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A profession threatened?

Discussion in 'United Kingdom' started by hannah999, Mar 27, 2015.

  1. hannah999

    hannah999 Member


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    Why is it that podiatry as a profession is letting every other profession slowly take over our field of expertise? I get so frustrated that nurses are doing the annual db checks surely we need to be making the case for podiatry to 'own' the assessment and management of db feet. Why is it that pts go to GP with plantar fasciitis and are referred to physio, why do I see so many nurses redressing foot and toe ulcers in the community, shouldn't we be doing all this?
    Rant over, just feel that as a profession we need more direction and leadership to survive.
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    This has been raised as a concern ever since I graduated a zillion years ago. Nothing bad has happened yet and we gone from strength to strength.
     
  3. plevanszx1

    plevanszx1 Active Member

    podiatrists need to expand their role and chief pods need to resist the temptation to get out of certain parts of the scope . during my time i expanded to cryo of hand warts . maggot therapy ,vac therapy . others did casts. if staff take easy way of getting others to do things then podiatry will refer its way out of a job. i was determined to redress diabetic wounds once a week with nurses doing other days. i came under pressure to refer and forget. the more podiatrists refer and forget the the more likely the rest of NHS will manage without us
     
  4. ProspectivePod

    ProspectivePod Active Member

    This is one area of the profession that's made me doubt whether podiatry was worth the 3 years plus investment and whilst excited I'm not going to pretend that I still don't have doubts. It is depressing that we don't really offer anything that other professionals can't do in some shape or form whether that's nail surgery by GPs and orthopod trainees, stretches and orthotics from physiotherapists, wound care and diabetes checks by nurses and so on.

    I truly sympathise with this and initially the thought of the above made me feel that if I studied podiatry I'd be in a profession that people didn't really value and one that felt unnecessary. However my outlook completely changed when I looked at the bigger picture (alongside the fact that those who need podiatrists tend to greatly appreciate the work they do).

    The bigger picture in my opinion is the fact that podiatrists can offer all of the above in one seamless package whereas care delivered above through numerous professionals i.e nurses, doctors and physios etc is disjointed. This is where our value lies and a reason I feel it important that podiatry and foot problems become synonymous much like that of tooth problems and dentistry.

    That's not to say that MDT working isn't important, it is but the fact that we can offer expertise on all of the above is to be celebrated and it is this that we need to convey to others i.e department of health, the public and so forth.
     
    Last edited: Mar 27, 2015
  5. Ashley,

    For someone who has yet to embark on a podiatry course let alone have worked in the profession for any period of time, you display a remarkable understanding of the issues surrounding podiatry, which no doubt, will serve you well when you commence practice. What is your background?

    Kind regards
    Mark
     
  6. Rob Kidd

    Rob Kidd Well-Known Member

    I have had this conversation for years. From where I am sitting (which is retired, on a river bank), you will only ever keep what you do by being best at it, not by legislation. If you are not best at it, you should not be doing it. Rob
     
  7. perkyr

    perkyr Member

    Where i am i have lots of people who done 6 week course and call themshelves chiropodists. No point complaining to hcpc as all they do is ask for them to remove the name chiropodist or dont bother doing anything!
     
  8. W J Liggins

    W J Liggins Well-Known Member

    When will we understand? The HCPC is not there to protect the public - they have no monitoring systems or authority to do so. The HCPC exists for two purposes only. To control the registered professions (ie. to offer an easy method of dismissing those who offend employing Trusts) and to perpetuate its own existence.

    To answer the OP directly: Ashley has hit the nail on the head. We should have become to the foot as dental surgery is to the mouth; that we have not is our own fault (ie. the pathetic persons who 'led' the profession at the time of the Medical Auxiliaries Act, the Professions Supplementary to Medicines Act, The Health Care and Professions Act). The opportunities were all there but vision, courage, will power and cohesion were not. :deadhorse:

    Bill Liggins
     
  9. Simon Ross

    Simon Ross Active Member

    Had a patient attend my surgery for nail surgery. Had had 9 lots of antibiotics, and nail surgery from the GP without phenolisation.

    I don't think that our profession is threatened when this is the case!

    Heard of another case of a diabetic with an ulcer plantar digit 1. the nurses had simply peeled callous from around the ulcer and not debrided. They didn't know about the need to debride/use scf padding.
     
  10. MARK SHERIDAN

    MARK SHERIDAN Member

    Well said Hannah.Im twenty five years in the foot business,no GP has ever Referred to me and the funny thing about it is I know most of them around my patch
     
  11. W J Liggins

    W J Liggins Well-Known Member

    So what should we do to change that situation? What assistance does your professional society offer you? What direct approaches have been made by the professional bodies to GP bodies to create a dialogue at that level? If not why not?

    Bill Liggins
     
  12. Tracy.gill

    Tracy.gill Active Member

    yep makes me made when Age Concern let untrained public cut old folks nails and even say they are chiropodists ( which I cannot get names of, otherwise I would report to HCPC) my main income is from providing home visits to older folks in their homes as they cannot get to me and I am being undercut constantly... cannot understand why this was allowed to happen I even wrote to my MPs and all I got was a long winded document supporting them, no protection of title or profession!! Rant over but I am finding it increasingly harder and harder to make a living anymore despite being in business for over 20 years.
     
  13. ProspectivePod

    ProspectivePod Active Member

    Thank you Mark. I really appreciate your comments, they mean a lot coming from someone such as yourself.

    I'm 20, have researched the profession to no end and just have an undeniable passion for podiatry. I've got healthcare experience and have voluntarily undertook placements in a number of primary care settings so have become quite versed in some profession specific issues; podiatry particularly.

    Theres a lot of issues in podiatry (specially privately from what I've seen and read) and I just want to be fully aware of as much as I can before qualifying to avoid disappointment. I've found a profession I can see myself in for the rest of my life and just want to achieve something valuable with it. Even if it means changing the face of podiatry on a community level I'd be quite content.

    I'm just eager and excited and hope upon starting my studies (and completing them) that my eagerness and excitement for the profession continues.

    Ashley
     
  14. APodC

    APodC Active Member

    The notion that McDonalds has no future because other people can make hamburgers isn't one we should be promoting for this profession. Podiatry is a good profession with a clear area of expertise. The social drivers are terrible with diabetes about to boom, which means the underlying economics for the profession are good. In Australia, there has been very good growth data with podiatrists growing to do over 2.2mil services under Medicare per annum (compared to 1.2mil in physio with a workforce six times the size).

    The greater threat to podiatry is if the profession doesn't outwardly demonstrate confidence in the value it offers. If any profession starts to become inward looking and defensive and focuses on infighting, ego and one upmanship; it will lose ground to others.

    The next thirty years look good for podiatrists as long as we're a unified, confident profession willing to speak proudly about the value we offer in the health system. Podiatrists must tell referrers, patients, the public, the person standing next to us at the school barbeque that podiatry saves limbs, podiatry saves lives and being a podiatrist offers a unique and irreplaceable contribution to the health of our people.
     
  15. I only wish I had your clarity, focus and articulation when I was twenty, Ashley. Good luck in your endeavours and keep the light shining.
     
  16. Ninja11

    Ninja11 Active Member

    I don't think our profession is "threatened" in the sense that we as podiatrists have nothing to offer. Yes, I concur that all these professions seem to operate outside their designated field of practice, to the point that they encroach on ours quite deliberately. But I also agree with Rob Kidd, be the best at what you do, and the patient will come to you. I have seen all manner of botch jobs, from nurses debriding tendons they thought to be slough in a wound, to GP's going against my instructions to refuse PNA surgery on a diabetic patient with BGL's >15mmol/L that resulted in toe amputation. Keep doing it bigger and better than the rest, and we can hold our heads high. In a perfect world, I'd like to see other professions show us a little more respect in terms of what we can do and how we fit amongst multiple team disciplinary care, but the world doesn't revolve around just podiatrist....unfortunately! ;-)
     
  17. Cyberbarn

    Cyberbarn Member

    Apologies for coming in late to this thread.

    I think the patients can have a part in this. Satisfied patients have a tendency to share their positive experiences with others. And extension of this would be the work that Healthwatch can do in local areas. Patients can have a strong voice though them and their reports on podiatry services can put pressure on CCGs to commission better services. Support groups are also a hot bed of referrals. One of the Ehlers Danlos ones I am on has a steady stream of people asking what they should do about their painful feet. I now have a set piece about self referring if possible or getting the GP to refer to a podiatrist and many people are now valuing their podiatrists more highly than their physios.

    So perhaps podiatrist can offer to do talks to their local support groups as a way of becoming known to the patients so that the patients can demand to see the podiatrist rather than the GP or physio or orthortics department.

    I wonder if anyone here has had a hand in the initiative in South Birmingham NHS trust? There is a case study on page 20:

    http://www.skillsforhealth.org.uk/index.php?option=com_mtree&task=att_download&link_id=173&cf_id=24

    Here is their website:

    http://www.bhamnailcare.co.uk

    From the page on who the Nail Carers are: "Nail Carers are trained and assessed by Podiatrists and Beauty Therapists over a period of 14 weeks." Also:

    The NHS has commissioned the following support for Birmingham’s Registered Nail Carers:

    -A Nail Carer’s NHS help line that they can use when they have a query about their nail cutting ; Nail --Carers are also able to refer directly to an NHS Podiatrist for a specialist opinion or some additional routine help when appropriate
    -An annual supervision session for each Nail Carer to ensure they maintain their quality of care
    -An annual training session for each Nail Carer in order to keep them up to date with current issues

    What struck me about this initiative is that the Nail Carers are trained by podiatrists and will refer to podiatrists. As I understand it toenail cutting is often the gateway to podiatry. I wondered if anyone from Birmingham has come across this? I know that sometimes reports can be overly optimistic when in fact things are different in reality, but it seems to me that this could be a good model to raise the profile and importance of podiatry. Get the GPs to refer to the Nail Carers who will refer to the podiatrist when necessary. Are there any other heads of podiatric services here that have tried something similar?

    I have just seen a presentation from our local council that included research from the Institute of Ageing in Newcastle. One of the things that they have found is that the elderly not being able to cut their toenails is the first indication of a deterioration of health. This can be slowed down if toenail cutting is provided, so it is very important to have a robust toenail cutting service. Social care see the importance of nail care and podiatry. in addition there are big changes happening from the bottom up in health and social care, and there is a feeling that it will all be integrated eventually.

    Perhaps then podiatrists will start to come into their own.
     
  18. Ninja11

    Ninja11 Active Member

    Hi Cyberbarn,
    I work in a place that is collectively a "Foot care team" This consists of Podiatrists, Foot Care nurses, and Allied Health. When I took this job, I was quite excited by the prospect of working in a team with varying skill sets, and bringing differing views to the table about client management. Some time down the track, I see a number of problems with idealistic team.
    - Our workplace holds that all team members are equal, so no one person is accountable for overseeing the running of the team. The CEo that does oversee us has nil medical training, so has little understanding of the importance of meeting clinical guidelines that we are taught as podiatrists.
    - Nursing staff often revert back to a nursing perspective, and miss the podiatric element to details.
    - We have Allied Health team members that are only allowed to cut Low Risk clients. But at times I come across notes that they have prov'd a a heel raise or toe prop or other to relieve client issues. Whilst their kindness is admirable, at times their treatment is inappropriate, & without the background training. As they say " a little bit of knowledge can be dangerous". They've been told not to do such things, but again, human kindness.
    Further to these issues, and a long list of others, there is no governing body that comes around annually to check and see if such footcare teams are running within clinical guidelines, which I find odd, as I am sure that when the Aust. Pod Assoc agreed to allow Allied Health Assistance etc to be permitted to perform such duties, it was with the understanding that such persons would be monitored in some capacity.
    Likewise, I recently was approached to teach carers how to cut the nails of their bedbound relatives. these are individuals who are unable to leave their home due to their physical incapacity...so clearly issues with poor circulation etc, suggesting High Risk type foot care. I refused on these grounds. But I know this project is still going ahead in Australia, funded by HACC. It's very disturbing how easily such programs get around red tape, when we seem to monitored so very closely.
     
  19. Catfoot

    Catfoot Well-Known Member

    Hannah999,
    IMHO, after some 30+ years in the profession, the biggest threat to our profession is ourselves.

    We need to market ourselves better, improve our skill-sets and have a robust fee structure.

    Last year I was asked to visit a care home to see a patient who needs were beyond those of the FHP they used. After this I persuaded the home that they needed input from a chiropodist to give their clients a choice of practitioner.

    They engaged a Chiropodist who was prepared to charge the same as the FHP ie £12 per patient. In addition this Chiropodist travels 38 - yes 38 - miles to work for an afternoon !!

    How can we get respect as a profession when some of us are prepared to engage in a price war with the unregulated sector ? :craig:
     
  20. Simon Ross

    Simon Ross Active Member

    A set fee structure is against competition law!

    The problem with this profession is that there are too many practitioners who seriously think that all pensioners are on the bread line! Some elderly just need to get their priorities correct!
     
  21. Jasharper

    Jasharper Welcome New Poster

    Well guys and girls,
    i'm just coming into the industry,but in my own field it is just the same
    nothing we can do will change it.whatever industry we are in there seems to be a revolution going on.
    embrase the changes and enjoy your work and please welcome us newbies
    as some of us are as dedicated as you all to give a professional service.
    at what ever entry level.
    regards.
     
  22. Jasharper

    Jasharper Welcome New Poster

    Well guys and girls,
    i'm just coming into the industry,but in my own field it is just the same
    nothing we can do will change it.whatever industry we are in there seems to be a revolution going on.
    embrase the changes and enjoy your work and please welcome us newbies
    as some of us are as dedicated as you all to give a professional service.
    at what ever entry level.
    regards.
     
  23. Raphael1974

    Raphael1974 Member

    Hi all,

    As a GP myself within the NHS in the UK my thoughts are as follows:

    1) Awareness: Most busy, jobbing GPs just don't understand the scope of Podiatry. The base assumption is that you trim nails and deal with verrucas and callouses. If they don't know the services that are out there then they won't access them
    2) Funding: Most CCGs (following from the PCTs before them) cut funding to community podiatry. Many referrals were sent back as 'no funded on the NHS'. This drives primary care clinicians to make do and mend so GPs ended up having to offer advice with only the most basic understanding of podiatric issues. The one area where funding wasn't cut was to Physiotherapy, hence a lot of lower limb biomechanical issues are referred there, with variable success depending on the department and expertise
    3) Waiting times (linked to funding): Getting podiatric input takes a LOT of time in many areas and patients just aren't prepared to wait. They bug the GP over and over again, hence the 'make do and mend' approach. Believe me, GPs would rather NOT be treating podiatric problems but if services don't exist, are minimal at best and take ages to access then the path of least resistance approach occurs.
    4) Skill: This is a tough one to say, but in my experience the skill level of podiatrists out there is highly variable and decision making can be very poor (I've seen podiatric surgeons rush to surgery for a Morton's Neuroma with poor outcomes and only then, after much time and patient pain, they get a 'decent' biomechanical assessment which address the problem with greater success).

    In summary, lower limb care NEEDS expert, skilled podiatrists. These aren't cheap and currently commissioners don't realise the value they would add to the NHS economy, hence the limitation to services and staff skill level. I'm not saying that there aren't superb clinicians working in excellent NHS centres with good local awareness and timely access, but these are far and few between and subject to huge postcode lottery issues.

    Richard

    P.S Within the Bedfordshire NHS Community MSK system I work, we realise all the above and have been handed the commissioning budget for all MSK care within the county. This allows us to invest in services which will add huge value to patients. We've only been going over a year and had a LOT of early dragons to slay, but we're meeting within the next couple of months to look at how we can develop services better. We already have an excellent podiatrist who provides some sessions for us but my vision to grow this part of the service and integrate the clinical team so we're all adding the particular value we have. My area of expertise is in MSK US so I see a lot of the patients with ?Plantar Fasciitis ?Achilles Tendinosis ?Tib Post/Peroneii dysfunction in order to scan these structures. This is partly why I've joined this site and am spending every available opportunity to increase my knowledge base in biomechanical issues since it's clear many of these problems need a biomechanical solution (and not just a sharp bit of metal with corticosteroid attached to it....).

    Hence, the future's not entirely dim.
     
  24. W J Liggins

    W J Liggins Well-Known Member

    Thanks Richard for your thoughtful posting. However, as a podiatric surgeon I must state that I have never 'rushed to surgery for a Morton's neuroma' and to the best of my knowledge neither do the colleagues I know of. The 'usual' protocol is i) exercise and change of footwear, with or without padding ii) biomechanical analysis and provision of orthoses iii) cortisone injection iv) surgery. The decision to proceed surgically is based upon a) pain level, b) duration, c) size of neuroma from US examination, d) fulfillment of the above protocol. Anecdotally, I have found that anything above 10-12mm tends to end up treated by surgery - with exceptions. Again anecdotally, excision is usually successful with infection being the most common adverse reaction (usually staph aureus).

    Having said that, I do believe that forms of treatment tend to be determined by the outlook of the practitioner and probably a podiatric surgeon is more likely to think in terms of surgery than a 'biomechanist' who does not carry out such treatment. However, I do have a few colleagues who like to use the aforementioned sharp metal with corticosteroid attached in conjunction with orthoses (hopefully not into the TA though!)

    All the best

    Bill Liggins
     
    Last edited: Jul 1, 2015
  25. Raphael1974

    Raphael1974 Member

    Hi Bill,

    As GPs we do see alot of the 'ugly' because of our role as spectator and referee for the patient. We refer patients, they see clinician X who does treatment Y and we see the after effects of that treatment. As is expected in medicine (where nothing is 100% guaranteed) sometimes the outcomes aren't good. The follow-up system should pick this up and make surgeons aware, but patients do fall between the tracks (and it happens more than it should) and follow-up occurs anecdotally in General Practice (usually when they're coming from a BP check or such like!).

    Surgeons within a department are likely to see this as well since patients may be re-referred back to another Consultant for a similar problem. Certainly my colleagues in one hospital were very aware of this situation.

    There is a sort of Omerta that occurs (both known and unknown) since we all realise that managing patients is far from a pure science and we don't wish to critique our colleagues. It happens rabidly in General Practice and I'm sure elsewhere.

    However, and this must clearly be said the expertise of UK Podiatrist and Podiatric Surgeons is very, very high and I in no way wish to cast any shadow on the undeniably high level of professionalism and skill within UK Podiatry or Podiatric surgery. I'm not here to critique but to learn.

    In truth we all know that clinical care is as much an Art as a Science and due to complex factors (clinician skill level, knowledge and/or clinic pressures/patient factors etc...) outcomes can vary.

    Kind regards,

    Richard Collins
     
  26. Raphael1974

    Raphael1974 Member

    ETA...

    Speaking of TA injections.....I've been very interested in the approach of Hakan Alfredson to managing Achilles Tendinosis. I believe he does a minimal incision and stripping of the anterior fat pad from the paratenon (I presume to cut off neovascularity). I was talking with one of my interventional colleagues last week above how one could achieve this same affect via USG injection, since introducing the needle anteriorly and infiltrating LA/Saline may achieve a similar dissection. I wasn't sure whether this was similar to Otto Chan's high volume injections since I had believed that this was into the paratenon. It's an area I'm looking into!
     
  27. W J Liggins

    W J Liggins Well-Known Member

    Martin Harvey in Tamworth was introduced to this form of t/t by an Australian GP and has done some work on it. 'll direct him to you, since he is keen to learn more.

    Kind regards

    Bill
     
  28. Raphael1974

    Raphael1974 Member

    Thanks Bill, that would be great.

    Richard
     
  29. Ian Reilly

    Ian Reilly Active Member

    Excellent post Richard. Very helpful.

    Im just up the road from you: MSK pod services were stripped out by our CCG 18 months ago so we can't access biomech services for our patients. So i now have to go quicker to CSIT or surgery because conservative care is out of contract. And we TOLD the GPS very clearly we weren't just a corn/callus dept.

    Ian
    jobbing Pod Surgeon
     
  30. Raphael1974

    Raphael1974 Member

    Ian,

    Good to meet you (albeit online!).

    Although the CCGs are technically 'GP led', those GPs themselves are heavily led by the continuing commissioning managers who have a set MO when it comes to health care service design. The MSK paradigm of the NHS is still very compartmentalised (Ortho, Rheum, Physio, OT, Podiatry - for corns, callouses and verrucas) and clinicians and patients are expected to fit into one of those boxes.

    It takes a critical balance of clinician knowledge and influence to start to reset the service design agenda from the commissioners and it's happening very sporadically from CCG to CCG. I had thought that Nene CCG was pretty forward in it's thinking but I've not had much to do with them since they morphed from Nene Commissioning into the body they are now.

    Within BCCG there were a few key movers who saw the potential value in outsourcing commissioning of MSK to another agency who would have more potential to design services around the needs of the patients. I'll admit it's an experiment and one where the benefit and value has still yet to be proven beyond reasonable doubt (and I think many surrounding CCGs are watching us and assessing to see if it works). My own involvement with Circle Partnership (who won the prime vendor contract) has been as part of the clinical pathway design team and it's certainly helpful to have a tighter team of skilled MSK clinicians (from all sectors) looking at how to improve MSK services than a less skilled, less clinical team at the level of the CCG. I don't work for them but instead am part of Horizon Health Choices which is owned by all the GP practices across Bedfordshire and which exists to design services which meet the needs of primary care patients and the clinicians seeing them.

    The one benefit is that we understand the MDT nature of community MSK care, that not everything needs a needle or scalpel and better services like biomechanical input help prevent disease progression and restore patients to functioning without a huge amount of expense. The one problem is that we need to prove the cost benefit of all this to Circle as they're seeking to make a profit from this contract and this requires a tightly argued business cases. I know that APOS Therapy have had some dealings with them to consider a pilot but my increasing knowledge base of biomechanics suggests to me that the same benefit can be achieved for far less with the right biomechanical/podiatric input.

    My 'vision' is to try and work with a core team of high level skilled biomechanical/podiatric clinicians (both surgical and not) to develop a regional NHS service which could provide local, integrated services on a commissioner by commissioner basis. Organisations like Circle would be easy to get on board but, with good outcomes, it shouldn't be too hard to make the case to other CCGs.

    A prime example would be that, within the Bedfordshire MSK model, there is a set tariff for physio (for a course of treatment aimed around 4+1 sessions) and I certainly see many patients with back/hip/knee/ankle/foot issues flying through many episodes of physio with marginal benefit. If a correct biomechanical assessment could be done in community MSK at first contact and the patient be seen by a skilled team of podiatrists/physios/surgeons to correct these issues then I'm convinced this would be a better use of the budget, but it needs the service and team to be 'out there'.

    I do honestly believe it can be done from the ground up but it'll need the right team, a good business case and demonstrably good outcomes (either existing from other centres/studies done or after a period of trial).
     
  31. Cyberbarn

    Cyberbarn Member

    Hi Richard,

    You make some interesting observations, some of which I have been finding myself.

    "Most busy, jobbing GPs just don't understand the scope of Podiatry."

    I agree. Having recently been involved in the podiatry workgroup run by our local Healthwatch (Our report has been submitted to the commissioners but as it hasn't been published yet I can't comment directly on anything in the report) as well as supporting families with children with SEND and people with Ehlers Danlos, I have found that many people are suffering with painful feet, but their GPs just don't think to refer to podiatrists, and not all areas do self referral. So there is a lot of education that needs to be done, both at GP and AHP levels, as well as at patient level.

    In fact, sometimes the patient is in a better position to do the educating of the GPs if they can manage to convince the GP that a referral to podiatry is a good idea.

    Although this paper is about reasoning, (an area that I study) it does illustrate the lack of understanding found with some GPs. As I started reading the paper I was trying to think of a situation in podiatry that it could be applied to, so I found it really amusing that their case example was a podiatric condition, but was disappointed that the referral was to orthopaedics and not podiatry. I felt that if the referral had gone straight to podiatry the outcome would have been better for the patient.

    http://fampra.oxfordjournals.org/content/30/5/501.full

    As for the funding, there is evidence that early intervention with regards to foot care slows the decline of older people, which in turn saves both the NHS and social care money.

    http://scot.adlsmartcare.com/life-curve-the-age-guard-tool/

    They have found that toe nail cutting rather than a service that is unimportant is actually a key to keeping older people healthy and that by providing good foot health care by well trained NHS staff older people can be kept well for longer avoiding the high costs of care and re-abeling.

    I know that some NHS podiatry services are fighting hard to convince the CCGs that podiatry is important, and this is where groups such as Healthwatch can help by listening to the patients who are telling them that more podiatry services are needed. But as you say Richard, it really is a postcode lottery. Some Healthwatch groups are really active, others not.

    PPGs might also have a role to play here, representing the patients, especially now that all Surgeries have to have a PPG.

    In order to convince the CCGs to commission more podiatric services, the podiatry services managers, Healthwatch, PPGs and those from the care services need good sound research to support their arguments.

    As for Bedfordshire, I am really glad to hear that you are slaying dragons! I have a friend in Bedfordshire who was told by her GP that as she had had physio, and orthotics already, that was her lot and they weren't going to refer her to podiatry. So she has had to go private for a proper MSK assessment and orthotics, and is looking at a bill of over £300. At the same time she is still in the NHS MSK system roundabout where physio has referred to orthotics, then back to physio, and now onto another person for another reassessment with a physio before the original physio referral to orthotics an be followed though. No wonder they can't make a profit!

    I am sure as you say with the right team, a good business case and sound research to back it up, changes can be make from the ground up. I wish you luck!

    Jennifer
     
  32. david meilak

    david meilak Member

    In my opinion all this talk about working in a profession (Podiatry) where we have no real expertise and all the other health care practitioners can do our work does not hold water. I understand that many podiatrists tend to shoot themselves in the foot (pun intended) by sometimes feeling like some kind of underdog. This is wrong as all in all your patient base and respect from other practitioners all depends on you.

    If you show dedication, show empathy with your patients, and most of all work with a smile then you will never have a shortage of patients. With regards to acceptance and referrals from other health care professionals such as GP's etc., my opinion is that by showing your dedication in your work, your own patients will mention you to GP's and other practitioners and time will prove that you will be on a good footing (excuse the pun), and there will be no reason to explain or reason out what we do or do not do. Your patients are your BEST advertising agency. If they feel good with YOU they will not let anybody touch their feet.

    Sometimes we tend to remain in our box, and a little lateral thinking about things that have nothing technically to do with podiatry but actually how we present ourselves, approach people, and work positively can go a real long way.
     
  33. Raphael1974

    Raphael1974 Member

    Jennifer, thanks for your response :)

    I agree that the arbitrary nature of funding and services is so bloomin' frustrating. It leaves every CCG to make up their own policy. We need a national podiatric strategy which will guide all CCGs as to how best to commission. There was actually something a bit like this re: MSK a while back and it formed the foundation for a lot of innovative services in that area. I know that podiatry is more than MSK but MSK is a significant part of the specialty and given that MSK commissioning is more advanced than other areas it would make the most sense for some podiatric services to dovetail with what's going on MSK wise. When we set up Bedfordshire MSK one of the early headaches was trying to differentiate 'MSK' from 'non-MSK' cases in those borderline cases (e.g. callouses but due to alternated kinematics related to structural foot issues).

    Healthwatch/PPG's/local media/MPs/local councils, all these can put pressure on CCGs but ultimately they take their pulse from above and what comes down to them from the LATs.
     
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