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I run a Domiciliary Care Service for the elderly which supports them in their own home and therefore delays or prevents admission to Nursing Homes. I am undertaking a Foot Health Practitioner course to add another service for my clients. Many of the elderly cannot afford the charges of chiropodists in my area and this became a concern to me. I will only undertake "general maintainance" of feet, nail cutting, hard skin, corns etc and would like to ask if anyone can give an indication of a pricing structure that could be used.

Registered chiropodists have an average charge of £26.00 for basic foot care in my area. I certainly respect their knowledge and qualifications but for some elderly people this is out of their price range. Any thoughts please?

£26.00 - why do they consider it out of their price range? What would they pay for a haircut?

I am in Australia, but recall visiting a patient at home several years ago and they complained bitterly about my fee. While I was there, there was a window repairman there to fix a window - they charged a 'call out' fee greater than my total fee, a fee for fixing the window which took less time and was greater than my fee, and a fee for the materials - she did not bat an eyelid at their charges. Since when should the hourly rate of tradesman (no disrecpect intended) be 2x higher than that of a health professional?

Your clients should consider themselves lucky its only £26.00

Here...Here DaVinci !

I totally 100% agree, I have had the same thing happen many times here in QLD (the cheap state!). I have the greatest affection for the elderly, I'll even be one one day hopefully! However, I attend to patients who also complain about podiatric fees but have NO problem getting cable TV, playing the pokies, giving significant amounts to their grandchildren, paying the dentist etc etc...but for some reason general foot care is an expense they groan about!

I even joke with my wife that if they ever invent a $100 cure for their incurable disease Queenslanders will moan that it is "beyond their means"!

In many respects this generation of retired elderly is lucky!
Will we be able to retire at 55-65 on a full pension?
Will those of us 10-20 years from retirement receive a pension at all?
How many of the elderly women never had to hold a job at all?
When in Human History has there ever been more social welfare entitlements than now? Yet it is never enough.

There is an organisation here called "The Toenail People" they are not qualified in any way,nor use Autoclaves, but have had run-ins with the local Board for verbally holding out to be Podiatrists...(conversations go something like...patient: "where did you study to be a podiatrist?...Answer: "In Sydney", thereby leaving enough room to suggest they might be qualified, but not an open admission of the same). They charge about half price of a Podiatrist house call, but it all ends up being a false economy,as many times the Patient needs to see a Podiatrist to rectify what the person does and therefore spends much more! the Board has received numerous complaints about the poor quality of these 'podiatrists' treatment (some even complaining they can't get Private Health rebates, DVA etc...), to the best of my knowledge they are embroiled in legal actions. For a member of the general public to take the time to complain suggests the obvious. One Nursing Home DON had the nerve to tell me that these people were "doing some courses" to become qualified Podiatrists!

So to the person who began this thread, no matter what you end up charging... perhaps being sued by one of your patients will temper your altruistic ambitions
Sorry for the rant, just gets my blood boiling..better go have a cup of tea and a rest!

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A bientot...

Julian
Podiatrist-at-large

I thought this would cause a stir. I am not critising podiatrists in any way but many of my clients are literally living on the bread line. Here in the UK we do not support our elderly and take away many services which they relied upon, podiatry being one of them. These people paid into a system which promised to support them from the cradle to the grave but sadly this is no longer the case. Their view is for 10 minutes work they are paying £26.00 which equates to over £150 per hour. This is for simple nail cutting.
I feel I have to mention that I am a Registered General Nurse with many years experience within different clinical settings so I do have an extensive medical background. I am insured up to the hilt and wouldn't try to treat a condition that should be refered to a specialist, i.e podiatrist.
I just want to give them a fair deal, and believe me, I have been in the health business far too long to be alturistic.
Kim

You are a registered Nurse and therefore have trained for your profession.

Anciliary grade care assistants are now called NURSES by many.

Is that right?

In 1948 when the NHS was formed many services were not provided.

So should people only receive the care that was availablw when they were young?

Or should medicalm advancement be available to all?

Podiatry came into the NHS in about 1971 so these elderly you refer to know that.

Many people want verything for nothing.

The reason you have a fee structure that is representative of the costs of running a successful and profitable business is so that you can reopen TOMORROW.

If you dont earn enough tp pay the bills you end up cutting costs and thus corners, so the care you provide is questionable in quality.

A colleague a few years ago said that if you want a 5.00 pt then charge 5.00.

A fair days pay for a fair days work is all we ask.

How much does your Dentist charge you?

Or even your Reflexologist?

regards David

Dear K928596
I like you came origionally from a nursing background. Having done both sets of training I can assure you that a BSc (Hons) in podiatry is completely different from nurse training and that no matter how good your nurse training it will not equip you to safely undertake the activities of a podiatrist. Further, please do not kid yourself, there is no such thing as a simple nail cut. With health issues, polypharmacy, mobility factors and psychosocial aspects the elderly represent complex and sometimes higher risk clients than they would appear on superficial evaluation. My strong advice to you is if you wish to provide podiatry services to any client group - do the podiatry training. Otherwise you will at best provide a second rate service and at worst a dangerous one.
Regards, Polly.

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If you are on the rollercoaster, open your eyes and enjoy the ride.

Ok. I get the message. Foot Health Practitioners are not welcome. I asked a question from professionals and I am disappointed that all I have received is negative attitude. I have been successfully running my Domicillary Care Service for 7 years and proud to say it is thriving due to the good policies and practices I have in place alongside an extremely competant workforce, all trained by me. My local Social Services have awarded me with 2 types of contracts so I would say I am well respected in my field. I have worked with the elderly for 16 years so I actually feel better qualified than some of the respondents to comment on care and social aspects of this group.
I am offering a further dimension to my existing business and if it offends anyone then I apologise. But I would ask if you truly believe you are worth £150 per hour?

Hello Kim,

A big problem in the UK has been the bargain-basement chiropodists undercharging everyone else. In my (limited) experience the pods charging the least do not survive. You may be busy charging £10 but this doesn’t equate to profit. So one question I have is do you intend to make a profit from your FHP venture?

I think you will find podiatry to be quite an expensive profession to practise. Before you even start you will need some equipment, eg. autoclave £800, sonicator £300, drill £1200, at least 3 sets of instruments £300, medicaments, dressings, sundries £400. Total = £3000 (at least). Plus yearly insurance and autoclave service contract. Plus CPD. The list is endless actually. So perhaps charging say £10 a time in your case is not such a good idea.

Also when you first start treating patients you will take a lot longer than your stated 10 minutes; in all probability it will be 45 minutes or longer. Only after a year or so will you have the skills to be able to treat in 30 minutes or less (IMHO).

You asked if pods were worth £150 per hour. I wish! But I don’t know any private pod doing a visit in 10 minutes. Normally 45 mins is in keeping (includes travel) so £26 a visit equates to £35 per hour.

It’s still an interesting venture though. And perhaps you will prove us wrong and make some money as well.

Regards,
Graeme

Thank you Graeme for your comments. I agree set up and running costs are not cheap. I am fortunate in the fact that I have a ready made client base and with careful planning travel time will not be an issue. Yes you are right I certainly will not be quick at the job! But you have given the answer I was looking for, highlighting areas for consideration to factor into costs. As this is an add-on to my existing services I am not looking for huge profits but as with any business it is nice to provide something your competitors aren't and further enhance the reputation I have built up plus giving the clients a service they need. So thank you Graeme. food for thought.
Kim

Hi Kim,
Any negativity is directed at the clients bemoaning paying a fee for a service, not yourself asking a perfectly legitimate question. Like a colleague stated , the housecall may be only 10 mins (although mine take 20-25 mins plus) but add on travel time , say 10 mins each way, extra prep for instruments, paperwork etc add another 10mins. So we're up to 40mins minimum, next add on petrol, and insurance (my wife deserves something if I get wiped-out whilst doing a house-call) and it all adds up. Most of my colleagues just won;t do domicillary work as they have to deny 3 patients appointments to see 1 at home for much less renumeration.
So the response is no, we don't get 150GBP/hour or equivalent, but then again why are the clients of yours calculating a Pod's fee anyway? I'm sure we'd all get a very dim response if we defended our 26GBP fee saying "...well I happen to know your Government income is XYZ per day or week so you can well afford it!" None of us can really know each others hourly/weekly/yearly income as we don't know the outgoings, so there's just no point. A BigMac costs around $5, but no way do you receive $5 worth of food!

In any case, best of luck in your business venture, there does seem to be a "gap in the market" for your services, but as we've all told you it ain't beer and skittles! But good on you for posing a contentious question and having the fortitude to respond!

Julian

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A bientot...

Julian
Podiatrist-at-large

Thanks Julian. I hope I haven't offended anyone and I have had some good advice. Just needed to clarify "value for money" for my clients so that I can explain behind scenes work and other costs.
Thanks to you all. Wishing you a prosperous future :)
Kim

Hello K

Believe me, I have no axe to grind. However, I think that some of the 'negative' points made are fair and reasonable and deserve an answer.
For instance, your G.P. will carry out an awful lot of 'routine' work. Do you practice that routine work? Likewise your dentist, do you act as a dental hygenist? Just because you could, should you? As a registered nurse you will know that may aspects of your job could be carried out by others, but should they?

Many areas of professionalism - by no means limited to medical areas, are now under attack in the U.K. Should dilution take place? Is it to the advantage of the public? Bear in mind also that society around the developed world is becoming more litigious. Is this also a good thing with which to replace professionalism?

Certainly, Julian's points are well made. I foresee a time when domicilliary treatment will become effectively a thing of the past; it will simply become a virtual impossibility because of autoclaved instruments, clinical governance etc. However, I may be wrong, please say so if you think that I am.

Finally, with Social Service deapartments amalgamating with PCT's in the U.K., do you foresee that your contracts (and I have difficulty understanding what sort of legal contract this could be) will come to an abrupt end?

All the best

Bill Liggins

Hello Bill
All your points are valid but roles are changing now. Many tasks I carried out in the NHS as a Registered Nurse are being performed now by Health Care Assistants. I think we all rightly want to protect our qualifications and the years of hard work we put in but systems change and can sometimes change for the better. I feel it is better to support each other and grow within these changes rather than cling to the "old days".
Your point about my contracts with Social Servcies is something I can clarify. Following a rigourous accreditation process Social Services contract my business to do work on their behalf. Sub-contracting if you like. I have a contract for eldelry care and the other for mental health. You bet that contract can be taken away! (It is unlikely as they cannot afford their own domicillary team and there is too much work for them to cope with.) I counter the risk with running my business as 85% private clients, 15% Social Services funded so if the rug was pulled, I am still in business. I don't beleive in putting all your eggs in one basket.
Even within Domicillary Care sector changes are afoot with the advent of NVQs. A person with NVQ level 3 can be an assistant manager of a Dom Care service or a residential home and a level 4 can be employed as manager. They have no formal medical training but are caring for peoples health and medication. So we are all accepting and embracing change.
Kim

To go off a slight tangent from the original post it needn't be the case. If you don't ask for a professional fee the patient certainly won't give it to you. But if you ask you never know. For example the agreed fee before seeing a patient for my last home visit was £102 which isn't too bad for one and a quarter hours work (including travel time and mileage allowance).

Regards,
Graeme

(including travel time and mileage allowance).
Crikey Graeme, where did they they live, The Himalayas?!!

15 mile round trip.

Thanks Bill...and 'they' said I'd never amount to much!!!

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A bientot...

Julian
Podiatrist-at-large

Hello Kim et al. I was really interested in posing questions, some difficult, rather than being specific about your business. My question concerning the latter was tied up with the delivery of foot care in Social Services homes now being encapsulated in the PCT/Social Services amalgamation. Do you expect to deliver (foot) nail cutting services under the new regime?

I agree that changes are taking place, but these are not universal. Although practice nurses are carrying out some tasks which a G.P. would have delivered some 10-25 years ago, this is strictly and explicity under the direction and control of the G.P. Likewise HCA's in hospitals are always under the control of a staff nurse or Sister. Dental hygenists can only work under the direction and employment of a dental surgeon.

The question that I am posing is should persons delivering nail cutting services be likewise under the control of a reg. podiatrist (as are current Foot Care Assistants) or is there no need? Should the government's drive to de-professionalise be fought or accepted as part of the changes which you mention? If accepted, what is to replace professionalism or should we accept that litigation against offending practitioners will create a balance because the insurance companies will inflate demands such that offenders will not be able to afford cover without the sort of fees that Graeme mentions?

All these are serious questions which will need consideration in the future.

All the best

Bill Liggins

P.S. I bet that Graeme wasn't carrying out routine treatment!

Response to Bill. I think regulation and control of FHPs will be inevitable and rightly so. When I first opened the Domiciliary Care business there was no regulation. 7 years on and I am governed by CSCI ( Commission for Social Care Inspection). I have to practice within a very controlled and regulated framework. I pay an annual registration fee and have unannounced inspections at least once a year. These reports are graded and available for the general public to view. Likewise, Social Services do an annual contract compliance inspection. I also have to submit quarterly quality monitoring reports and attend quarterly providers meetings at the Town Hall.

With all these government bodies delving into my business on a regular basis do you not think they will also be looking into my practices as a FHP? Of course they will! They will be assessing that I am practicing in a professional and safe manner and the first thing they always check is my public liability insurance ( the cost of which has tripled in the last 2 years).

The first ripples of regulation are there for the FHP. There is a register, albeit one with no teeth, but as it's supported and grows the natural progression will be into regulation and control. Podiatrists I am sure will also be calling for control of FHPs. So yes I agree we all need to be accountable and work within specific frameworks.

Finally may I ask do Podiatrists have to be inspected and what format does this take? I am enjoying this debate and listening to all the view points. Thank you
Kim

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We pass by this way only once. ENJOY

Actually it was routine treatment so you would lose your bet!

I explained to the patient it would be much cheaper to visit the clinic where I charge £32. But the patient wanted me as their podiatrist and insisted on a home visit so who am I to say no? I estimated the total visit time, including a generous travel time and petrol money allowance, and applied my clinic rate and the total came to £102. The patient agreed with the fee before setting off and everyone was happy. I even got a £3 tip!

A professional fee for a professional service.

Regards,
Graeme

Hello Graeme

A bet I don't mind losing. More power to your elbow!

Bill

Hello Kim

I can only speak for myself, but I am required to have a pretty stringent annual peer review by 2 independent colleagues and I have to have a bi-annual ALS or ILS update. In addition, all reg. pods are required to carry out CPD which is inspected by the HPC.
I suspect that each professional body will also have their own requirements.

I am obliged to undergo the above because of required clinical governance. If I do not, then I lose my private hospital privileges.

All the best

Bill

Hi Kim,

All things change and soon visiting podiatrists will have to use a vacum packing autoclave with printer and expect to provide evidence of use.
This would probably increase your start up costs and this might just be the start of further regulations, so fees may well have to go up again.

Neil

I know regulations start to put a strangle hold on profits. I am attending a course in January so hope to get up to speed on current and pending regs and therefore will be able to do realistic costings. Unfortunately all professions are drowning in red tape and the needs of the poor clients at the end of the paper trail are forgotten. Sadly, our compensation culture has killed our caring side.
Kim

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We pass by this way only once. ENJOY

Hi Kim,
I also run a small home nursing service,and provide basic footcare.I agree with you about cost for simple toenail cutting,a foot rub,sometimes a good scrub is all that is needed.Podiatrist provide a more complex service.There is one way around your situation.Never call yourself a Podiatrist.Register as a Pedicurist and insure as well.Only provide basic Footcare and leave the litagating stuff alone.Goodluck to you,you are providing a wonderful service to the elderly that do get lost in the system. Regards to charges,why not consider each patient on there needs??All the very best to you Luka.

i find it curious why home care services etc do not see basic toenail cutting as a part of their general package of care - do you cut fingernails?

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malpractice makes perfect

Hi Andy,Yes I do fingernails if needed.I had a dear little lady the other day who had been to a Podiatrist to get her toenails cut,she was so disapointed she thought they soaked the feet,cut the nails,and rubbed cream in.So you see there is a gap between Basic Footcare, and Podiatry,dont you think??

Hregulation for all is coming sometime soon but not decided yet. These fee debates are interesting but have gone on for all of my 35yrs post reg. Very little has been done to heal the various rifts I caused in 1978 southampton by employing the firstFCA with Wally Spencer the then District Chiropodist! There is work for all , the jam is spread more thinly but always charge what the 'market will bear'.
ps I always thought one should tip 10% for good service!?

Regards to all
andrew Wilson

Hi Andy. Home Care workers are no longer allowed to provide basic footcare. A slip of the clippers leads to infection, and worse, which in turn leads to our good old friend, litigation!! Of course the big NO NO is cutting nails of diabetics. In whatever we do we must be trained for the job and that includes even simple tasks such as supervising a client taking their medication. So as I run my own Domiciliary service I decided to take the Foot Health Practitioner diploma so that I will be able to offer a basic footcare service. Of course I will be referring clients to Podiatrists if their problems are outside of my scope.
Thank you Luka for your encouraging words. I am very proud of my team and the service we provide and I am always looking for ways to improve on what we have. I think foot health will be a welcome addition to our service.
Kim

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We pass by this way only once. ENJOY

hi Kim
Having qualified by the degree route 13 years ago I have always been very anti the other routes into podiatry. however,the advent of the grandparenting scheme brought us all under the same umbrella and I just have to accept parity in theory! Up to last week I would have been very much against FHP but it was brought to my attention that the government are now funding Foundation degrees( 2 years) for Podiatry assistants. These practitioners will be trained to do basic footcare including corns and callus, but will not have diagnostic skills. The purpose of their training is to set up a cheaper means of supplying routine podiatry in the NHS, leaving 3 year degree graduates to become podiatry specialists. The podiatry assistants will therefore be trained purely for the national health and not be equipped to go into private practise nor be expected to. In other words, the government are training their own FHP under a different name!
As I see it, you would be better to train as a FHP with the backing that their professional body offers, and provide the sort of basic footcare that your residents so desperately need. I agree with you completely that there are a lot of elderly who do not have the money for HPC pods. It is not just a case of a professional fee for a professional service, I often tailor my fees to suit the client and that is entirely up to me.
I hope you achieve your goal.
heather