Better Care

Referral process

  • On receipt of a referral once it has been through triage the family will receive a letter from the Central Booking  service (CBS) to invite them to call up to book an available appointment that is most convenient to them. They will then receive an appointment letter detailing the time and venue and the name of therapist that they will see.

  • At this initial appointment the child will receive a specialist Initial Assessment with a Senior Peadiatric Physiotherapist. This will take place in a Local Health Centre in the majority of cases. We would always carry out the assessment with the parent or carer present.

  • It could also be carried out in a specialist setting if the child is in a Special School or as part of the Child Development Centre team assessment if the child requires multi-disciplinary input. In these cases the families would be contacted directly by CDC’s or therapists for there initial appointment.
  • Very young children, or those with complex medical conditions may be seen at home for their Initial Assessment and for on-going intervention. Children with musculoskeletal injuries will always be seen in a local health centre.

Intervention decision making 

Assessment includes looking at the child’s;

  • Strength and co-ordination
  • Motor development
  • Posture and balance
  • Quality of movement
  • Function

This may include both formal and informal assessment such as observation.

Following assessment, a decision-making framework is used to profile the child and identify what they may need from the Physiotherapy service. The profiling and decision-making tool used (known as the physiotherapy profiling tool) is a locally-devised and evidence-based framework to standardise PT decision making across all sectors of the PT service.

The profiling tool provides a profile for decision making based on 5 parameters; The type of physical difficulties the child may have or the severity of their Impairment and itsimpact, the risk to the child without PT intervention, the role of the PT in effecting change and the level of support available for the child to make progress.


There are a number of types of intervention that children are offered dependent on their clinical profile. If Intervention is appropriate Physiotherapy takes place in Episodes of care. This is where there is a period of intervention with a care plan following one of the services Packages of care.

The care plan states the family and child’s goals or aims of the Physiotherapy intervention and records the treatment plan and then records the outcomes for the child and family following the intervention.

The ‘Packages of Care’ (POC) are based on up-to-date best evidence. Therapy may take place directly with the PT (1:1 or in groups), or indirectly carried out by Physiotherapy assistant and will always involve working with and through parents and others such as classroom assistants, and class teachers, therapy support practitioners, and nursery workers.

Possible ways of supporting the child in any POC may include one or more of the following:

  • Training and advice for parents/carers and other service providers (health, social care, education)
  • Providing home exercise programmes
  • Provision of programmes of work and ways of supporting the child in different environments and by different people
  • Specialist equipment and appliances advice
  • Special swimming (Hydrotherapy or Aquatherapy)
  • Involvement with educational and transition planning
  • Direct therapy with the child, either individually or in a group

Each Package of Care (POC) may be of a different length dependent on clinical assessment of the model required. 

At the end of the agreed period of support, the child's progress is reviewed in partnership with parents/carers, and a reassessment occurs using the profiling tool. If no further intervention is required the child is either discharged from physiotherapy at this time, or the child will have a period of time without PT intervention to consolidate and practise their new skills and an agreed follow up date for reassessment is made.

If at assessment there is no requirement at that time for an Episode of care then recommendations are made to the school staff and parents on exercises or activities and  positioning that are recommended to be carried out with the child usually in the format of a Physio tools programme or the 24hr Postural care approach. This programme is shared with parents and carers and a review date is arranged for the next therapy assessment with the understanding that a child can be seen before this date if there are any concerns or changes.

The physiotherapist can refer children to a consultant physiotherapy clinic if required for further assessment of there intervention needs.

Referral process:

Click here to download the referral form.

Referrals are accepted from doctors, other therapists and from the Education Physical Disability Support Service, Health visitors and school nurses.

Referrals would not be accepted from sources other than those stated above or for presentations that are normal at certain stages in a child’s development, e.g. Knock knees or bow legs.

Referrals are not accepted for children for whom respiratory difficulties are the presenting problem.