Beyond the Cape: The Invisible Workforce

What the Numbers Actually Show About Private Healthcare - By Katie Knapton

There are 300,000 people waiting for MSK care in the UK right now. Meanwhile, 3000 newly qualified physiotherapists are struggling to find NHS jobs [1]. If that sounds like a planning success story to you, we need to talk. Because while headlines scream about workforce shortages, the real story is hiding in plain sight and the data tells a very different tale than the one we keep telling ourselves.

Here’s what nobody talks about: data from over 100,000 patient episodes shows that those in less well-paid jobs are increasingly likely to turn to private physiotherapy. Not because they’re wealthy, but because they literally can’t afford to wait [5]. When your livelihood depends on being physically capable, six-month waiting lists aren't just inconvenient, they're impossible.

Yet policy conversations still act like healthcare stops at the NHS border.

A Strategy Bursting with Buzzwords

The latest long-term health strategy positions itself as a 10-year blueprint for the future. It promises neighbourhood health models, digital-first prevention, and personalised genomics (whatever that means to your average patient with chronic back pain). But as ever, it reads more like a wish list than a workable roadmap.

The NHS Long Term Workforce Plan [2] talks about training more professionals, but assumes they'll all walk straight into NHS roles. It makes no meaningful mention of the thousands of qualified physiotherapists, podiatrists, osteopaths, and others already working outside the NHS, and certainly no recognition of the ones who would happily join the effort if there were jobs available [1].

It's like trying to solve traffic congestion while pretending half the roads don't exist. You might redesign the motorway network but if you ignore all the side streets already helping people get where they need to go, you're not solving the problem, you're just creating gridlock in new places [3].

The Numbers Don't Lie

While policymakers tweak their spreadsheets, something fascinating is happening in the real world. The data from our data sets reveals that private physiotherapy isn't some exclusive club for the worried wealthy. Administrative and secretarial workers? 63% self-fund their care. Elementary occupation workers - that's cleaners, packers, security guards - 65% are paying out of their own pockets [5].

These aren't people with money to burn. They're people who've done the maths. Missing work costs more than paying for treatment. Waiting six months for a 20-minute assessment that might lead to more waiting isn't a viable option when your mortgage depends on your ability to lift, walk, or stand.

The self-pay market isn't booming because people love spending money they don't have. It's expanding because people are tired of 10-minute consultations and printouts of generic exercises. They want care that listens, engages, and actually helps.

Beyond the NHS Badge

Let's address the elephant in the room. Some argue that private practice undermines the NHS; that it fragments care and creates inequality. But here's the uncomfortable truth: we already have a two-tier system. Patients in affluent areas fare better - shorter waits, more services, better outcomes. The Inverse Care Law captures it perfectly: those who most need care often have the least access to it [4].

Meanwhile, private clinics are relieving pressure, absorbing demand, and freeing NHS resources. When a shift worker accesses employer-funded physiotherapy instead of waiting months for an NHS appointment, that's not unethical, it's essential. It keeps them working, reduces long-term sickness, and leaves an NHS slot free for someone else.

If the independent sector didn't exist, the NHS would have to invent it or drown without it.

The Reality of Choice

The data reveals something policymakers seem reluctant to acknowledge: patient choice is already happening, with or without their blessing. Employer health plans, occupational health schemes, and yes, people paying directly, all step in where the system falls short [5].

A cleaner choosing to self-fund treatment for back pain isn't making a lifestyle choice. They're making a survival choice. When your job is physical and your family depends on your income, you can't afford to wait for the system to catch up with your needs.

Pretending that limiting patient options somehow preserves equity does the exact opposite. By failing to acknowledge and engage the independent workforce, we're leaving capacity untapped and letting inequality deepen [3].

You Can't Digitise Your Way Out of This

Don't get me wrong, technology helps. Virtual consultations, AI-assisted triage, patient portals, they all have their place. The recent buzz around AI physiotherapy clinics like Flok Health shows genuine promise for straightforward cases. If you're young, tech-savvy, and have a simple acute injury, an AI-guided approach might work perfectly.

But here's the catch: the patients filling those 300,000-person waiting lists aren't usually dealing with simple problems. They're the people the data shows us are already self-funding: the cleaners with chronic back pain from 20 years of physical work, the admin workers with complex neck issues from decades at desks [5]. These are presentations layered with workplace factors, social circumstances, previous failed treatments, and co-morbidities that need human insight, not algorithmic responses.

So while AI solutions might help the less complex, engaged patient get back to their morning runs, they risk deepening the inequality gap. The people who can navigate apps and have straightforward problems get faster digital solutions. Everyone else - those with complex, chronic presentations that really need skilled human intervention - gets pushed further back in the queue.

You can't replace human clinical reasoning with an algorithm when dealing with real-world complexity. Prevention isn't something you upload to an app when someone's been struggling with pain for months or years.

Healthcare is fundamentally about human beings supporting others through pain, recovery, uncertainty, and hope. No digital platform, however clever, can replace the humanity that lies at the centre of meaningful care for complex cases.

The plan keeps promising transformation through technology [2]. But without acknowledging which patients need which solutions, and without the people to deliver care where algorithms can't, it's just digital lipstick on a workforce crisis.

What the Data Demands

The numbers are clear. The need is urgent. The workforce exists. What's missing is the courage to acknowledge reality and plan accordingly [1,3].

First, count everyone. If they're seeing patients, they count. Include independent clinicians in workforce modelling and projections.

Second, stop the false divide. Quality care exists both inside and outside the NHS. A badge doesn't make a clinician competent - training, ethics, and outcomes do.

Third, give real choice. Patients deserve to know what good care looks like and where they can get it, regardless of the funding route.

Finally, use the capacity we already have. Many of those unemployed graduates aren't just waiting in the wings, they're already on stage. Maybe it's time we started watching the show [1].

The Bottom Line

The debate shouldn't be about public versus private. It should be about access versus absence, outcomes versus ideology, and reality versus rhetoric. The data shows us what's really happening: people across all income levels are prioritising their health, finding solutions where they can, and keeping the system afloat while official plans catch up [5].

If we're serious about reform, prevention, and improving population health, we need to stop pretending that care only counts if it wears an NHS lanyard. There are thousands of professionals doing the work, and the numbers prove they're serving exactly the people policy claims to protect [1,5].

It's time we put them back in the plan.

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References

[1] Chartered Society of Physiotherapy (2025). CSP takes action to address graduate recruitment concerns. London: CSP. Available at: https://www.csp.org.uk/news/2025-06-25-csp-takes-action-address-graduate-recruitment-concerns

[2] NHS England (2023). 'NHS Long Term Workforce Plan'. https://www.england.nhs.uk/publication/nhs-long-term-workforce-plan/

[3] The King's Fund (2023). 'The NHS workforce plan: strengths, weaknesses and questions'. https://www.kingsfund.org.uk/insight-and-analysis/nhs-long-term-workforce-plan

[4] Hart JT. (1971) 'The Inverse Care Law', The Lancet, 297(7696), 405-412. https://doi.org/10.1016/S0140-6736(71)92410-X

[5] Physio First (2025). 'Data for Impact Initiative: Demonstrating Equity and Diversity in Private Physiotherapy' [Internal briefing document].