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So having a s*** in the morning is fast becoming a negative euphemism.
I can see how conversations will run at Harrogate in a couple of weeks; " So, do you s*** in the morning?" "Nah, I have an FCA".
I don't think of it as negative blinda, I think of it more as waking the soul to the realities of life. As for FCA's, you can have people to wipe your arse for you, but ultimately you've got to **** for yourself. Unless you go for a manual evacuation, which is messy and another story entirely.
__________________ Science is the antidote to the poison of enthusiasm and superstition
of course, I`m sure you realised that when I said "negative euphemism" I meant the opposite to the usual substitution of a less offensive expression in place of one that may offend.
of course, I`m sure you realised that when I said "negative euphemism" I meant the opposite to the usual substitution of a less offensive expression in place of one that may offend.
Cheers,
Bel
Nope, way too clever for a working class boy. Me, I know nothing of the women's mind. Although, I do find the term "Harrogate" slightly offensive.
__________________ Science is the antidote to the poison of enthusiasm and superstition
You look up morbidity, days in Hospital due to complications with lower limb disease. Costs of medications due to complications with lower limb disease.
etc etc.
You are tasked with establishing a modern Podiatry Service with the express intention of reducing admissions to Hospital and Burden on District Nursing Service and reduce prescription of drugs to manage said lower limb complications.
So how would you design your dept?
Invest in high quality highly trained staff to run at risk foot wound clinics, supported by Bio Mech staff and Specialist footwear.
Access to Anti Biotic drugs
or Here we go
Cut as many nice old ladies nails as possible with the max no of ancilliary staff one can squeeze out of the budget.
And surrender our skills to the Specialist Nurses, Specialist Physios and O/T's etc etc.
I wonder why we train to a BSc level and then do not use these skills on the at risk patients who can best benefit from our skills and training.
The use of Ancilliary grades is a misnomer as it presumes you have the spare budget to squander on ancilliary staff and and have the resources available to provide SOCIAL Non Essentail Nail Care.
Currently this is provided at the expense of the AT RISK limb as resources are removed from this aspect of care and diverted to nail care.
We are talking about the NHS here and not Madam FiFi's Pedicure Salon.
Private Practice is where most care should be provided and referral from PP to NHS when there is an acute problem. This is what we do here in my practice here in Sydney. We manage minor ulceration which will resolve easily.
Critical acute infected ulceration is referred to the Hospital At Risk Foot Clinic for intensive management. When resolved the At Risk Foot Clinic discharges said patient back to us in PP.
Is this not a better use of Valuable and Finite resources within the Hospital Health Care System.
It also leads to a much more rewarding life in PP as your caseload is very varied ranging from Nail Care through Bio Mech, Nail Surgery, Diabetic . R/A, PVD and minor wound care.
regards david
They are coming to take me awayy HAHA HEE HEE
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Personally I love a bit of routine work or nail surgery, unfortunately my boss won't pay me to do it when she has a dept full of people who can do that and few / none who can do biomech.
You never said - I'll re-jig the timetable today. I'm sure a few of the others would love to cover your paeds reviews................
This thread has turned into a nice debate, but one I feel will not be resolved for some time.
My personal oppinion on this is that there should be a service for routine nail cuts on the high risk patients who need treatment. For example you elderly patient with severely involuted nails on a whole cocktail of medication with severe PVD etc so nail surgery is not an option.
I agree with others that there are 2 groups of people needing Podiatry, those with a medical need and those with a social need. I have a lot of patients who enter the clinic complaining they are unable to get to their feet due to arthritis but are otherwise in good health. Now I am of the opinion that most of these people are, put frankly and dont linch me, just old. As we get older we cant bend down as well or do jobs we used to do, that is a fact of life. But should we be seeing everyone that cannot cut their nails or should they be referred into PP? I can't reach my toes, should I receive routine physio to sort this?
This thread links back to the one about what, we as a profession, are aiming towards in respect to what treatment we offer. I believe we should be seen as the forefront specialty in lower limb biomechanics, diabetic foot care, nail surgery and not just as "cut and come again".
I like how David is doing things, routine care is done in PP and when a problem arises the patient is sent into the NHS to have this sorted before being discharged back out into PP. Everyone wins, PP get a nice varied case load and the NHS has more time to spend on the chronic wounds, biomech clinics etc
I have always believed that nail care is part of Podiatry, I do not agree with Footcare Assistants.
If Podiatry was put on the High Street and Private Podiatry was allowed to undertake NHS work whether part paid by NHS/patient I think HPC reg Pods would.
1. Clear the back log of patients waiting for NHS.
2. Provide quicker access to Podiatry.
3. Provide a full routine service.
NHS should to maintain high risk patients as part of a MDT so as easy accesss to full hospital services are maintained.
There would need to be a referral pathway between private and NHS Podiatry.
The door between NHS and private has to close even more in the future, remember it is our profession and we are HPC approved.
morning all
yes it is a sevice we should provide but it should not be abused and its the abuse of the system that is the problem. i agree its not best use of a band 7 or 8 to be cutting nails but thats why we employ assistants/technicians.
every patient should be asssesed on an individual basis and retained/discharged as a result. it shouldnt be age related or whether youve " paid your stamps for years" or any other of the reasons and excuses we have all been hearing for years. it should be based on need and we should have provision available if the need is there.
its a contencious issue that wont go away.
cheers
JB
Quite simple I think that at this time it is an errosion of of services that should be undertaken by Podiatrists.
I do however believe that Foot Health Professionals are more quaified to notice other foot problems that the patient may have that require Podiatrist attenion.
Doesn't provision always depend on available money?
There is a finite amount of resources available within the NHS. Although laudable to facilitate a service providing nail care to 'those in need' who would decide on the line of definition?
Pensioner A. In good health. Active although has arthritis in her left shoulder. Podiatric referral states: Involuted L hallux nail.
Pensioner B. Deteriorating health. Rheumatoid arthritis, Diabetic. Housebound. Excellent support network including family & carers. Podiatric referral states: Peripheral vascular changes. Plantarflexion deformities both PMA with H/Ds & callosities.
Pensioner C. Terminally ill. In hospice. Podiatric referral states: Requires nails cutting.
In our imaginary budget for Podiatry provision there is £60.00 left in the kitty.
Current cost of imaginary provision within the NHS:
Nail surgery: £20.00
Routine nail care: £20.00
High risk ongoing T/X £40.00
Any takers?
I understand that this is just an imaginary exercise but without funds you cannot run any service.
Only my thoughts.
Regards,
Patient A is offered a partial nail avulsion, after which she will be discharged. If s/he declines, they are given advice about self-care and a discharge pack with advice leaflets and a list of HPC registered practitioners.
Your budget does not take into account short treatments.
Patient B is at risk of developing serious foot complications, especially with vascular changes and foot deformity. S/he will be given the care that is needed.
Patient C: Will not require long-term care. The least we can do is go in and provide one or two treatments for nail care if nobody else is willing/able to do it.
All of these are the options given by my local NHS trust.
Patient A is offered a partial nail avulsion, after which she will be discharged. If s/he declines, they are given advice about self-care and a discharge pack with advice leaflets and a list of HPC registered practitioners.
Your budget does not take into account short treatments.
Patient B is at risk of developing serious foot complications, especially with vascular changes and foot deformity. S/he will be given the care that is needed.
Patient C: Will not require long-term care. The least we can do is go in and provide one or two treatments for nail care if nobody else is willing/able to do it.
All of these are the options given by my local NHS trust.
Thank you for your reply Charlie. The problem is though you have just created an overspend on your budget. My local NHS Trust invites all nail care referrals into clinic for a 'keeping your feet healthy' presentation. From what I remember up to 30 patients/carers were invited to attend the talk.
When 'routine nail care' was part of local podiatry provision the podiatry waiting list achieved nearly 2 years. That was across the full spectrum, not just nail care but all referrals. The problem spirals when you offer an NHS service such as routine nail care to one individual & decline it to another. As is often the case in the NHS if an individual complains against lack of what is seen as an entitled provision of a service. Those who shout loudest are those which will gain treatment.
The NHS has no 'Magic Cooking Pot' refilling with on demand funds unfortunately.
Best regards,
Mandy.
__________________
:)
twirly
Mandy Brooks
Brooks Podiatry
S64 0DE
Suffering a fondness for odd things.
Wow Twirly did we work for the same Moribund Organisation in 1986 when i joined NHS.
We had 2 year waiting lists then and for several years after 1986.
Women applied on 58th birthday as this meant they were 60 after waitng 2 years on waiting list.
Us poor chaps had too wiat till 65 years young to apply.
Blatant SEX and Age discrimination against us poor chaps
The other problem was that if the 60 year lived till 100 years they would get their nails cut for 40 years which would be longer than a full working life for the Pod.
This shows what LUNACY the old eligibility criteria was
To see how the Aussie system works please go to Aus page and look up the Pod Provision for Team Care Arrangements.
It makes interesting reading as to local and regional and national provision of Pod Services.
It also compares the different AHP professions provision of services.
Just do not look at the Medicare fees payable.
GP gets loads of Dosh for his part in referral.
Pod gets a bit for his provision of care.
BUT NO PAYMENT for letters and reports.
At one of our clinics we are up to almost 65% of total caseload Medicare Provison.
At the other we may only see about 1 medicare per day between 2 staff members.
Why the variance?????
I am not Politically Correct so please do not censure the following comments as being racist.
The clinic with high levels of provision is in a Lower Socio Economic suburb. Also it has a high level of recent immigrants from 3rd world countries. Also if you are Indian and have an Indian GP then you will be on medicare.
The other clinic is basically Upper Socio Economic Tertairy level of Education and Professional employment.
Also GP's here wont refer under medicare as a matter of principal.
So we seem to have a high level of social injustice against Middle Class Australia.
Reading through this thread I wasn't sure if was reading comments on the state of government policy on the NHS, a tyraid against immigration, or a comment column from the daily mail.
I'm assuming that when Paul posed the question he was referring to non-pathological / simple nails. If unsure of what this is referring to I try and use the following reasoning.
Could the patient cut their own nails if,
They had the right equipment - (in my experience a lot of patients use inappropriate nail scissors and often just need advice on the type of nippers to use).
or
They did not have a physical/mental disability - (back problems, foot phobia, poor eye sight, arthritis etc, etc).
In general if the answer is yes to these questions then I'm dealing with a personal care issue. Note I have said in general, we all know there are no absolutes when it comes to clinical decision making.
For those of us working within the NHS we have budgetary constraints and we have to target our service at those deemed most at need. This is a situation we may not be happy about but it is a reality nor is it specific to podiatry.
About 15+ years ago in the region I work in, District nurses used to be involved in the bathing/showering of their patients. To much consternation a decision was taken to change this and transfer this aspect of the patients care over to those responsible for providing personal care. 15 years on and our nurses are just as busy dealing with the ever increasing caseload of high risk patients in the community. No one would now even consider requesting that the nurse carry out showerng / bathing.
In my area we are actively working with our social services colleagues to help individuals maximise their benefits and ultimately sign post these individuals to the care they need.
Another similar thread on this forum wondered why the UK seems to be the one country were patients complain about podiatrists not cutting toenails. I think the reasons for this are complex and often very individual, but I have often wonder,
Has the NHS, (envy of the world - allegedly),somehow actively disempowered patients (or perhaps more relevant- relatives). Allowing them to abdigate responsibility for their own (or their loved ones), care, assuming the NHS is there to deal with all the difficulties that automatically come with getting older.
Has podiatry contributed to this complaint culture by withdrawing a service (social nail care), that it probably should never have been involved in the first place thus creating a historical dependacy for a whole generation of individuals.
In an ideal world I would love to be able to provide that personal care service to individuals. I'm not too proud or too qualified to cut nails - I still do these things and as others have said this is a very rewarding service to provide.
Sadly I don't think the ideal situation exists anywhere in the world, so could I justify using my skills to carry out nail cutting clinics to the detriment of those patients in pain or worse? - No.
I don't think NHS podiatry should be involved in routine nail cutting but it may take a generation to fully accept this situation and for UK podiatry to achieve that status enjoyed by other colleagues across the globe.
Of course we will still have lots of pathological nails to contend with and if say nail surgery isn't an option for such patients then where do clinicians develop the skills to treat these patients without necessarily starting out with non-pathological nails first??
Perhaps that's another discussion entirely!!
Michael
__________________
Michael Gates,
Podiatrist,
Inverness ,
Highlands
Scotland
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Having recently returned to the NHS after a few years away, it's comforting to hear that not too much has changed in my absence!
The PCT that I work for has specific criteria for patients who want to access the service. Essentially we'll only see people who have a medical condition that puts their feet "at risk". The PCT uses assistants for "nails only" patients.
__________________
For God and Parliament! My location
For 25 years I had the same crap from NHS managers that you obviously are exposed to an a daily basis. Be careful - it is catching and ultimately fatal. You might like to try this little game next time you're at a staff meeting. Print the attached "Bingo" card and distribute amongst the staff next time your Service Manager is doing a presentation. Tick the box each time he/she/it utters the phrase. Winner is the first one who stands and shouts "Bullsh!t Bingo" with a complete card. It helps - promise!
MR
__________________
"citing an indisposition due to special circumstances"
Thank you for your reply Charlie. The problem is though you have just created an overspend on your budget. My local NHS Trust invites all nail care referrals into clinic for a 'keeping your feet healthy' presentation. From what I remember up to 30 patients/carers were invited to attend the talk.
When 'routine nail care' was part of local podiatry provision the podiatry waiting list achieved nearly 2 years. That was across the full spectrum, not just nail care but all referrals. The problem spirals when you offer an NHS service such as routine nail care to one individual & decline it to another. As is often the case in the NHS if an individual complains against lack of what is seen as an entitled provision of a service. Those who shout loudest are those which will gain treatment.
The NHS has no 'Magic Cooking Pot' refilling with on demand funds unfortunately.
Best regards,
Mandy.
Hi Mandy,
I'm a Grade 7 Podiatrist with 17 years experience of working in the NHS. I am well aware of the budgetary constraints and the fact we have to make choices about who we are able to treat.
The options I chose are the ones that this Trust provides
We do not provide routine nail care to those who are infirm but not at risk of developing ulceration (for example) if we release them to self care, care by relatives or the private sector.
And frankly, I think that stinks since along with not providing routine nail care we also don't provide care for any of the other "routine" problems the low-risk caseload has. They are given one (or two at most) treatments and are then discharged. It seems the elderly in this country, most of whom have contributed in many ways to their country, are at the bottom of the heap when it comes to getting care in their old age. Oh, it's just "routine", tough.
Now, a good few CAN afford private care. Lots can't though - a small percentage amounts to a lot of people. It sucks, big time.
Still, the NHS doesn't have a bottomless well of money and this is the best we can do.
For 25 years I had the same crap from NHS managers that you obviously are exposed to an a daily basis. Be careful - it is catching and ultimately fatal. You might like to try this little game next time you're at a staff meeting. Print the attached "Bingo" card and distribute amongst the staff next time your Service Manager is doing a presentation. Tick the box each time he/she/it utters the phrase. Winner is the first one who stands and shouts "Bullsh!t Bingo" with a complete card. It helps - promise!
MR
OOPs - guilty of "budgetary contraints" and "episode of care"!! Trouble is, I've gotten into so much trouble over the years for speaking frankly and not using management speak that now I watch what I say carefully and ending up using "safe" terminology just to keep my head below the parapet....most of the time.
The DofH/NHS/PCTs need to recognise that ageing is a systemic problem and needs to be treated as such. Nail trimming to a high standard takes just 3 minutes, rather less time than the administration, and therefore less expense.
The DofH/NHS/PCTs need to recognise that ageing is a systemic problem and needs to be treated as such. Nail trimming to a high standard takes just 3 minutes, rather less time than the administration, and therefore less expense.
Are you arguing for or against?
This 'high standard' nail trimming you describe.
A. Who does it?
B. Who books it?
C. Who assesses the patient?
D. Who pays for the overheads: reception team, clinic room, lighting, instruments, clinical waste.... etc. etc. etc?
E. Which mug pays extra tax to fund it?
Kind regards,
Intrigued of Doncaster.
__________________
:)
twirly
Mandy Brooks
Brooks Podiatry
S64 0DE
Suffering a fondness for odd things.
If it can be done by one person in private practice, (and it can and is!!!) it can be done by any podiatry team. In fact, it should be easier due to the economy of scale! Organisation is the key, and ridding yourselves of ridiculous bureauocratic nonsense.
The cost is pushed up by a huge and unneccessary administration far too many layers deep. This country needs a large dose of common sense - it's what we should have... in common. Without it society has no common ground and no coherence.
I find it difficult to justify a university education aimed at teaching critical thinking that leads to a 'job' that demands blind adherence to guidelines. That's really expensive and wasteful!
I agree with much of what Simon said; the problem is very much a NHS mentatlity issue - on the approach to the issue and the clinical attitude from the staff. I enjoy the variety of the job. Every patient offers a different challenge. Some simple; some complex - that is the nature of general practice.
You adapt your practice to suit the demand. Take bookings for example. You can manage a bigger caseload by structuring your appointment system appropriately. Don't forward book unless its for short-term management. Let the patient make their appointment as and when they need one. In other words when they are symptomatic. Even in public health, if implemented properly, it is rarely abused - and if it is, often a kind word of guidance suffices. Remember who we serve! Who pays their taxes to fund your wages.
I have to say that anecdotaly, I have found the attitude of some colleagues in public practice rather condescending towards some elderly patients. I even find some comments on these pages distasteful and disresectful towards those in our care. For me, no matter if they were a private or NHS patient - they are equally important to me irrespective of what they present with. As far as NHS eligibility criteria is concerned - it has always been flawed. Those who trumpet the policy on behalf of the profession usually have, in my books, the lowest aggregate IQ and nominally have a perfidious streak more akin than Benedict Arnold.
The government could fund the NHS properly. But it doesn't. Many colleagues in public health simply do not care - and have little incentive do do so. A sizeable number in private practice provide a fantastic range of podiatric care - effectively, efficiently and to the highest standard. Specialist/generalist/call-it-what-you-will.
Another example of NHS stupidity tonight. My sister has H5N1 influenza - a virulent strain. She has been seriously ill for the past 10 days and has menigitis-like symptoms that have not improved. She is a nurse practitioner and missed out on the first wave of vaccination the day she took ill. Her husband has had to take time off work to nurse her. He was refused the vaccine as he has "no underlying medical condition". Even though he is in close proximity - and has been for the duration of the illness. Now, 10 days later, he is exhibiting the first symptoms..... Needless, stupid, bureaucratic sh!te. Much the same as dictated to podiatry depatments over the last 3 decades.
__________________
"citing an indisposition due to special circumstances"
Mandy here's another hypothetical:
87 year old British born male, fully paid-up national insurance contributions, fought in world war 2, sustained gun-shot damage to left leg- tortured as a prisoner of war at the hands of the Japanese by repeated beating of said injured leg. Abnormally high pain experienced upon merely touching the foot, let alone trying to cut the nails- requires nail cutting. A real patient of mine that passed away recently, who did not apparently "qualify" for NHS chiropody provision.
Versus
Immigrant 30 year old female, paid zero national insurance contributions, working as a prostitute, requires treatment for a sexually transmitted disease and heroin addiction. Get's care on the NHS
What is fair and what is right?
I'm with Simon all the way on this one, the somewhat dubious criteria implemented by "caring people" often leaves a lot to be desired like an 80 yo CVA pt with a hemiplegia attending an NHS clinic for routine care only to be met be two podiatrists who were "abrupt and rude" who promptly sat the lady in a chair facing a wall, gave her a long handled file and told her to file her nails in future as she was not eligible any more. when she complained she couldn't reach her feet the podiatrists told her to put her foot up the wall which the lady promptly did and yes you have guessed it, she fell off the chair as the paralysed side of her body could not support her !!She was still discharged and this story was related to me by the patients daughter when she brought her to my surgery for Tx.
Now how proud does that make us feel ?? she instanced several equally appalling discharges that were done the same day in a similar manner which she witnessed, wont complain though dosent want to make a fuss( another of the too nice people around)
If you want to get more money into the NHS then stop the benefit system that is so abused and yes by people that have paid nothing into it and are bleeding it dry. I was listening to a health minister bleating at the rise in cost of maternity services and they were working out why they were going up ??
Couldn't be the immigrant population has 5/7 kids instead of our 2.5 could it
Are we becoming radicalised due to NHS podiatric policy?
Nah just injecting common sense into the Marxist ( communist) government policy that prevails in this nanny "look after all that are non contributors first the rest, thanks for your contributions and now go away ( FO) coz your entitled to nothing "state of ours !! Dont think, dont say, dont do anything unless it has been sanctioned .. blah blah blah ( don't get me started Si pleeeeeeeze dont get me started )
Cheers
Derek
Do you know Del, I think that's the first time I've been called Si on this forum.
I call my Son it all the time
His names frank BTW
No seriously he is a Simon as well and all my friends call me Del ( or Derek if they have the hump with me )
Be lucky mate great minds and all that bo***cks
Cheers
D
Re: Should the NHS do routine nail cutting?
Unless you go for a manual evacuation, which is messy and another story entirely.
of course, I`m sure you realised that when I said "negative euphemism" I meant the opposite to the usual substitution of a less offensive expression in place of one that may offend.
She was still discharged and this story was related to me by the patients daughter when she brought her to my surgery for Tx.
)
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