Dr. Susan Coote:

There are two parts, namely, specialism and working with a team. Primary care is very generalist, and I admire my primary care colleagues, who might work one day with somebody who has back pain and the next day with somebody who has multiple sclerosis or stroke. Within physiotherapy, occupational therapy and speech and language therapy, neurological rehabilitation is a subspecialty and you want to be treated by the people who have that subspecialty, but it is also important these teams work together. As a physiotherapist, I might work with somebody who has communication problems and problems with thinking and memory, which would be addressed by psychology, as well as other issues with their physical presentation. I cannot work in isolation, so the teams are the important aspect of this. It is the multidisciplinary nature of the teams that is the key to their effectiveness.

Moreover, you do not want a physiotherapist who specialises in back pain but, rather, a neurological physiotherapist, which is why there is specifically a senior physiotherapist at that level. You want somebody who knows about stiffness and spasticity and about rewiring the brain, neuroplasticity and the mechanisms for recovery. The specialist nature plus the multidisciplinarity of the teams is the key, and that is why they need to be teams rather than just one individual discipline. These are people with complex needs and multiple issues who need that team to improve.