Mr Sunack.

'We urge you to act by publishing a sustainable plan immediately. None of your policy commitments on health can be achieved unless we address the chronic workforce shortage,’ the letter states.

‘Across all sectors, professions, specialities, condition pathways and services there are mass vacancies and insufficient numbers of staff to meet current, let alone future, population need. It will take time to resolve this situation, which is why the delay in acting to address the workforce crisis is so damaging.'

The letter adds that urgent action is needed to train and recruit more healthcare staff, and to retain those already serving the public.

‘Many of us have contributed to developing the workforce plan. We want it to succeed. We want to be able to welcome it if it provides the long term vision needed and clearly commitments to funded workforce expansion. Please act now.’

Across all sectors, professions, specialities, condition pathways and services there are mass vacancies and insufficient numbers of staff to meet current, let alone future, population need [Kaen Middleton and others]

Other signatories include Sue Brown from Arthritis and Musculoskeletal Alliance, Henry Gregg from Asthma & Lung UK, Phil Banfield, from the British Medical Association and Matthew Taylor from the NHS Confederation.

CSP director Rob Yeldham tweeted: 'The #workforceplan is over a year late. In a year we could have supported physios upskill for advanced roles, be half way through training additional MSc physios and have recruited and trained additional rehab support workers. That wouldn't solve the crisis but would be a start.'

Twitter: @RobYeldham

To see the letter in full, which is on CSP headed paper, click 

Physiotherapists, occupational therapist and orthotists will buck a trend backed by the other allied health professions (AHPs) by continuing to wear uniforms with a base colour of white while working in the NHS in England.

Most of the other groups that fall under the AHP umbrella opted to sport 'smart scrub tunic' with a dark magenta hue, a colour that gained the most support among their members, the NHS Supply Chain announced earlier this week (24 May). Physiotherapists and other AHPs had their chance to state their preferred colour from a selection in a ‘base colourway survey’ (which included pale grey) that closed on 31 January 2023.

More physiotherapists voiced their opinion in the survey than any other AHP profession (23.2 per cent of all respondents), being closely followed by radiographers (21.6 per cent). 

Thousands of AHPs took part in survey

‘After an overwhelming response from over 26,000 AHPs, representing different occupations, regions, genders, ages and ethnic groups, we can confirm that AHPs will be allocated a single base colour which is aligned with the vote received from their members,’ the NHS body stated.

‘In the main, this means most will adopt dark magenta with physiotherapy, occupational therapy and orthotists adopting white as this was their preferred choice.’

Important caveat

There was a caveat in the announcement, however. The NHS Supply Chain said the workforce consultation did not signal the end of the ‘engagement process’. ‘It is imperative that the views of individuals and representative bodies right across the NHS continue to be heard and considered as we move forward,’ it noted.

‘We will communicate progress with the project when appropriate and will continue to take guidance and direction from NHS England and NHS Improvement.’ The NHS Supply said its staff will continue to engage with professional bodies [such as the Chartered Society of Physiotherapy] to ‘ensure the voice of the NHS workforce continues to be heard’.

We believe that the responses clearly show that there is an overwhelming desire across the NHS to adopt a standard national uniform and that this approach should be followed by all trusts [Kevin Chidlow, NHS Supply Chain:Hotel Services]

Regional preference

The preference for dark magenta was consistent across all regions of England, with the highest percentage of first choice votes in London (47.8 per cent) and the lowest in the south west (39.9

The preference for dark magenta was consistent across all regions of England, with the highest percentage of first choice votes in London (47.8 per cent) and the lowest in the south west (39.9 per cent).

Last December, the NHS Supply Chain said that it had been conducting a ‘wearer trial’, with the new garments being ‘verified’ with an independent testing house to ensure high standards of quality – for example, in terms of fabric durability, washability and colour fastness.

To see the NHS Supply Chain release, click 

To see the AHP consultation report, click