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BBC London has discovered that there are almost 80 "surgeons" operating in the NHS whose surgical qualifications are not recognised by any statutory body.
Podiatric Surgeons are chiropodists who go on to learn surgical techniques to operate on feet and ankles. But BBC London has learned that there is no independent body which accredits these training courses.
Furthermore, these surgeons do not have to be medical doctors, they usually hold a BSc in chiropody and a masters degree in the theory of podiatric surgery but as chiropodists they are not qualified to be admitted for traditional surgical training within the Royal College of Surgeons
There are almost 80 "podiatric surgeons" working in NHS hospitals, some of them have even been awarded the title of Consultant, a situation which causes much confusion among patients who believe they're being operated on by medical doctors.
After years of playing sport Huw Foxall, from west London, developed a problem with his feet. He was diagnosed with hammer toes and a bunion and was referred to a podiatric surgeon.
After a long and gruelling operation, gangrene set in.
"The cast was taken off and the foot was a truly awful sight, it was absolutely black and blue. The chap in the plaster room who took it off said he'd never seen anything like it except when people had been mangled in some sort of industrial accident."
Mr Foxall had to have his big toe amputated and says he would never had agreed to the operation if he'd known the podiatric surgeon wasn't a qualified doctor.
'Ambitious chiropodists'
We contacted the Department of Health to ask why surgeons with unaccredited qualifications are permitted to operate in NHS hospitals.
They replied: "The Department of Health has previously expressed concern to the Society of Chiropodists and Podiatrists about the use of the term "surgeon" which is protected for healthcare professionals who have a medical qualification as recognised by the GMC for doctors."
In the early 1990s the Department of Health published a document called "Feet First" which promoted the idea of chiropodists with some surgical training performing procedures within teams.
It's common for chiropodists to do minor skin surgery - removing in-growing toenails and corns for example. But a group of ambitious chiropodists realised that there was nothing to prevent them from doing ever more complex surgery.
In a presentation called "Crossing Professional Boundaries" to the Society of Podiatrists and Chiropodists, one member of the society quoted a podiatric surgeon as saying:"We were fully aware at the time that there was nothing in law to stop us from doing bone surgery… and that loophole is what we used…it would be very difficult for the law of the land to stop you."
The Society of Chiropodists and Podiatrists established the Faculty of Podiatric Surgery as an educational establishment and the body chiropodists would apply to for training as a podiatric surgeon.
On its website the faculty says its qualifications are registered under the Health Professions Council. But when asked about this registration, the HPC told BBC London: "There isn't a specific podiatric surgery course on our accredited list."
Patient safety
The Society website also claims that a podiatric surgeon can apply for an NHS post after being awarded a fellowship at their own faculty of podiatric surgery, as well as the Royal College of Surgeons in Edinburgh.
But the RCS in Edinburgh told us that they don't have a single podiatric surgeon as a fellow, and yet there are 80 of these surgeons working in the NHS.
In contrast, a medical doctor training in England to become a surgeon would need to complete a training programme recognised by the Royal College of Surgeons, which in turn is overseen by the Post Graduate Medical Education Training Board - the statutory body responsible for all postgraduate medical training.
The Department of Health says: "The employer is responsible for ensuring that they (podiatric surgeons) are competent to undertake the role and that patient safety is not compromised."
If you've been affected by anything in this article, please contact the Health Professions Council on 0800 328 4218.
__________________
"citing an indisposition due to special circumstances"
mmm, I wonder if there is a motive behind the story, ok othopedic surgeons do more than the foot and take 16 years, well if they are doing more then feet you would hope so.
They also go to med school to learn about the workings of the brain, and the sexual reproductive organs, but does that realy mean they are better on the foot and ankle, a podiatrist has spent three years studying the foot a MD probably spends two weeks in med school.
maybe this story will put podiatry on the map and the public will stop thinking we just cut toe nails. interesting anyway.
Do I feel another raft of regulation and restriction being fiested upon the "Chiropodist" ? (Interesting choice of terminology by ALL concerned)
Time will tell
Cheers
Derek
"Political Correctness" is a doctrine, fostered by a delusional, illogical minority, and rabidly promoted by an unscrupulous mainstream media, which holds forth the proposition that it is entirely possible to pick up a turd by the clean end
me thinks, if this article catches the wider attention of Brown and Co there maybe ramifications to come as the GBP (Great British Public) will need to be reassuranced the NHS has only regulated practitioners.
1. Isn't it interesting that this comes at a time where independent prescriber status has been recommended for uk pods
2. the report details pod surgery failures but doesn't mention orthopaedic surgical failures
3. pod surgeons have to pass a final exam to gain fellowship.....orthopaedic surgeons don't
4. pod surgeons are cheaper, and consistently get better outcomes for foot and ankle surgery than orthopaedics, yet none of this evidence was included in the report
5. orthopaedic surgeons in private practice are complaining bitterly that their workload has reduced due to the recession, however most podiatric surgeons have seen little difference in work loads and income......perhaps they want our work to pay for their winter skiing?
6. The interview with Mr Prior was an hour long and covered a lot more than was used in the report......an element of bias perhaps?
7. pod surgery training is directed at the foot and ankle and does not need to include shoulders, spines etc....surely this explains the length of training rather than the quality of training.....was this mentioned in the report?
8. the title surgeon was used instead of doctor as traditionally surgeons served an apprenticeship and did not do medical training. Just because they now have to do a medical degree first does not mean they weren't good surgeons before...
9. maybe the fact that our pod surgery training is getting longer and includes pretty similar stuff to orth surgeons means its time to merge the training schools....and they don't like this thought?
10. why was the term chiropodist used? Wasn't that consigned to the dustbin in approx 1990 when training schools awarded degrees in Podiatry/podiatric medicine? So most people trained in that last 19 years are not Chiropodists they are Podiatrists.......but using an old fashioned term presents us as more limited in our scope of practice to the general public....
11. what will the right of redress be? will it be unbiased? how about a documentary following training of pods through to pod surgery......facts always win over fiction.......
10. why was the term chiropodist used? Wasn't that consigned to the dustbin in approx 1990 when training schools awarded degrees in Podiatry/podiatric medicine? So most people trained in that last 19 years are not Chiropodists they are Podiatrists.......but using an old fashioned term presents us as more limited in our scope of practice to the general public....
AND the SOP dropped the title Chiropodist recently but it would appear to be still alive and well, living in the halls of power behind closed doors perhaps ??
Makes me wonder if a storm is about to break especially with Brown & Co after saving loadsadosh to get the country out of the mire ??.
"Political Correctness" is a doctrine, fostered by a delusional, illogical minority, and rabidly promoted by an unscrupulous mainstream media, which holds forth the proposition that it is entirely possible to pick up a turd by the clean end
nothing to worry about there then.....Podiatric Surgery is significantly cheaper at the point of delivery than orthopaedic surgery......primarily due to the amount of day case surgery performed using regional anaesthesia rather than GA....no need for overnight stays.......
Interesting response Julian - would you be willing to put these points to the BBC and see what response (if any) you get?
I gather Trevor Prior already made these points in the interview and they didn't use them.....wonder why......
Trevor spoke at the conference extensively about this matter calling for transparency and support, and delivered all the evidence including studies comparing the two professions (by patient outcome and satisfaction). Guess who came out better....?
I had another interesting thought......it takes 10 years for Podiatric Surgeons to train in this country and the Orthopods don't like us using the word surgery (even though we do surgery on the feet so how else would one describe the work done?), however, dental surgeons only take 5 years to train. Do the orthopods have a problem with them using the title surgeon..........?
nothing to worry about there then.....Podiatric Surgery is significantly cheaper at the point of delivery than orthopaedic surgery......primarily due to the amount of day case surgery performed using regional anaesthesia rather than GA....no need for overnight stays......
That needs to be stated in the appropriate places BUT it wont command the news at 10 Julian anything like "unqualified" Surgeons working in the NHS will.
Sorry but IMHO a swift response is required by the professional bodies to counter and grab headlines to prevent the public disquiet that you so rightly state will follow.
Cheers
Derek
"Political Correctness" is a doctrine, fostered by a delusional, illogical minority, and rabidly promoted by an unscrupulous mainstream media, which holds forth the proposition that it is entirely possible to pick up a turd by the clean end
That needs to be stated in the appropriate places BUT it wont command the news at 10 Julian anything like "unqualified" Surgeons working in the NHS will.
Sorry but IMHO a swift response is required by the professional bodies to counter and grab headlines to prevent the public disquiet that you so rightly state will follow.
Cheers
Derek
I agree but in a measured way......ask yourself why this has come via the media......do you not think that interested parties may have already tried the government route and failed?
I spoke to lots of people today about the report (I have the joy of living in the south east where it was broadcast) and I simply asked them 2 questions:
1. why are dentists allowed to use the title surgeon when they only study for 5 years (half the time Podiatric Surgeons train)? Maybe this isn't the real issue but an "add-on" issue.....
2. Do you think the NHS would condone payment for almost 100 Podiatric Surgeons at consultant grade, 100 registrars, surgical trainees, specialist Podiatrists and the nursing and admin staff if they weren't confident in the training, outcomes and regulation of Podiatric Surgery......?
The HPC regulates Podiatrists in all forms (including enhanced scope practitioners such as Podiatric Surgeons), the GMC regulates doctors in all forms (including surgeons). The Royal College of Surgeons is responsible for surgical training, the faculty of Podiatric Surgery is responsible for Podiatric Surgical training (including validating MSc syllabi).
Can regulation be improved? Of course!! We can always improve regulation....but when does it get to the point where a profession is so regulated that it cannot function.
Many Podiatric Surgeons work with and alongside Orthopaedic Surgeons and have done successfully for years, wonder how many of the Orthopods agree with the "vocal"?
Ask yourself why this has suddenly been raised, Podiatric Surgery has been around for many years.........
and consistently get better outcomes for foot and ankle surgery than orthopaedics,
Julian,
If this is true and can evidenced then if I were a podiatric surgeon, I would be shoving this and the DOH paper: "An NHS of all the talents" under the noses of the BBC reporter responsible.
But me thinks the RCS has more power than the SCP, SOCAP, SOP, whatever the acronym is now.
__________________ Science is the antidote to the poison of enthusiasm and superstition
Julian,
If this is true and can evidenced then if I were a podiatric surgeon, I would be shoving this and the DOH paper: "An NHS of all the talents" under the noses of the BBC reporter responsible.
But me thinks the RCS has more power than the SCP, SOCAP, SOP, whatever the acronym is now.
I believe Trevor Prior already pointed this out during the interview......love the BBC.....so unbiased........
As for the DOH paper....is it available as a download?
By and large, a pretty bias and rubbish report. Although that said there may be a grain of truth in it...
It does trouble me that there seem to be few "checks and balances" on Pod Surgeons once qualified and given that many work in a relative vacuum (unlike Orthopods) their is no means for them to be flagged or monitored.
There is pascom of course. Possibly the most profoundly useless outcome audit tool I've ever seen. Here is how it works in my area. Patients are given a pascom form on discharge. The patients who have poor outcomes are simply not discharged. I can think of patients still being seen 2 years on from the initial surgery who are still having serious ongoing problems. They get a stream of "hmmm well we could do a steroid injection... tell you what, come back in 6 months and we'll see if its settled down." type appointments and NEVER get discharged. Some have had 3 or more ops to try to "sort things out". No discharge, no form. So the pascom data looks fantastic because only the patients with good outcomes get to take part and the surgeons get to refer to a success rate based on that data. If that is the basis for the statistics on the success of pod surgery I'm afraid I cannot take it too seriously!
Do I think orthopods do it better? No. Do I think that all is rosy in the garden? No.
"The story so far: As usual, Ginger and I are engaged on our quest to find out what the hell is going on and save humanity from my nemesis, some bastard who is presumably responsible."
I believe Trevor Prior already pointed this out during the interview......love the BBC.....so unbiased........
As for the DOH paper....is it available as a download?
It's probably 7 or 8 years old now, but it basically stated that the right people to be doing the job were the ones who could demonstrate with evidence that they were the best at it. Check DoH website to see if you can still get it, you used to be able to.
__________________ Science is the antidote to the poison of enthusiasm and superstition
No. But I can smell a pot of dripping on the go. DO you understand the word "dripping" in the South East? It's something occasionally eaten with bread by your poor cousins in the rest of the country
__________________ Science is the antidote to the poison of enthusiasm and superstition
BTW, you are right Robert, if we want to compare podiatric surgery with orthopaedic surgery in terms of outcomes the same audit tool and protocol must be employed across the professions. Has this been done?
__________________ Science is the antidote to the poison of enthusiasm and superstition
BTW, you are right Robert, if we want to compare podiatric surgery with orthopaedic surgery in terms of outcomes the same audit tool and protocol must be employed across the professions. Has this been done?
Are they hell as not.
So our data is better. Shows we're better at cooking the stats. Nothing more.
Of course that's not to say we're NOT better. But as audit tools go Pascom has holes you can drive a bus through.
Hey ho.
Cheers
Robert
PS. Can't honestly say I've ever eaten dripping although I am aware of it. I come from norf london stock which means jellied eels are my raison d'etre. Do you have eels up north?
"The story so far: As usual, Ginger and I are engaged on our quest to find out what the hell is going on and save humanity from my nemesis, some bastard who is presumably responsible."
No. But I can smell a pot of dripping on the go. DO you understand the word "dripping" in the South East? It's something occasionally eaten with bread by your poor cousins in the rest of the country
Yep as an old S E London boy who's father toasted the bread over an open fire and slapped the drippin on thick( coz in the days of ration books after the war that was a good meal,) and I have done the same over many years, until the GP gave me a Bo*****ng and put me on the Cholesterol pills
The whole point is :- This story made News at 10 probably the most viewed news programme in the country.
The point has been made on there however much we think it is biased the reply should be made BY the professional bodies to get back and put the case for the profession on the same media to retaliate on the same level.
To my knowledge this has not been done as yet so now it is old news and the likelihood of gaining media interest is fading fast so now all the relevant government departments mindset will be working from that broadcast as they have nothing more to go on.
IMHO missed the boat ....wait for the outcome, yet again
"Political Correctness" is a doctrine, fostered by a delusional, illogical minority, and rabidly promoted by an unscrupulous mainstream media, which holds forth the proposition that it is entirely possible to pick up a turd by the clean end
BBC London news broadcast a story about podiatric surgeons (on 7 December 2009)
The piece has highlighted there is further work to do in increasing the understanding of podiatric surgery and the Society of Chiropodists and Podiatrists is committed to doing this.
Podiatric Surgeons, who work as part of the NHS and private practice, are the only profession who train specifically to manage foot and ankle related pathology and are highly skilled professionals with a minimum of 10 years training. Most referrals for treatment are made from consultants in rheumatology, diabetes and dermatology and GPs.
Podiatric surgeons can be identified through the website here by checking the 'find a podiatric surgeon' option, and if you have any questions relating to this subject, please contact Nita Parmar, Director of Marketing and Communications at np@scpod.org
Not exactly a strong rebutal?
The BBCs story is really a storm in a tea cup and will probably pass unnoticed but it does rather expose the fragile nature of podiatric surgery in the UK. Bearing in mind what happens there is reflected in other Commonwealth countries. Whilst the fiscal nature of training costs compares well against orthopaedics the absence of regulation is a weak link. No matter the sterling work of the past, on the grounds of safeguarding the public, it might be an attractive option politically to up the anti for practicing in the NHS. Brown and Co are looking for simple and effective policies in the wake of the election and I can image the lobby from the medical sector would potentially be in favour of such a move. However conspiracy theories aside I guess there may be bigger fish to fry and this "beefed up story" is not anti podiatry per se. However it is a salutary lesson none the less and warning to all working with the media. My sympathies on this occassion lie with Trevor and all the take outs that are lying on the cutting room floor.
BBC London news broadcast a story about podiatric surgeons (on 7 December 2009)
The piece has highlighted there is further work to do in increasing the understanding of podiatric surgery and the Society ofChiropodists and Podiatrists is committed to doing this.
Ermm dont you think whoever made this statement should at least use the agreed ?? title of the organisation they represent
Cheers
Derek
"Political Correctness" is a doctrine, fostered by a delusional, illogical minority, and rabidly promoted by an unscrupulous mainstream media, which holds forth the proposition that it is entirely possible to pick up a turd by the clean end
By and large, a pretty bias and rubbish report. Although that said there may be a grain of truth in it...
It does trouble me that there seem to be few "checks and balances" on Pod Surgeons once qualified and given that many work in a relative vacuum (unlike Orthopods) their is no means for them to be flagged or monitored.
There are some very valid points raised in this thread and I am in general agreement.
Robert, regarding the above quote, how do you know? Ever heard of clinical governance? Peer review? Other audit/ research within podiatric surgery units nationwide?
As far as PASCOM goes, yes there's plenty of bad points, but how many other sections of our profession consistently use a national audit scheme? It's certainly something that could be improved upon, but at least it's a start. My orthopaedic collegues have nothing even vaguely similar. Try looking for published infection rates following orthopaedic foot and ankle surgery as an example. If you find a decent report, post it up on here - I'd buy you a virtual beer if you do.
Regarding the 'investigative journalism' - simply brilliant work. Amazing. Fantastic. Astounding. Phenomenal. Well done beeb.
Robert, regarding the above quote, how do you know? Ever heard of clinical governance? Peer review? Other audit/ research within podiatric surgery units nationwide?
Yep. Heard of them. Not seen the tracks though.
I'm certain many units have those in place. I'm certain many have abundant peer review of outcomes and processes. I'm certain many carry out research. I would suspect that most if not all do so better than their Orthopaedic counterparts.
But I am also certain that not ALL departments do these things in a meaningful way.
Quote:
As far as PASCOM goes, yes there's plenty of bad points, but how many other sections of our profession consistently use a national audit scheme? It's certainly something that could be improved upon, but at least it's a start. My orthopaedic collegues have nothing even vaguely similar. Try looking for published infection rates following orthopaedic foot and ankle surgery as an example. If you find a decent report, post it up on here - I'd buy you a virtual beer if you do.
What is the point of a national audit scheme if it can be so easily abused? Generating biased data could be argued to be worse than generating no data at all because it can be (note I say CAN be) so misleading.
Lets say we have two surgery units. One gives their patients the pascom questionaire 6 months after surgery with true academic zeal and integrity, regardless of outcome. Over a 2 year period they do 300 proceedures and produce 300 completed questionaires. The other gives the questionaire "on discharge" which may be after successful surgery or after several years, steroid injections, additional surgeries and suchlike. Perhaps they also have a few patients who get fed up of coming / go elsewhere / die before they can be formally discharged. They produce only 200 questionaires for the same number of proceedures.
I, as an informed patient, access the data for the two units to see which one I want for my surgery. Unit one will have a far higher complication rate than unit two, not so? Does this mean unit two is doing better work?
To take another example, if i proposed an outcome measure for biomechanics wherin patients who were happy with their devices, discharged, then given a satisfaction questionaire were included, but patients who were not happy were given a constant stream of adjustments and remoulds and never given a questionaire. I could produce a success rate which would bring a warm glow to Les Bailey's heart! Would that be a fair reflection of my practice? Course not. And if it were published I would be quite rightly torn to shreds.
Pascom is, as you say, a start. And it does perhaps represent a framework upon which to build and I applaud those who are trying! But in its present form it is so open to abuse that I'm afraid I cannot lend the figures derived from it much weight.
Quote:
Try looking for published infection rates following orthopaedic foot and ankle surgery as an example. If you find a decent report, post it up on here - I'd buy you a virtual beer if you do
Quote:
Perioperative wound infection in elective orthopaedic surgery
G. J. S. Taylor, G. C. Bannister and S. Calder Journal of Hospital Infection
Volume 16, Issue 3, October 1990, Pages 241-247
Between 1981 and 1987, 1207 consecutive open elective orthopaedic procedures were performed. The in-patient infection rate was 1·43%. There was a significantly greater risk of infection in revision total knee replacement (15·3%), ankle fusion (9·3%), subtalar fusion (5·8%), primary total knee replacement (5·7%), spinal fusion (5·7%) and revision total hip replacement (4·5%). Revision surgery carried approximately a threefold greater risk than primary procedures. Staphylococci were present in 83% of positive wound cultures. Infection rates varied among surgeons but when number and type of procedure were taken into account only two surgeons differed significantly from that expected. Patients undergoing spinal and hindfoot fusion suffered considerable morbidity as a consequence of wound infection. Antibiotic prophylaxis may be helpful in these procedures.
Can I have a Dr Pepper instead of a beer please? I'm drying out before Christmas.
"The story so far: As usual, Ginger and I are engaged on our quest to find out what the hell is going on and save humanity from my nemesis, some bastard who is presumably responsible."
I'm certain many units have those in place. I'm certain many have abundant peer review of outcomes and processes. I'm certain many carry out research. I would suspect that most if not all do so better than their Orthopaedic counterparts.
But I am also certain that not ALL departments do these things in a meaningful way.
Sorry Robert, but ALL surgery units HAVE to go through peer review, etc...
Quote:
Originally Posted by Robertisaacs
What is the point of a national audit scheme if it can be so easily abused? Generating biased data could be argued to be worse than generating no data at all because it can be (note I say CAN be) so misleading.
Lets say we have two surgery units. One gives their patients the pascom questionaire 6 months after surgery with true academic zeal and integrity, regardless of outcome. Over a 2 year period they do 300 proceedures and produce 300 completed questionaires. The other gives the questionaire "on discharge" which may be after successful surgery or after several years, steroid injections, additional surgeries and suchlike. Perhaps they also have a few patients who get fed up of coming / go elsewhere / die before they can be formally discharged. They produce only 200 questionaires for the same number of proceedures.
I, as an informed patient, access the data for the two units to see which one I want for my surgery. Unit one will have a far higher complication rate than unit two, not so? Does this mean unit two is doing better work?
To take another example, if i proposed an outcome measure for biomechanics wherin patients who were happy with their devices, discharged, then given a satisfaction questionaire were included, but patients who were not happy were given a constant stream of adjustments and remoulds and never given a questionaire. I could produce a success rate which would bring a warm glow to Les Bailey's heart! Would that be a fair reflection of my practice? Course not. And if it were published I would be quite rightly torn to shreds.
Pascom is, as you say, a start. And it does perhaps represent a framework upon which to build and I applaud those who are trying! But in its present form it is so open to abuse that I'm afraid I cannot lend the figures derived from it much weight.
I'm certainly not disagreeing with you on any of your points, but as we say, it's a start.
Quote:
Originally Posted by Robertisaacs
Can I have a Dr Pepper instead of a beer please? I'm drying out before Christmas.
NO! Damn you! I said beer! Now DRINK IT YOU SOFTIE!
NO! Damn you! I said beer! Now DRINK IT YOU SOFTIE!
Ah, takes me back to my university days!
Now I've had my misty moment of happy memory, here's fun.
As you say, pascom is a good start and a laudible effort. I was really blinged at the SCP conference by the idea of all the data being available online. For me the biggest flaw is the fact that the inclusion criteria are so open to abuse.
What if each surgeons pascom stats were audited (randomly or by peers) so that the number of operations carried out is compared to the number of questionaires being returned. That might highlight where an excessive number of patients are falling through the cracks.
Further, should there be guidelines (or indeed are there already) on how long post operatively the form should be filled in?
"The story so far: As usual, Ginger and I are engaged on our quest to find out what the hell is going on and save humanity from my nemesis, some bastard who is presumably responsible."
Perioperative wound infection in elective orthopaedic surgery
G. J. S. Taylor, G. C. Bannister and S. Calder Journal of Hospital Infection
Volume 16, Issue 3, October 1990, Pages 241-247
that's 20 years old......found anything current? These days antibiotic prophylaxis has moved on a bit.....
Podiatric Surgeons Unregulated?
If that is the basis for the statistics on the success of pod surgery I'm afraid I cannot take it too seriously!
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