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Podiatry vs. Chiropody in the UK

Discussion in 'United Kingdom' started by aidanakira, Mar 4, 2005.

  1. aidanakira

    aidanakira Welcome New Poster


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    Hello there!

    This is an old debate, but I want to get an idea of the current feeling among podiatrists on this.

    I'm a polyclinic manager in a small town in the UK who's new to the job. The Chiropody service recently changed its name to Podiatry to reflect the development of new services in the form of podiatric surgery and to better describe its specialist research and service.

    The service manager is insistent that a hard approach to changing patients perspectives will be best in order to create a totally different impression of the service from the previous 'chiropody'. Treatment on corns and callouses will eventually be devolved down to trained podiatry assistants. To further this approach, all references to 'chiropody' have been replaced by 'podiatry' in appointment cards, signage and so on.

    The trouble is, this has caused a lot of the patients (who are mainly old) to be very confused. They are often lost, do not know where Podiatry is any more, they keep asking for 'chiropody' and do not understand why the change has taken place.

    Do you think this kind of approach to reshaping the patients' perceptions is appropriate? I want to ask in particular to any practioners that have managed a similar change -
    1. how did you communicate the idea that foot services had evolved to 'podiatry'. I think miscommunication may be at the root of our problem.
    2. did anyone try a totally new title, like 'foot care centre' 'healthy feet centre' 'foot surgery' 'foot care specialists' 'healthy feet for life'.....?

    Thanks, I'd appreciate any insights into this.

    Aidan Moss
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Maybe others in the UK can help more specifically than I can, but I just wanted to say that this problem to the rest of the world is a very distant memory ---- its no longer an issue, as the changes happened everywhere else, except the UK, a very very very long time ago. Our students do not even know what chiropody is!!
     
  3. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    podiatry vs chiropody

    I agree with Craig's sentiments.

    Here in Australia when chiropody was "dropped" in favour of podiatry many years ago, I am told there was similar confusion **for a little while**. Nowadays, I still get the odd old timer in his/her 80's who still asks what is the difference between chiropody and podiatry.

    I don't understand why the UK continues to use both terms.

    Why not choose one and stick to it - I suspect there must be more confusion for the public when both terms are used by the one profession at the same time??

    The Society of Chiropodists & Podiatrists - huh?? :confused:

    Tony
     
  4. davidh

    davidh Podiatry Arena Veteran

    Hi,
    In all of this you really have to put the patient first.
    By all means call podiatry "podiatry", but a qualifying statement such as "formerly called chiropody", or some such would help the pts, helpers, and other healthcare staff who may also be wondering why the change. You need only be run this for a year or so.

    You may like to remind your service manager that he/she is there to help provide a good service for patients :) ?
    Regards,
    David
     
  5. Cameron

    Cameron Well-Known Member

    >I don't understand why the UK continues to use both terms.

    Before we get too carried away and make too many rash statements. "Chiropody" is still used in Australia and does appear on several State Acts. The term may be in the process of eradication but does still exist.

    > Here in Australia when chiropody was "dropped" in favour of podiatry many years ago, I am told there was similar confusion **for a little while**.

    " Many years ago" would be precisely two decades. The half-life of a medical fact is 25 years, so you may have another five years in Australia to see the end of chiropody. UK Managers, please note.

    >Why not choose one and stick to it - I suspect there must be more confusion for the public when both terms are used by the one profession at the same time??

    The Society of Chiropodists & Podiatrists - huh??

    The reason why the UK professional association uses the double-barrelled name is because many practitioners and their patients are very proud of being and seeing chiropodists.

    >I still get the odd old timer in his/her 80's who still asks what is the difference between chiropody and podiatry.

    Many great thinkers would contest the dismissal of the past without acknowledging its existence, as a folly and I would think foot physicians should avoid this pitfall.

    If you don't know your history then you are destined to repeat it. "or some such sage words to that effect.

    From the beginning of recorded time foot physicians have held a respected place in high society. Throughout history their contribution to the health of nations has been acknowledged, not in a loud manner but rather befitting the humility of caring for feet in a silent reserve. Clashes with orthodox western medicine are well recorded with the Quack Act being one particular victory for those who specialised in skin care. From that time onwards however the division between corn cutting and orthodox medicine has had a forced separation. The term chiropody enters the English language in the 18th century after a plagiarist contrived to avoid discovery by entitling his works Chiropodologia. The title consisted of two classical prefixes Greek 'chiro' meaning hand and foot, and Latin 'pod' meaning foot; 'ologia' or study of, meant a new science of foot care through hand manipulation was born.

    In the world of language mixing classical prefixes is not a good start, but the intention was well meant and the works was a literal English translation from a French treatise on ' corn and callus'. The despicable author wanted to do what all authors of chiropodial text want and that was to write the definitive book. No one has achieved that task, However Low or Lowe also invented the concept of the modern 'hotel' and is recorded for this contribution. Corn cutters were in the 18th century upwardly mobile and keen to drop their early associations with street traders and some took the title corn operators and others chiropodists. The terms would be synonymous then. As history will account in the UK and Australia (countries which actually mirror each other) developed along parallel lines but the former with a greater critical mass. Professional group of chiropodists (corn cutters) formed. In the States at the turn of the 20th century chiropodists conscious of sharmanistic medicine were eager to separate themselves from 'quackism' and formed private colleges and retitled themselves 'podiatrists' or treaters of the foot. During this time many electrical gadgets were in vogue and hence the scope of practice from chiropodist to podiatrists became apparent. Sadly for the US podiatrists, two world wars followed and medicine in the US became legitimised and education was incorporated into public universities. Whilst podiatric education mirrored the medical curriculum it was only in the past two decades the discipline was accepted in to the public higher education system in the US.

    As an aside one of the primary early US text on podiatry was plagiarised from a contemporary English Chiropody text. So I suppose we should all be grateful to the French podologues for giving us our daily bread.

    The reason why the French played such a pivotal role in development of foot physicians has all to do with the Revolution and La Gaze or medical specialisation.

    So historically we could conclude chiropodists treat skin lesions, topically with hand dexterity, and Podiatrists treat foot morbidity. I might argue there is every reason to have both titles in a professional association, albeit I accept it is a mouthful and uses up the entire vowel in Letraset. :)

    Who wants the name change are practitioners, embarrassed by the term ‘chiropody’. Why, no one really knows but may be consistent with a profession that has low self-esteem. Shakespeare had something to offer with his immortal lines

    ~A rose by any other name smells as sweet.”

    My sympathy lies with the old timer who sees the change of name for what it is worth.

    Cameron
    Hey, what do I know?

    PS Available for public engagements and media interviews discount prices to foot physicians changing their occupational name.
     
  6. dmdon

    dmdon Active Member

    Hi all

    The Mr goody goody that I am, I have started to give out A3 size information sheets to my patients with a few lines on there stating that,

    'The term 'Chiropodist' will soon be no more and the the term 'Podiatrist' will be adopted, this does not however mean that the standard of footcare you recieve from me will change. Please keep this piece of paper in a safe place for future reference'

    I have not had any confusion over this matter, but why do I keep getting asked question from my elderly patients about 'chip and pin!' :confused:

    Cheers

    DavidD
     
  7. dmdon

    dmdon Active Member

    Hi again

    What a coincidence...

    'Tis but thy name is my enemy, though art myself not a Montague. Whats Montague it is nor hand nor foot..........!

    Cheers

    DavidD

    Played Romeo in school play, tights and all, man I looked hot in those days! :eek:
     
  8. Cameron

    Cameron Well-Known Member

    Nice one

    There is also a reference in Hamlet to 'corns and callus ' and the reason why young ladies cannot dance. Shakespeare had to walk through the cordwainers section of London to get to the Globe (was there on Wednesday) and may have picked up many of his metaphors to the leg and foot on this journey.

    Interesting but completely irrelevant to anything, Fats Domino has had more hit records with reference to the feet and walking than any other recording artist. Most of his works came from the same studio which had a narrow entrance with a shoeshine boy in residence. The large artist had to squeeze past to enter and leave the building. A brush with feet leaves a lasting impression.
     
  9. Tuckersm

    Tuckersm Well-Known Member

    Cameron,

    The profession in Austarlia officially changed its name in mid 1977, some 28 years ago, when all of the Australian Chiropody Associations become Australian Podiatry Associations. Only one state (South Aust) still has a Chiropody Act, but the title Chiropodist is protected in All state Acts
     
  10. Cameron

    Cameron Well-Known Member

    > The profession in Austarlia officially changed its name in mid 1977, some 28 years ago, when all of the Australian Chiropody Associations become Australian Podiatry Associations.

    Many thanks for that Stephen , I can complete my History of Podiatry in Australia now, cheers

    The earliest mention of chiropody in Australia was in the 1840's with chiropodists in Sydney (NSW) and Geelong (Victoria) advertising their services. Full time practices were established within the more populated areas of Sydney (1862), Melbourne (1857) and Brisbane (1899). Gradually new and second practices sprung up until by the end of the century there were nine chiropodists working in Sydney; two in Melbourne and Brisbane. The cessation of the Great War (1914-18) saw the number of practitioners swell because many who served in the Australian Army Medical Corps took practising podiatry. New associations were formed in each state and these had both familiar names as well some exotic combinations. The Society of Chiropodists and Practipedists was formed in Sydney, 1924 and there were ten members. The association had a short life and were soon replaced with the Australian Institute of Podology in New South Wales, three years later. The Institute established a foot clinic, which provided free foot treatment to citizens in need. Later this became the College of Podiatry of New South Wales and continued for another twenty years. A rival group was the Incorporated Institute of Chiropodists of New South Wales, formed in 1939, it had seventy members. They also sponsored a training centre and clinic and introduced the first Australian professional journal. Other states e.g. Victoria and South Australia had independent but mirrored developments. In 1934 Victorians formed the Australian Institute of Surgical Chiropodists, but later the word surgical was deleted from the title. The first attempt to draft a Chiropody Bill was in 1936 in South Australia, This took to 1944 before it became law and other states followed the established pattern. In 1940 the National Society of Chiropodists (Victoria) was formed and like their counterparts in New South Wales, provided training facilities in many of the larger metropolitan hospitals. Queensland, South and West Australia had similar metamorphoses. During the forties, there were three main organisations in the most populated state of Australia i.e. Incorporated Institute, College of Podiatry, and the Pharmaceutical-Chiropodists Society. Eventually there was a New South Wales Chiropody Council, which was formed to uplift the profession and act as an advisory body. The Chiropody council had out of state representatives in neighbouring Queensland, Victoria and Tasmania, which formed the beginning of a true national body. The Australian Journal of Chiropody was first published in 1940 and although publication was suspended during the war years it did reappear in 1947. New groups formed and reformed as the profession spread throughout the populated areas. Many soldiers returning from the Second World War took the opportunity to train as chiropodists under the government's rehabilitation scheme. Full time courses were twelve months in duration with an option for two years part-time. By 1949 there were two associations claiming to represent the profession. Each had its own training school, code of ethics but so little differences between them; they merged in 1954 to form the Australian Chiropody Association. During this time the vast majority of practitioners in Australia were from overseas and immigration brought chiropodists from the UK and a decade later, podiatrists from the US. The average fee was 17/6d (18 pence). The establishment of a Chiropodists/Podiatrists Registration Act for each state assured a closed profession and this took place between 1957 and 1962 across the country. At the National Convention in Adelaide (SA) in 1963 delegates moved to incorporate Australian Chiropody Association and two years later, rival association amalgamated. The first three year full time course of training was started by Australian Podiatry Association (NSW) in 1965, Victoria followed in 1968 This brought Australian and UK training into alignment. The Western Australian Institute of Technology were the first to offer a full time diploma in 1972, by 1975; the Sydney Technical College was offering and Associate Diploma in Podiatry. Queensland Institute of Technology followed in 1977 with a diploma; and Lincoln Institute of Technology, Melbourne, a year later with the South Australian Institute of Technology offering its diploma in 1980. Later these institutes were absorbed into universities. Eventually the state chiropodiy associations formed the Australian Podiatry Council in 1977 (Tucker, 2005) with its administrative offices in Melbourne. There are now six Registration Boards and six teaching centres with two levels of awards i.e. unclassified bachelors degree and honours level. Courses vary from three and a half to four years of full time study. The Australian universities offering podiatry are: Charles Sturt University; La Trobe University (Victoria); Queensland University of Technology; University of South Australia; University of Western Sydney (NSW) 1; University of Western Australia 2.

    1 The University of Western Sydney replaced the podiatry program from Sydney Technical College in 1997.
    2 The University of Western Sydney, Perth WA will replace the podiatry department at Curtin University of Technology (2006).


    Reference
    Tucker S 2005 Personal Communication Podiatry Forum La Trobe University.
     
  11. stephen m hewitt

    stephen m hewitt Welcome New Poster

    podiatry vs chiropody

    Hello.
    It is my belief that the two names are not interchanged but are used disticntly to identify, to all who need to know, exactly what you as a professional in lower limb and foot health can actually diagnose, treat or cure.
    The problem with the profession is one of patient and inter professional lack of respect. Many colleagues are fed up with fighting their corner about (quote)SShhiropody , and other comments like why do you need to know all this information when all you do is cut my nails!! we have all heard them.
    We missed a great oppotunity to expand the patients and other health professionals perception of what podiatry is by continuing to interpose the use of podiatry/chiropody. Patients deserve general chiropody (nail care etc) and some colleagues will want to continue providing the same care that they have for many years, there is no problem with that. Some of these same colleagues do not want to expand into surgery or biomechanics and that too is fine. But what you cant or should not do is change your name without changing your overall practice. A change or expansion of practice from the percieved normal chiropody deserves a name change to reflect and delineate the expanding knowledge and expertise required to practice podiatry.
    One of the biggest problems is that some colleagues are fed up with the low job esteem and have changed their name to try and gain that esteem. Unfortunately, this will devalue the advances that podiatric medicine and surgery would achieve, in the eyes of the public and other professionals. Respect and esteem are earned by showing others your expert knowledge and this is slowly happening with multi-disciplinary working, they are not gained by changing you title alone. But there is still professional miss-understanding because some 'podiatrists' cut toe nails and reduce callus on cavoid feet while other 'podiatrists' complete triple arthodesis, Dywer osteotomies to the calcaneus, jones suspension to the first and heyman suspensions to the lesser metatarsals with arthrodesis and arthroplasty to the lesser digits for the same cavoid foot.
    Here lies the problem. No wonder patients and professionals dont understand what we do.
    We need to step out of our own arena and see what happened to other professionals . If you look into medicine approximately 200 years ago surgery was undertaken by barbers not medic's. barbers had the wherewithall and dexterity to use sharp instruments and hence people would have their hair/beards trimmed and any lumps and bumps removed. Surgery is now a facet of medicine and I dont see many surgeons cutting hair or trimming beards! Dentistry is exactly the same, originally the 'tooth puller' travelled around propably with the circus, he just had the equipment! Now look at what they have achieved Doctorates in dentistry, huge esteem from the public because they have been able to separate out what they did to what they do now. However, ( I appologise in advance if this comment offends but i need to use it as a simili for illustration only not personal thought) dentistry was identical in some ways to chiropody. both extermities, quite often foul, dirty, unkempt, smelly areas, drill and fill holes, silicone casts etc. Look at your own practice and imagine what a dentist used to do. Now look at dentists, high patient esteem, some dentist operate on sinuses, perform implants and are paid a considerable amount of money for their work. They created and employed dental technicians and others to do the original basic work. There appears to be a delination that patients and professional staff can understand.
    I believe that podiatric medicine and surgery, where the practitioner has the ability to use a one stop shop approach, eg assess, diagnose, treat/operate and then prescribe medication or recruit the expertise of other professionals for each of the lower limb and foot aliments that presents to them. Then this will be a step in the correct direction.
    I am sure while some of you are reading this that you may think that I am an high flying arrogant self opinionated, i'm alright jack, podiatric surgeon. Well I am not I am a chiropodist who can see an ideal oppotunity to develop our profession being erroded away and we will never recover.
    s hewitt (quote)
     
  12. Cameron

    Cameron Well-Known Member

    >It is my belief that the two names are not interchanged but are used disticntly to identify, to all who need to know, exactly what you as a professional in lower limb and foot health can actually diagnose, treat or cure.


    Sure that is a commonly held belief but it is not supported by history. The reasons why the Uk folks have not embraced the term podiatry lock stock and barrell is because of the Trade Union Status of the Society. Considered a worhwhile acquisition this may itself be eroded in the near future and then the term chiropody will pass into archiac language. However for the foreseeable future the two terms remain synonimous with the public which in turn makes protection of both terms critical (at this time) .

    > We missed a great oppotunity to expand the patients and other health professionals perception of what podiatry is by continuing to interpose the use of podiatry/chiropody.

    To be hoenst apart from foot physicians themselves no one really cares what podiatrists do ,and how hard a course it is, and how many subjects they need to study. Patients like the service and many depend on it. That's enough. The issue of status relates to a group of professionals with low self esteem. Podiatry is not alone and many other medical disciplines suffer the same low self esteem.

    >Patients deserve general chiropody (nail care etc) and some colleagues will want to continue providing the same care that they have for many years, there is no problem with that.

    I would say that covers the vast majority of practitioners. Indeed the very backbone of the profession across the board. To date identiiable specialisation (in the terms defined by medicine) affects less than 5% of the total podiatry population, with surgery about 1%. Many practitioners spend a lot of money and time becoming throughly offey with areas of specific clinical interest but spend no significant time practicing that specialty. This is often because the practice demographic prevents them. Following on from the Agenda for Change (UK) there is likely to be more clear focus on specialism but we have yet to see how this will affect general practitioners working within the public sector. The implication is the NHS want to employ less podiatrists/chiropodists then they currently do. One of the undoubted strengths of the profession is majority are involved within the public sector and work place negociation needs to be done via the Trade Union of Chiropodists. Loose that title, loose the status and there may be a gross reduction of practitioers left working in the NHS and when that has gone the specialist podiatrists may heve litle or no platform for negociation.

    >One of the biggest problems is that some colleagues are fed up with the low job esteem and have changed their name to try and gain that esteem.

    A rose by anyother name smells as sweet. But I agree many practitoners feel life will change with a change of name. Not so however .


    >Unfortunately, this will devalue the advances that podiatric medicine and surgery would achieve, in the eyes of the public and other professionals.

    How so?

    >No wonder patients and professionals dont understand what we do.

    The real reason I fear is because as a collective profession we have an oral culture and not a written culture. Secrets are passed down by word of mouth or small interest groups who are not always willing to share their information to a wider academic community for fear of criticism.

    >We need to step out of our own arena and see what happened to other professionals . If you look into medicine approximately 200 years ago surgery was undertaken by barbers not medic's. barbers had the wherewithall and dexterity to use sharp instruments and hence people would have their hair/beards trimmed and any lumps and bumps removed.

    A popular myth but from my days at reading medical sociology orthopaedics predates barbers per se. Major changes in modern medicine relate to Le Gaze post French Revolution and the introduction of specialisation and teaching hospitals (affiliated to public universities) .

    > Dentistry is exactly the same, originally the 'tooth puller' travelled around propably with the circus, he just had the equipment! Now look at what they have achieved Doctorates in dentistry, huge esteem from the public because they have been able to separate out what they did to what they do now.

    The original tooth pullers were also corn cutters to be accurate and the legitimacy of dentisty was their inclusion in to the publc university systems. Something which podiatry was not able to achieve universally until a quarter of a century ago.

    Now look at dentists, high patient esteem, some dentist operate on sinuses, perform implants and are paid a considerable amount of money for their work. They created and employed dental technicians and others to do the original basic work. There appears to be a delination that patients and professional staff can understand.

    Dentistry in Uk (and presumably elsewhere) was nearly extinct by the late 50s and early 60 due to improved dental hygiene thanks mainly to the success of TV marketing of tooth paste. Seeing the lie of the land many dentist sdiversified into preventative work and developed orthodental disciplines. Foot problems did not decline and hence foot physicians continued to do what foot physicians do. So there is no real similarity. Interesting to note however dental health of many older Brits is now very poor due to the absense of routine dentistry over the time dentists were specialising.

    >I believe that podiatric medicine and surgery, where the practitioner has the ability to use a one stop shop approach, eg assess, diagnose, treat/operate and then prescribe medication or recruit the expertise of other professionals for each of the lower limb and foot aliments that presents to them. Then this will be a step in the correct direction.

    No argument from me there

    Cheers
    Cameron
     
  13. C Bain

    C Bain Active Member

    Chiropody/podiatrists!

    Hi All and to Cameron and his solid Post above,

    The HPC. accepts the fait accompli reference Chiropodists/podiatrists and define them as, 'A chiropodist/podiatrist diagnoses and treats disorders, diseases and deformities of the feet!' They do not separate them because the public, our patients do not separate them!

    The second one, Podiatry, was it invented by the Americans??? I agree with Cameron's sentiments when he states, 'No one really cares what podiatrists do,' Why tinker with something that is already working in the UK?

    Then there definitely is the other thing when in conversation with other professions. If we are a profession of PODIATRISTS; Why do we have the largest society of podiatrists in a trade union of white collar workers??? The argument for being on a par with Dentists and Nurses, (Yes there are a lot of nurses in a union now but I still think of the Royal College of Nursing when I think of nurses), falls flat on it's face when people in the know realize that they are not top flight professionals but trade unionists! I don't believe you can mix them! I am a professional belonging to one of our oldest professional bodies! Now that the 1960 state registration has been put in the dustbin, why are they still clinging to trade unionism which has never won a war yet. Plenty of battles won, but no wars. Just have a look at the Railways, Road transport, Mines, Steel, Shipbuilding, electricity, gas, water, and I'm sure you can add more!!! How about the coming demise of the NHS. to privatization under another name? You might not like it some of you but is it now part of the past. What is a group of professionals doing clinging to the workers identity. They have always been the underdogs.

    Is there anything good to say about dropping the term and title CHIROPODIST, the podiatrists around my way and possibly the HPC. might both just possibly agree with me! All Society members young and old all have CHIROPODIST in their front street advertising boards as far as I can see, (They want to speak to the Patients with them you see?). Never mind the USA. or Australia, (Sorry fella's and the ladies of course!), what about the PATIENTS???

    Regards,

    Colin. (Now where did I put that tin-hat?).

    P.S. Well that's enough of venting of the spleen for one day!

    P.S.S. Sorry Cameron, I realize I have stood part of your argument on it's head but that's how the argument I have followed has led me in this Post. I have to admit that sometimes I let myself explore the argument as I write! Dangerous but sometimes exciting to see where you end up? It can be painfully interesting at times also of course!!!
     
    Last edited: May 15, 2005
  14. Cameron

    Cameron Well-Known Member

    Trade Union

    As I understand it the trade union status means the government needs to negociate before implementing change. No trade union, no negociation. Since we are witnessing the biggest work place negociation in modern history (NHS Agenda for Change) that might prove to have been a very clever move on behalf of the largest foot physician organisation in the UK. Hence the reason why the Society have held fast and by doing so kept both tiltes (which are now protected by law). I suppose thad hey not done this then changing their name to podiatry (exclusively) would have meant losing protection for chiropody. I agree the public know and trust chiropodists and change the name with no protection would only add to chaos.

    Cameron
    Hey, what do I know?
     
  15. C Bain

    C Bain Active Member

    Trade Union and Negotiation?

    Hi Cameron,

    Yes I am always ready to take your point in the argument of negotiation. Has the Trade-union actually negotiated with NHS. reference the rules governing 'Agenda for Change' and it's adjudicating the level of NHS professionals, workers, technicians and the like? Or was it Hospital Management plus Government influencing the production of the Rules to be applied? It appears from an observer looking in and watching it unfold that there is some form of devaluational change at work here with a possible hidden agenda?

    My point still remains! I think, that chiropody/podiatry has been reduced to a workers negotiating with professional managers of various kinds in the inner sanctums of the NHS. It is a pity that what started out as the establishment of a profession, that of CHIROPODY, should now be viewed as an 'Employer - Worker Negotiation', on very unequal terms, (I hope that I am mistaken in this, but I and other Chiropodists like myself will still need convincing???).

    Could it be that in fact in our case the strategy is to separate the lower pay grades of chiropody out from the higher specialized grades of podiatry, (Foot Physicians), there now, you have forced me to admit they exist, but where are they! Five years time, I wonder if Wm. Hill will take a bet on which of us are going to be left still around to cash it in? (That is of course, if I was a betting man, or just a plain hypocrite?).

    I wonder whether they can be able to remove nail cutting, callus and corn cutting from the field of FOOT PHYSICIANS in the NHS. or for that matter in Private Practise?

    Can we have Foot Physicians fireproofed from the Royal College of Surgeons use of Greek Fire in their efforts to purge and purify the medical profession from such interlopers?

    Regards,

    Colin.

    P.S. For example when playing football with my seven year old Grandson in the back garden on one of the lawns before 9.00am on a Sunday morning, should we also take the rule seriously whilst scoring a home goal, "To scream and shout, quietly!" Mark it well as things in Agenda for Change progresses downward, I fear!!!
     
  16. Cameron

    Cameron Well-Known Member

    Colin
    >Has the Trade-union actually negotiated with NHS. reference the rules governing 'Agenda for Change' and it's adjudicating the level of NHS professionals, workers, technicians and the like?

    Seems like it.

    >Or was it Hospital Management plus Government influencing the production of the Rules to be applied? It appears from an observer looking in and watching it unfold that there is some form of devaluational change at work here with a possible hidden agenda?

    The argument seems to be there is the person power to cater for demand and it is just a matter of reorganisation and reshuffling. The clear intent is to eventually produce a generic health care worker that can specialise. This would include within its spectrum medics to physiotherapists.

    >My point still remains! I think, that chiropody/podiatry has been reduced to a workers negotiating with professional managers of various kinds in the inner sanctums of the NHS. It is a pity that what started out as the establishment of a profession, that of CHIROPODY, should now be viewed as an 'Employer - Worker Negotiation', on very unequal terms, (I hope that I am mistaken in this, but I and other Chiropodists like myself will still need convincing???).

    This would certainly be my understanding.

    >Could it be that in fact in our case the strategy is to separate the lower pay grades of chiropody out from the higher specialized grades of podiatry, (Foot Physicians), there now, you have forced me to admit they exist, but where are they!

    It is that deliberate. In a sense podiatrists have shot themselves in the foot by crying in their beer ‘no one understands us’ and ‘we do more than toenail cutting’. the UK government have taken that lobby at its word and now wish to reduce the number of chiropodists they employ directly. Meantime the Trusts, once organised, will eventually employ specialist podiatry for the targeted groups like diabetics and elective surgery candidates. The vision, if there is one is the bulk of chiropody would shift to the private sector and subcontracting would be likely to occur.

    >Five years time, I wonder if Wm. Hill will take a bet on which of us are going to be left still around to cash it in? (That is of course, if I was a betting man, or just a plain hypocrite?).

    Plenty money in pedicure and certainly a window of opportunity exists now for entrepreneurs in podicare, beauty therapy and foot health care within the private sector. A new generation of foot health professionals are being trained to meet this demand already and may well become registered with the Health Professional Council in due course. I would agree podiatry/chiropody will change from what we currently understand it because of specialisation and that will potentially divide the profession. Whether this is a good thing or a bad thing or mere evolution I could not say, but there are just not enough feet for us all to practice open or closed surgery.


    >I wonder whether they can be able to remove nail cutting, callus and corn cutting from the field of FOOT PHYSICIANS in the NHS. or for that matter in Private Practise?

    That would appear to be a clear intention. Of course no one yet knows what the outcome of the new Labour Government with a smaller majority will be. Obviously all these changes are on the NHS cards and likely unless contested to be implemented no matter who is in power. Speaking as an outsider I think the Society may have misjudged the situation but did the very best they could to negociate for their articulate membership. This may not have been the best for the silent and apathetic majority, only time will tell.

    >Can we have Foot Physicians fireproofed from the Royal College of Surgeons use of Greek Fire in their efforts to purge and purify the medical profession from such interlopers?

    Clear evidence that has already taken place. Podiatric surgery training in Scotland for example operates under the umbrella of the Royal College of Surgeons. It is only a matter of time before surgical podiatrists are grand parented. The same is likely to happen in Australia now that the latest podiatry education department is part of an Orthopaedic Faculty. How long this will take will be determined by aggressive lobbying. As a collective podiatry/chiropody body has that critical mass whereas if general practice chiropody is separated from specialist podiatry then the latter becomes incredibly vulnerable as a group and likely to make other allegiances to survive. There are other examples of similar professional dichotomies, midwifery and nursing; orthotists and prosthotists; and orthodentists and dentists.

    >P.S. For example when playing football with my seven year old Grandson in the back garden on one of the lawns before 9.00am on a Sunday morning, should we also take the rule seriously whilst scoring a home goal, "To scream and shout, quietly!" Mark it well as things in Agenda for Change progresses downward, I fear!!!

    A goal is a goal is a goal is a jail.

    Cameron
     
  17. Lawrence Bevan

    Lawrence Bevan Active Member

    the future...

    I would agree on how things are going with "devolvement" voluntary or otherwise of basic Podiatry treatments.

    I think that the pandoras box is now open and cannot be closed. Cameron has it right that we have been shouting about are abilities and "they" are now saying "ok get on with it oh and by the way surely you dont want to be cutting nails and corns as well?..."


    For my 2 pence worth the age of the (initially) smaller profession and a profession composed of highly trained individuals is coming. I think that the model of the Society Medicine Fellowhip is one to follow and I think the majority of the uber Super Pods will be doing conservative care and I also think that the recent divide of specialising in either diabetes or biomechanics will dissapear with all expected to be very competant in both. Agenda for Change does at least allow some recognition of this change in role...

    I dont think that the Pod Surgeon can always expect to be at the top of the tree in the future especially as in many surgery set-ups that I have seen the Surgeons are doing up 75% conservative care! I envisage a profession that the majority will be rooted in conservative care but accessing investigations such as radiology, histopath etc, utilising medication eg steroid inj, other modalities such as AFO's and prescribing footwear and when this fails a small percentage forwarded to a Pod surgeon who would have a high conversion rate from outpatient to theatre. This is the model we are slowly moving towards in my area. The employing trust want more extended scope conservative Podiatry and are willing to fund/open up referral pathways/set up PGD for POM's etc but are slow to uptake Pod Surgery.

    As I said initially it may be a smaller profession but the one-stop shop for all foot ailments delivered in this way I reckon would be very popular and demand more resources. Also it would be more "glamourous" and attract more entrants.
     
  18. Actually Lawrence, the profession of highly trained individuals is already here and has been for over a quarter of a century. The problem is that the model of employment offered by the NHS has restricted rather than developed practice. It's not the profession that is the problem - nor is it the demand from patients - it is the way the NHS organises and pays for podiatry provision that is destroying the general practice base.

    I consider myself to be a general podiatric practitioner. I am a specialist only as far as the term chiropodist or podiatrist relates to the wider healthcare disciplines. As such I see variety of clinical conditions from developmental problems in infancy through to all the manifestations of the ageing foot. As an autonomous practitioner I decide who and what I treat. I have no difficulties with that. What I do have difficulties with is people dictating what it is I should do, especially when their proposals run contrary to everything we stand for in a caring profession.

    The problems faced by the NHS are predominately those of its own making - they way podiatry departments deliver and fund their care is archaic, and does nothing to offer clinicians any ownership. We tend to think of the NHS as some form of national treasure - it is not - it is simply the largest state employer in Western Europe, and a pretty inefficient one at that. The NHS is a customer of the podiatry profession - an important one, I agree - but the profession of podiatry is and should always be considered to be independent and sovereign from the customer.

    If we truly aspire to parity with the dental and medical professions (as opposed to parity with art and music therapists) then we have to start rethinking our relationship with the NHS. There has been no new money for podiatry services over the last 10 years, and to develop 'specialist' services like podiatric surgery, managers will have to divert funding from general podiatry care to meet the cost. That is why there has been a workforce redesign - assistants are perceived to be the cheaper option over graduate practitioners - however......consider this:

    The cost of sitting a patient in an NHS chair is circa. £28.00 The cost of the graduate practitioner's salary in treating that patient is circa, £5.00 The cost of treating that patient with an assistant practitioner is £1.00 less - around £27.00 Where does the majority of costs arise from? Operational and managerial activities within the Trust! Assistant grade practitioners will give negligible savings to the NHS, in fact I would argue that deskilling the NHS workforce will incur greater long-term costs that it is designed to save.

    It is the model of employment that is flawed and just like clinical practice - address the underlying problem and the symptoms will disappear.




    Mark Russell
     
  19. Lawrence Bevan

    Lawrence Bevan Active Member

    Specialisms

    No new money? - all of the changes in our area are being delivered through separate new investment from the employing trust.

    I think it is futile to think we can turn back the clock on these issues. The NHS is very inefficient but I think many elective forms of treatment will be seriously struggling to meet the demands and will have DoH changes imposed on them. We dont like the idea of an advanced assistant, do you think Orthopaedics likes the idea of us taking their work?

    By the way anyone any idea as to whether the Society got their Medicine Fellowship of the ground?
     
  20. It's only futile if you don't have an alternative and there is no mood or appetite for change. Nothing is impossible. If this profession so wished, it could turn its practice environment and its prospects on their respective heads. We are a monopoly provider in a niche market. The NHS is simply another customer. Should we allow one customer to dictate our business and professional policy to the detriment of all others? Surely not.

    What really disappoints is the lack of ambition and vision within the UK professional heirarchy. Maybe its the weather? We all know podiatry has enormous potential but how do we go about turning that potential into reality? Do you think, Lawrence, that contracting the profession into the NHS version of specialist practitioners supplemented by an army of assistants will realise that potential?

    What I had hoped to see during my professional life was a time where registering with a podiatrist would be as natural as registering with a GP or dentist. There's a goal for you - having everyone in the UK registered with a podiatrist - from cradle to grave. Rather than contracting the core workforce I would have preferred to see it grow and develop as an independent profession. I would have liked to see podiatrists in group practices - wholly owned by themselves - undertaking a range of work, both NHS and private, and where the patient is given the choice to select whatever practitioner they wish. I would have preferred to see all podiatrists practice under the NHS banner - where that banner is a symbol of excellence and innovation - but to do so, you have to change the NHS mindset that prevails today.

    Keep it small. Target public money to the front line - that is clinicians rather than management. Allow people to invest in themselves. Return ownership of healthcare to the professions. Give patients real choice and standards would climb overnight.

    Lastly, I think we all know how orthopaedic surgeons view territorial encroachment - we see similar views expressed in our own profession regarding grandparented practitioners. The fundamental issue is competency. The RCS have valid concerns over the way podiatrists train - and have trained for surgery in the past. Hopefully with the joint MSc in Scotland, some of these concerns can be alleviated, but it might be some time before we see the same level of collaboration throughout the rest of the U.K. Perhaps in time podiatric surgeons can be 'grand-parented' into the Royal College (although the HPC are considering regulating podiatric surgery as a 'stand-alone' profession) and relationships may harmonise once again.

    Regards

    Mark
     
    Last edited: May 19, 2005
  21. C Bain

    C Bain Active Member

    Monopoly!

    Hi All,

    Sorry Mark but that one about,

    Quote:- ..."We are monopoly provider in a niche market".....?

    It doesn't wash anymore. Some of you are employed by the NHS. who is a massive monopoly provider in Podiatry!

    The large monopoly always, always swallows up the smaller one. I should know I've lived through plenty of them. All the NHS. has to do is flood the old field of chiropody with assistants who can work without supervision! It's easy and goodbye to a fare number of bread and butter podiatrists, (Sorry Fellas and ladies, bear in mind this an extreme consequence here?),

    Then of course there are always the others ready to step in and break the monopoly, (What monopoly?). Are you sure there is one? (What about me, I'm not, with great respect part of your monopoly, am I?), then the others,

    1. FHP.'s.

    2. Nurses.

    3. Volunteer's to cut and second to FHP's, after first treatment?

    Quote:-'Registering with a Podiatrist would be as natural as registering with a G.P. or dentist.' '?' I thought Cameron had already shown us that below twenty percent of the population would need chiropody of some form in their lives. I deify anyone to produce to me a human being who has never been in need of a doctor or dentist before he started popping up the daisies! Please someone prove me wrong? I need to know now before it is to late?

    Quote:- 'Should we allow one customer to dictate our business........' [Mark Russel].

    Yes Mark I think we should when he is bigger than me, the sum total of the podiatrists working for it and the Union put together?

    Question:- "What is the Union/Society going to do about it?"

    1. Go on strike?

    2. Go slow, work to rule?

    3. Podiatrists in the NHS. resign on block?

    What about 'Agenda For Change?'

    A little extreme don't you think! Best way to get FHP.'s etc trained in chiropody. Look what has happened to nursing when they went to degree standard? Remember Margaret Thatcher took ten years to workout the miners problem, and she did. Some of my lot were training for ten years, crossing the tees and dotting the I's for her! Now that really was engineering political change!!!

    But I feel I must leave you all reading this Posting pointing out that this is an extreme consequence of tempting Providence in a huge way??? I hope for my sake never mind yours that we will never drive the NHS. into such an extreme corner as to wake the sleeping GIANT!!!

    Regards,

    Colin. (I shall now go and assault the next patients' toe-nails!!!).

    P.S. I wonder whether Admin. will swot me on this one??? Where did I put that tin-hat???
     
  22. C Bain

    C Bain Active Member

    Worthy of a Second Read, Perhaps?

    Hi All and Newcomers,

    This one worthy of a second read perhaps?

    Cameron has mentioned above [No.14],

    Quote, "No trade union, no negotiation ..................... changing name to podiatry (exclusively) would have meant losing protection for chiropody."

    Therefore now as of the 23rd. July 2005, CHIROPODY may have become FHP. A hot chestnut for HPC. perhaps?

    Regards,

    Colin.
     
  23. dipper

    dipper Active Member

    whats in a name

    Chiro is greek meaning hand and foot,Pod is the latin for foot.
    It seems to me that Podiatry is a much better name and Podology means the study of feet in health and disease, as I am sure you are aware.
    I would be inclined to have a leaflet if needed explaining the difference.

    Do not take offence, as I am british too, but why are we always last to embrace change, and make such a meal of it.
    All that matters is that feet are looked after properly with care.
     
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