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FHP Practice.

Discussion in 'United Kingdom' started by R.E.G, Feb 25, 2008.

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  1. R.E.G

    R.E.G Active Member


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    Re: Foot health student

    Hi Tony your observations are very true.

    As a UK degree trained HPC registered Pod I am not alone being antipathetic to the advent of the FHP.

    However what you have chosen to do is lawful.

    Would you be prepared to explain to this community how, assuming you did carefully investigate the UK foot care market, you chose to follow this course. (East Staffs; is is safe to assume you are doing the Alliance based one?).

    It would also be interesting to know what your expectations of the level of education and final scope of practice are.

    We, the community, could then follow your progress and revisit when you qualify in a years time.

    Georga the same offer is made to you.

    Bob Golding.
     
  2. mistertooth

    mistertooth Member

    Re: Foot health student

    Bob,
    Thank you for your reply.
    I have worked to twenty two years in the NHS, I am an HPC registered Operating Department Practitioner and still currently practising. I spend a great proportion of my time working in orthopaedic surgery and in particular Podiatric surgey. I have, over the years spoken to many hundreds of patients about their care and something became very clear and that is that the standard of general podiatric care out in the community is so variable. A postcode lottery seems to be the in phrase on the availability of certain medication and the same is true for general footcare.
    You are right, I have researched the current siutuation, with regard to training, and I did consider the part time BSc at Salford but firstly I cannot afford to go back to university and secondly I do believe that with the standard of training that my chosen course offers combined with their practical course that I will be able to provide a good standard of general footcare.
    I have two friends who are both University trained Pods and neither of them are interested in visiting patients in their homes and getting down on their knees to offer basic care. They are both very content in their salaried NHS jobs seeing, in the main, diabetic referrals.
    My expectations are firstly to do know harm, and provide my local community with a reliable, safe footcare service.
    I currently work alongside consultants, staff grades, nursing staff and many professionals, none of us own the right to provide care. We all work within our scope of practice and in doing so provide the patients with a very good level of care.
    In the years to come I plan to continue with this approach, I will work within my scope of practise and refer on when required. I will make CPD part of my personal requirement rather than a necessary chore. I will be more than happy to sit additional examinations / tests if required to do so.
    I do not wish to become part of this essential service with my sword already drawn. I was put on this planet to care for my fellow men and that I will do to the best of my ability.
    And finally, I am doing my training with Stonebridge, my reasons, well the theory for these couses are virtually the same but their practical training is focussed on smaller class sizes and importantly, they were the only provider that did not run down the others but instead provided me with factual information.
    I do hope that this will give you alittle insight into my intentions.
    Thank You

    TT
     
  3. twirly

    twirly Well-Known Member

    Re: Foot health student

    Hi Tony (& Georgia too),

    :welcome: To Pod' Arena,

    Loads of information available & as one poster said 'it can be addictive.'

    Thank you too Tony for your constructive comments RE: your experience in the provision of foot health.

    Best regards :drinks
     
  4. Dido

    Dido Active Member

    Mistertooth,
    In common with all potential FHPs your aims are laudable in that you aspire to deliver a safe, affordable foot care service for domiciliary patients. However, your answer belies the fact that you have not approached this project with business acumen.
    I wonder if you have researched the market? There may well be a postcode lottery for domiciliary podiatry treatment in your area, but will you be able to capture the perceived market share? Remember, you will not be providing Chiropody/Podiatry and should not promote yourself as doing so. Some FHP training schools send their practitioners down the "leaflet the planet route". This is time-consuming and has a > 1% take up rate.
    If you unable to fund yourself through university(for 3 years) how will you fund yourself while your business develops? A good rule of thumb is to equate 1 full days work for every year of trading.
    Does your business plan include set up costs? From 2010 all autoclaves will be required by law to have a printer attached. So the scrabble for second hand ones will peak about 2009 just as you qualify.
    You will not be able to provide nail surgery or othotics which are the two biggest earners for podiatrists. Instead you will be aiming at the lower end of the market ie; those clients who cannot or will not pay a podiatrist's fees. Your patient turnover needs to be significantly higher than a podiatrists to accomodate this. You will have to work very hard, often in difficult conditions and be prepared to travel in all weathers.
    Postings on other forums indicate that some FHPs finish their training with gaps in their knowledge and skills base, so you may have to take this into account. As Stonebridge, as far as I am aware, does not provide any CPD then you will also have to fund this yourself.
    I have flagged up what I conside to be the main considerations for self-employment as an FHP, but it is no means exhaustive. As 2 out of 3 new businesses fold within the first 2 years, ( not necessarily through lack of skill on the part of the trader, but by a failure to access market factors correctly) it is not a course of action to be taken without serious thought.
    You have a very secure, superannuable, salaried position within the NHS, providing an essential service, i would not reject it lightly.
    Dido
     
    Last edited: Feb 26, 2008
  5. mistertooth

    mistertooth Member

    Dido,
    Firstly may I thank you for taking time to read my contribution.

    I read and take on board all that you say in your reply, I am trained in business and operatinal management and have therefore carried out a considerable amount of research and planning before injectingmy hard earned money in to this venture.

    I am fortunate in that I will be able to continue on in my current role and this will allow me a phased exit and entry into what I hope will be a full time role.

    I probably have a more thorough and up to date understanding of sterilisation than a greater number of Pods, I introduced instrument traceability for all autoclave cycles into my Theatre several years ago and to be honest I am shocked that the standards are generally quite poor outside of the Operating Theatre in areas including Podiatry and Dentistry. Most Operating Theatres have had their 'Little Sister' autoclaves removed now and instruments have to be either centrally processed ina CSSD or instruments need to be replaced with disposable one.
    I have purchased a 'Little Sister' and I intend to carry over my I high standards into my FHP practise. All instruments will be ultrasonically washed and autoclaved and the cycle number for those instruments will be added to the patients care plan for that day of treament, that way I have evidence of instrument traceability. Fortunately my Little Sister does have a cycle print out so really that should be stapled to the care plan but I believe that keeping aregister with all the cycle print outs will suffice if the cycle number is included on the individual patients care plan.
    I may only be a FHP when qualified but that will not prevent me from offering high standards in my practice, I will access CPD which is available in abundance and I will keep abreast of change. We all have limitations in our roles and I am a great advocate of working within ones scope of practice, I would like to think that with your wealth of experience and knowledge that you would welcome any referal I made to you in the best interest of the patient. I mentioned in my last contribution that none of us own the right to care but patients do have a right to be cared for.

    I have spoken to many FHP's and Pods in the months leading up to my training and one thing is very clear, 90% of their work is basic general footcare and the domicillary privision in this country is mainly provided by FHP's or the now, 'Grandparented' FHP's who have been accepted on the HPC register. This is mind I see know reason why I should not be able to set up and provide this service.
    I would not dispute with you the number of private practitioners who fail in business - why? , I have no idea. What I do know is that I have a wealth of healthcare experience, I am a registered Advanced Life Support Provider and Trainer, I am a qualified Counsellor and I will be a competent FHP, combine all that experience and qualification and I surely must have a reasonable chance of developing a business, afterall its foundation is secure.
    I have no desire in becoming wealthy from this move, my current position pays me on NHS band 7, a pay scale that the university trained, Senior Pods struggle to achieve. I want to become a FHP because it is the right move for me, I follow my heart and rarely my head. My intension is to provide a caring, professional and competent service and with the right intention, time will bring wealth.
    Thank You
    TT
     
  6. Dido

    Dido Active Member

    Mistertooth,
    Your second post is quite enlightening and I concede now that you have put considerable effort into researching the implications of your proposed career change.
    I am pleased to note that you will be carrying over your stringent cross-infection and decontamination procedures and protocols into your FHP practise.
    However, I must say that I am disappointed that you have chosen to leave the NHS, as it needs personel of your calibre to function effectively.
    However, as you have decided that this is the way forward for you, I hope that your FHP practise will achieve all you would wish for.
    Dido
     
  7. mistertooth

    mistertooth Member

    Dido,
    Once again, thank you for your constructive reply.
    I must apologise, reading back over my last post, I sound a triffle militant and along with a string of spelling mistakes it doesn't exactly make a good read.
    I hope we can remain in touch.
    Tony
     
  8. cornmerchant

    cornmerchant Well-Known Member

    Hi mistertooth

    I have to say you have done your research and you have identifed a definate need in the market .

    What I dont understand is how you can go from a respected registrant of the HPC to an unregulated professional that is the bane of the registered Podiatrist.

    I see from your previous posts that you have the patients welfare at the heart of your ambitions- if that were the true scenario, would you not be better equipped by doing the degree course?

    Try and convince me it is not about a short route to a profitable business!

    cornmerchant
     
  9. admin

    admin Administrator Staff Member

    I have merged some posts from the other thread to this one.
     
  10. mistertooth

    mistertooth Member

    Hi C,

    Thank you for your reply.

    You know more about me than I have let on if you think I'm 'respected' or is that the conclusion you have reached because I am HPC registered. Registration does not bring respect, a competent, caring individual providing a professional service brings and deserves respect.

    Regulation is an interesting one. I believe it will come for FHP's eventually, the government recognises that FHP's exist and without them the elderly in many areas would have their mobility compromised and this would probably progress into additional expense to the already financially burdened NHS.

    Podiatrists should not see FHP's as a burden but more an important cog in the machine we call care. I only wish that Podiatrists would get more involved in taking the FHP forward. The same situation is happening to my own profession, we now have Theatre Support Workers who are slowly extending their roles and in some areas are more qualified to carry out specific procedures than registered staff . This isn't because we, the registered staff, can't do these duties but often because we don't want to do them or that our own areas of practice have advanced and we simply haven‘t the time. The difference is that we welcomed our fellow healthcare workers advances and from the onset we the registered practitioners took ownership of the care and this multi-professional team approach is an approach that can grow and develop and at its core is a contented patient. So It would be nice to be accepted for the skills and care that I can bring to patients rather than seen as the 'bane of the Podiatrist'.

    I would probably do the degree course if it were distance learning with bolt-on vocational placements but not in its current format. I have recently been involved with several clinicians in writing the framework for a degree in advanced ophthalmic science that is to be offered through a Nottinghamshire college, this has involved a great deal of time spent with senior college tutors debating educational outcomes and I have to say that the there is a change in the wind and thankfully we may soon see our clinical degree level courses moving to vocational training placements. Universities are struggling to fill places and the drop out rate for clinical degree courses is very high, universities are after all businesses and they are correct in looking at alternative ways of providing education. There are also several bodies looking at the Nursing / Midwifery models which like my own profession are very successful vocational programmes. So for the moment the FHP route is my way in to this speciality.

    Do I need to convince you that this is not purely a short route to a profitable business? No more than you need to convince me that all this FHP vs. Podiatrist squabbling is more an issue of personal egos rather than the ability of individuals to provide a safe level of patient care.
    Thank You
    TT
     
  11. betafeet

    betafeet Active Member

    Hi Mistertooth

    Sounds like you know where you are going and you will enjoy the journey. I think any Pod in your area should grab you quick to do their home visits. There is plenty of work out there for all, and if you are good you will always be busy.

    My only thought is you may well feel frustrated after awhile but you seem willing to adapt, hopefully you will use this as a stepping stone to a Pod training.

    jude
     
    Last edited: Feb 26, 2008
  12. cornmerchant

    cornmerchant Well-Known Member

    Hi Betafeet
    While your encouragemnet of mistertooth is admirable, I am not sure that it i actually legal for HPC registrants to refer on to an unregistered practitioner? Have you checked the code of practise?

    Mistertooth
    You are certainly an enigma- here you are 22 years of ODT under your belt and a band 7 to boot, an intergral part of the formation of a degree framework for "ophthalmic sciences" ( not sure how this fits with ODT? ), you obviously are well up on the educational situation- yet you opt to do a short course in Foot Health which is at present unregistered and unregulated. ?

    It seems to me that you are determined to champion the cause of the unregistered and therefore it begs the question as to whether you have a hidden agenda.

    C
     
  13. cornmerchant

    cornmerchant Well-Known Member

    Sorry- should read ODP
     
  14. Dido

    Dido Active Member

    Betafeet & Cornmerchant,
    There is nothing in the HPC Standards of Proficiency that prohibits an HPC registered practitioner from referring to an FHP, there is only mention of a Duty of Care.
    However, The Society of Chiropodist & Podiatrists' Code of Ethics is quite specific in this area.

    Para3.4 States that :-
    "Members must comply with the General Medical Council Guidelines for delegating, accepting and making referrals. para 54 & 55 of Good Medical practice pub by GMC 2006."
    "Referral means transferring some, or all of the responsibility for the patients' care, usually temporarily and for a particular purpose, such as additional investigation, or for care or treatment that is outside your competance. You must be satisfied that any healthcare professional to which you refer is accountable to a Statuatory Regulatory Body or employed in a managed environment. If they are not then the transfer will be seen as delegation not referral. This means that you remain responsible for the overall management of the patient and accountable for your decision to delgate."In addition para 3.15 states
    " The Member should not delegate activities that properly fall within the remit of a Chiropodist/Podiatrist unless to another Chiropodist/Podiatrist"
    Hope that helps
    Dido.
     
    Last edited: Feb 26, 2008
  15. mistertooth

    mistertooth Member

    C,
    ODP's in Team Leader positions manage operating theatres, I have spent the last four years working in both Orthopaedics and Ophthalmology. I have more an educational and development role within Ophthalmics and it is my clinical experience combined with my involvement with the development in ODP's training programmes and the working closely with the Royal College of Ophthalmologists head of Training and Development that got me involved with the Ophthalmic Science Degree and that is simply how it fits in.

    What hidden agenda are you implying?

    TT
     
  16. mistertooth

    mistertooth Member

    Betafeet did not mention refering patients to me or any other FHP but simply that I could carry out their home visits. That is not refering it is asking a fellow professional to carry out part of that patients care and in doing so I (FHP) would be responsible for what work I carried out. If I were to be employed by a Podiatrist to do their home visits then that would be a different story. I am sure that any problem may then fall back on the employer - vicarious liability.
    TT
     
  17. George Brandy

    George Brandy Active Member

    There is only one ommission to this scenario you describe. A Foot Health Practitioner is an independant practitioner probably not wishing to be managed in the situation you describe, standing on the lowest rung of the financial ladder and therefore why on earth would a FHP wish to be taken forward by a Podiatrist?

    I am certain in a properly managed situation such as the NHS Podiatrists do welcome Footcare Assistants with open arms and have, in the past, worked with FHPs in this role but only temporarily before the indpendent nature of these people have shone through and off they have hopped into the private market.

    Within the free market it is the patient who decides what level of service they wish to receive, treatment alone or assessment, diagnosis and treatment leading to eventual recovery. To have a market with everyone claiming to offer the same service at painfully different standards is where issues arise between the regulated sector and the unregulated. If you plan to offer a high level of service at a premium rate as a FHP, the wise will not purchase and the market you have to aim at will not afford.

    It is not what you offer but how you offer it and where. A fully managed situation you describe in theatre cannot be emulated outside of the NHS nor private hospitals where the Healthcare Commission keep standards managed at a level where a patient can expect treatment carried out legally, effectively and safely.

    GB
     
  18. Dido

    Dido Active Member

    With respect Mistertooth, I think you have misunderstood my post, in which I supplied information at the request of Cornmerchant. There is no such scenario as "I could just carry out their(Chiropodists) home visits". Chiropodists are regulated practitioners you will not be. A regulated practitioner either delegates, refers, or discharges a patient under the definitions I stated. Whether or not you are employed by the Chiropodist/Podiatrist is not relevent in the scenario you quote. If you were providing treatment for a patient that had come to you of their own volition, then you would be covered by your own indemnity insurance. However, this is not the situation you refer to.
    The SCP publishes guidance and instructions for their Members because of this thorny issue of professional liability. SCP Members are expressley forbidden to delgate, refer or discharge any patient requiring Chiropody/Podiatry treatment into the care of anyone who is not a Chiropodist/Podiatrist. To do so would constitute a breach of the SCP Code of Ethics and they would be subject to investigation by the SCP Conduct Committee. This could result in membership and the associated benefits, such as professional liability insurance being withdrawn.
    I hope that makes it clearer.
    Dido

    Dido
     
    Last edited: Feb 27, 2008
  19. Debbie Delves

    Debbie Delves Member

    The exception would be delegation to a foot care assistant working under direct supervision and who would then be covered by the podiatrist's own insurance. This scenario would not work for home visits.

    Debbie
     
  20. cornmerchant

    cornmerchant Well-Known Member

    Mistertooth

    I must thank Dido and GB for articulating so welll my own feelings about this scenario.
    A hidden agenda? I am not at all sure what I meant by that except that I cannot equate in my mind why you are pursuing the FHP course when you have excellent credentials ans experience in your own field. Is there something in the wind for the future of FHPs that you are privy to before the rest of us? You do seem to be involved in the development of education.

    As GB states, the ODPs have always been under the remit of the NHS -unlike Podiatry where privately trained were able to get in by the back door -so to speak, and therefore ODPs are carefully regulated so your comparison is not valid.

    From your replies so far it is obvious that you are firmly entrenched in your views and will use a skillful play on words to make the process legitimate in your eyes.

    C
     
  21. betafeet

    betafeet Active Member

    Interesting debate, so I went in search of the evidence:

    The Society Bi-Laws 2001
    Rule number 7

    "A Fellow must not without the consent of the Council (which may be withdrawn by Council) (a) be in practice with or associate professionally with or allow his name to be associated in any way whatsoever with a chiropodist or a podiatrist who is not either a Fellow or Member of the Society, or a State Registered Chiropodist, save in the case of a person who has passed the recognized examination of the Society and is awaiting admission to Membership or (b) become or remain a member of or be otherwise associated with any corporation, society, association or other body which shall have been declared by a resolution of the Council for the time being in force to have objects conflicting with the objects of the Society."

    ?How will this affect Pods employing Podiatric Assistants as there has been many changes to the proffession since this Bi-Law.

    jude
     
  22. andymiles

    andymiles Active Member

    wonder how this effects members employed by a certain retail chain which certainly in the past has also employed unregistered practitioners
     
  23. Dido

    Dido Active Member

    Hello Betafeet,
    You are correct in saying that a good many changes have taken place since that bye-law was instigated, not least that the title "State Registered" is now defunct. I am sure there must be a more current version of the bye-laws available.
    Re: Podiatry Assistants, I cannot quote you chapter and verse on this particular issue as their role has yet to be defined. However, for more clarification I would suggest that you contact the Professional Practice Officer, Kay Blowes, at the SCP offices. Her contact details are on page 4 of February's Podiatry Now.
    Andy, with regard to the retail chains you mention the same rules re delegation/referral would apply. From what I know about these traders there is not normally much continuity of care as they rely a lot on passing trade and "one-off" treatments. Again, I would suggest you contact Kay Blowes for more information with regard to SCP Members liabilities in this area.
    Hope that helps.
    Dido
     
    Last edited: Feb 27, 2008
  24. mistertooth

    mistertooth Member

    Cornmerchant,
    I can assure you that I am not privy to any developments in the world of FHP's.

    What I am privy to is the knowledge that registration and regulation = competent, safe Practitioner is not the case. In fact the number of health professionals that are being 'struck-off' is at an all time high.
    I agree with almost all of your comments and I am inspired by your passion but unfortunately there will always be those that care and those that once cared and have become apathetic and those who really don't care, whether FHP or Pod.
    If registration and regulation = safe practitioner why is it that in this time of evidence based foot care that the standards in instrument cleaning and sterilisation along with instrument traceability vary up and down the country. Surely if the evidence and guidance is there it should be implemented for the safety of our patients. Waiting for a regulatory body to say that you must now comply is surely not good enough.
    So, I will introduce such standards in to my practise and although, for the moment, I am unregulated I will be able to offer my patients a service that they will have confidence in. Regulation, in the main, comes from within. I will welcome with open arms regulation and registration but until that comes I shall pursue a career with the promise of self regulation because as my example suggests I may be offering the patient a safer option.
    Thank You
    TT
     
  25. Dido

    Dido Active Member

    Mistertooth,
    Your response consists mainly of some sweeping generalisations and much rhetoric.
    I am curious on what figures you base your statement "..the number of health professional being struck off is at an all time high"...? As there are more registrants than ever before, due to more professions being regulated, then statistically there will be more FTP hearings. Expressed as a % of all registrants, it might tell a different story.
    We all know that there are no comparible figures available for non-regulated practitioners because if no-one regulates you, then no-one can strike you off! :D Ipso facto one should not try and compare apples with pears.
    You have expressed concerns about variable standards of sterilisation "up and down the country" for dentists and podiatrists. I wonder how many private surgeries (including FHPs) you have seen in order to make this claim and against what yardstick are you measuring these standards? The standards from a hospital CSSD can not logistically be achieved in the private sector. Nor do they need to be, for the majority of Podiatrists who do not perform invasive Podiatric Surgery.
    I am pleased to note that you intend to have high standards in this area, however, you are not alone, as you will find that The Society of Chiropodist & Podiatrists reccomends specific procedures for cross-infection control, instrument tracebility and decontamination in its Minimum Standards of Clinical Practice.
    Dido
     
    Last edited: Feb 27, 2008
  26. cornmerchant

    cornmerchant Well-Known Member

    Mistertooth
    I too admire your aspiration to provide a safe and competent practise albeit somewhat restricted due to limited training .
    Dido makes good points about the numbers you quote- whats more if you look at the fitness to practise hearings, a large number are totally unrelated to competency but rather to life style misdemeanors!

    At least if regulation is in place there is always the hope that it can be endorsed whereas the likes of the FHPs can practice unchecked- and how many are as conscientious as you? Not all are from high profile ,well informed careers such as yours.

    I hate to say it but you do have a misguided idea about the work you are going to pick up- few pods will refer on to you for the "doms" - if they dont want to do them there will always be registered pods who do want to do them. From the codes being thrown up as a result of this thresd I think that it may be very precarious for pods to refer on at all!

    Still at a loss to understand your throwing of morals to the wind

    regards
    c
     
  27. davidh

    davidh Podiatry Arena Veteran

    I'm not sure where to start here:confused:.

    Lets start with the "throwing of morals to the wind" - a sweeping and emotive phrase - which I for one would like to see explained in relation to someone moving out of the NHS into the foot-health field as an FHP, rather than a Podiatrist.

    Are you really suggesting that anyone who trains as a FHP is "throwing their morals to the wind"?
    :D:D:D

    As far as being able to work with Pods is concerned, the only Pods affected by the SCP Code of Ethics are, err, those who belong to the SCP:rolleyes:.

    There are plenty of skilled, ethical and highy-regarded Pods who don't belong to the SCP, and who are happy to work alongside FHPs.

    As far as not being regulated is concerned, I can't comment for the Alliance or Stonebridge, but certainly SMAE-trained FHPs have to work to a Code of Ethics, otherwise their indemnity insurance is compromised. They are regulated by their own professional body. I know the Institute have a similar system in operation - I would imagine Stonebridge and the Alliance do too, since it is fairly obvious that our professional bodies mostly/all share the same professional indemnity insurance Underwriters.

    Regards,
     
  28. cornmerchant

    cornmerchant Well-Known Member

    David
    So just because they are insured that makes everything ok then?

    Mistertooth wants to do the Stonebridge training- have you looked at the diverse subjects that they offer ? Hardly a specialist college .

    Lets see what the hpc have to say regarding referral on to unregistered members- I dont know the answer to that yet.

    Yes I am really suggesting that a person moving from a regulated profession in the NHS to the unregulated profession of FHP IS throwing morals to the wind. Prove me wrong- a man that gives up a band 7 income with 22 years of NHS pension has got to be deluded !

    I think we all know that grandparented Pods are the only ones happy to work with or refer to FHPs - after all they are of similar trainings but the grandparented were able to register and the FHPs missed the boat.

    I would expect you to diss the ethics of the SCP- your allegiance is elsewhere of course.

    C
     
  29. Robin Crawley

    Robin Crawley Active Member

    This is an excerpt from my research project proposal under the heading: "Do Professional Titles Matter?" This part of what I wrote regarding FHPs. I've not included the refs, but can if anyone wants. After my writing this (last year) I notice on the College of FHPs website that they do NOW have to have a CRB check before doing their course, which is a good thing. However, admission onto the HPC register much more exacting. There are registation appeal panels at the HPC where people who have just got their BSC (Hons) Podiatry or Physiotherapy or what ever have to appeal in some circumstance to get on the register because of past convictions/cautions. Therefore technically they can get struck off before they get onto the register. This does not apply to FHPs. There are positives to FHPs but the following I did find interesting when I researched it especially as the HPC regulation is about protecting the public. Anyway...:

    JM Consulting (1998, p.59) did warn that changes in legislation would allow loopholes to appear. This is shown by the fact that the Health Professions Order (2001) does not proscribe anyone setting up in practice with any alternative title, such as “Foot Health Professional” or “Foot Health Practitioner” to provide foot care. Foot Health Professional and Foot Health Practitioner are now professional titles (College of Foot Health Practitioners 2007c; SMAE Institute 2006, p.1), just not statutorily recognised ones.

    Added to this is the fact that we do not know if an unregulated foot carer is “of good character” in the same way that we are assured that a Health Professions Council registrant is. To illustrate, prospective registrants to the Health Professions Council’s register must sign to say that they are of good character, provide character witnesses and must disclose any criminal convictions they may have (Health Professions Council 2007g). Providing false information for application onto the register is a crime (Health Professions Council 2007h). The thirteen professions regulated by the Health Professions Council are exempt from the Rehabilitation of Offenders Act (1974) (Health Professions Council 2007g). This means that normally if a convicted person does not re-offend during this rehabilitation period after they have served the sentence imposed on them by a court of law they become a “rehabilitated person”, and their conviction becomes “spent”. In this context “spent” means that in most circumstances the convicted person does not have to reveal the existence of any previous convitions (Criminal Records Bureau 2007). However so called “spent” convictions are always considered by a screening panel to determine an applicant’s eligibility for registration with the Health Professions Council (Health Professions Council 2007g). If the screening panel do not view them as a suitable person to enter the register, the are not entered onto the register and thus cannot use one of the thirteen protected titles regulated by the Health Professions Order (2001) (Health Professions Council 2007g). The same checks and balances may not be applied to other unregulated health practitioners such as those in foot care work because they are not regulated under law. Even though the College of Foot Health Practitioners (College of Foot Health Practitioners 2007c) have a voluntary register of its members it states that its register is open to all privately practising practitioners and gives a surety that they are of good character. This may be true but it does not say that fraudulent application onto its register is a crime. This concern is amplified by Marc Seale, the Chief Executive of the Health Professions Council, who is reported to have said: “At present you could come out of Wormwood Scrubs and set yourself up as a counsellor” (Marc Seale 2007 cited by Day 2007, pp.929-931). For “counsellor” we could substitute any statutorily unregulated health profession in this context (Day 2007, pp.929-931). This view is given further credence by the Department of Health (2007, p.11) who stated that the practice of many unregulated health professionals carries at least some of the potential risk to members of the public who use their services as that of those who use the services of other statutorily regulated health professionals. Therefore employing the services of a Podiatrist as opposed to any other “foot carer” may afford greater protection to the patient because there is greater legal accountability.

    Cheers,

    Robin.
     
  30. George Brandy

    George Brandy Active Member

    Cornmerchant,

    Taken from HPC standards of conduct, performance and ethics:

    8. You must effectively supervise tasks you have asked others to carry out for you.

    People who consult you or receive treatment or services from you are entitled to assume that a person who has the knowledge and skill to practise their profession will carry out their treatment. Whenever you give tasks to another person to carry out on your behalf, you must be sure that they have the knowledge, skills and experience to carry out the task safely and effectively. If they are not health professionals, you must not ask them to do the work of health professionals. If they are health professionals, you must not ask them to do work that is outside their scope of practice. If they are training to be health professionals, you should be sure that they are capable of carrying out the task safely and effectively.

    Whoever you ask to carry out a task, you must always continue to give adequate and appropriate supervision and you will stay responsible for the outcome. If someone tells you that they are unwilling to carry out a task because they do not think they are capable of doing so safely and effectively, you must not force them to carry out the task anyway. If their refusal raises a disciplinary or training issue, you must deal with that separately, but you should not endanger the safety of the patient, client or user.

    13. You must carry out your duties in a professional and ethical way.

    You must carry out your duties and responsibilities in a professional and ethical way. Patients, clients and users are entitled to receive good and safe standards of practice and care. We want to protect the public from unprofessional and unethical behaviour, and we aim to make sure that health professionals know all about the standards we expect them to meet. These standards are needed to protect the public and, as a health professional, you have special responsibilities that go beyond those expected of other people.


    16. You must make sure that your behaviour does not damage your profession’s reputation.

    You must not get involved in any behaviour or activity which is likely to damage your profession’s reputation or undermine public confidence in your profession.

    Interpret as you wish.

    David, never one to miss a snipe at the SCP but do remember none of the professional bodies hold the power to remove your licence to practice. This remains firmly with the HPC. Reading what Dido and Debbie Delves have said regarding SCP ethics and relating this to the HPC standards, their posts make perfect sense.

    GB
     
  31. Dido

    Dido Active Member

    David,
    To say that the SCP code of Conduct/Ethics only applies to SCP members is only partially correct. It is true that the instruction not to work with or delegate/refer to a non-HPC member is perculiar to the SCP. However, the recomendations I quoted from the General Medical Council Guidlines 2006 represent "best practice", against which all the HPC registered will be judged. The regulated practitioner (and this will hold true for all professions)will be responible for and will have to justify their decision to delegate to someone they knew was not HPC regulated and they will continue to be responsible for the overall management of the patient.
    If Chiropodists who are not SCP Members choose to work alongside FHPs, then that is, of course, their choice. On the face of it it may seem advantageous for a Chiropodist to engage an FHP as a "gopher". However, I fail to see any advantage for the FHP in this arrangement. FHPs are told that they are "fully-trained practitioners" and are designed to function autonomously. As such they will not want to be the handmaidens of chiropodists.
    You state that SMAE-trained FHPs are "regulated by their own professional body", and this may well be true. However, I am unable to locate any information about these "regulations". I am surprised that this information is not readily available for public consumption in order to create public confidence in this new breed of footcare worker and an intrinsic part of SMAE's marketing strategy. Therefore, I would be interested to know what form this "regulation" takes and what the penalties are for FHPs who do not follow their Code of Conduct, bearing in mind that striking off and loss of title do not apply.
    Your statement about insurance underwriters, which may well be true, is irrelevent, as it is the substance of the policy that is important, not the name of the provider.
    I await your response with interest.
    Dido
     
    Last edited: Feb 28, 2008
  32. davidh

    davidh Podiatry Arena Veteran

    I'll address your points one by one.....

    Being insured carries certain obligations. For example - try crashing your car whilst drunk and see if your car insurance stands up.

    I didn't comment on the training at all. I also, you will notice if you read my post again, didn't comment on the worth of a full-time Degree against an FHP Course. In fact, like Robert and Twirly in another thread, I believe the Degree to be a far better, more comprehensive Course.

    Suggest you look up the definition of morals - you're clearly talking about something else.

    Now this is a strange one. I know several Pods who are not Grandparented who are quite happy to work with FHPs. Maybe you have not looked hard enough?:D

    Finally, and again, you may want to re-read my post, I did not "diss" either the SCP or it's Code of Ethics.

    Cheers,
     
  33. davidh

    davidh Podiatry Arena Veteran

    George - re-read my post.

    May I respectfully ask you to stop "having a go" at me?

    Thank you.
     
  34. davidh

    davidh Podiatry Arena Veteran

    Again, I'll take each point in turn...

    "To say that the SCP code of Conduct/Ethics only applies to SCP members is only partially correct."
    No, it's completely correct. We all have our own Codes of Ethics, and there will be some overlap, but in the same way you would not want to work to, say, the Institute Code of Ethics, I and many others have no wish to work to the SCP Code of Ethics. Any Best Practice as defined by the HPC is just that, and is not the SCP Code of Ethics.

    You make an assumption about FHPs being "gophers" (a particularly, and I suspect purposely derogatory term). Why would you think that? I work in an Assistant capacity to a Pod Sugeon - I'm certainly not his/her "gopher".

    As far as SMAE Policy on Regulation is concerned, I am neither part of, nor privy to the decision-making process within the SMAE Organisation. It may be in their interests to publicise this for marketing reasons, and I'll be sure to suggest this to Mr Batt when we next talk - thank you.

    You are quite correct about my statement about Insurance Underwriters being irrelevant.
     
  35. Dido

    Dido Active Member

    David,
    I think we are getting down to semanatics here. The 2006 GMC Guidelines I quoted make up part of the SCP Code of Practice, and all members are required to follow them.
    I have also assisted a podiatric surgeon, with the role of "gopher" or "dirty nurse" :D and found both these titles quite amusing. I used the word in the absence of any other available title, as I know no defined role for an FHP who works "alongside a chiropodist". However, if you chose to take ofence at this word, then I will retract it. Please be so good as to suggest another. My remarks about FHPs and autonomous practice still stand, however.
    I see little point in mentioning any kind of "regulation" for FHPs that is not available for public consumption.
    I would also be pleased if you would resapond to my question about sanctions for FHPs who do not abide by their code of ethics. The HPC is very transparent in this area and herein lies a pertinent difference between those that are HPC regulated and those that are not.
    Dido
     
  36. mistertooth

    mistertooth Member

    Taken from HPC standards of conduct, performance and ethics:

    Quote: People who consult you or receive treatment or services from you are entitled to assume that a person who has the knowledge and skill to practise their profession will carry out their treatment. Whenever you give tasks to another person to carry out on your behalf, you must be sure that they have the knowledge, skills and experience to carry out the task safely and effectively. If they are not health professionals, you must not ask them to do the work of health professionals.

    Forgive me for contributing to this interesting thread, not only am I unregulated and unregistered but its seems my mental state is also at question -'deluded'.

    I can see no breach in this code (8) for a Pod to ask a FHP to visit and treat a patient.
    Firstly the definition of a Health Professional is 'a person who helps in identifying or preventing or treating illness or disease. The FHP is therefore a Health Professional. Providing you (the Pod) don’t ask the FHP to carry out work outside of their scope of practise and you have seen evidence of their qualification, experience, CPD and insurance you would not be breaching this code and lets face fact this is happening all over the country. I know of several FHP's who provide holiday cover and regularly do dom visits for Pods.

    So now the legalities have been addressed and I have convinced you that my mental state si alblosulty fene, sorry slight slip of the right hemisphere there, I am interested to know if anyone out there has had any experience with the Health Care Commission and clinic inspections.
    A close friend of mine opened a clinic last year, he is an Ophthalmologist and his wife a Dermatologist. He planned to carry out minor ocular plastics and his wife to run a laser clinic, they also have a vacant suite which I am sure will be taken up by another close friend and Pod. They followed almost to the word the set-up guidance (very limited) that they manage to detract from the HCC but they were completely slated on the first inspection. The sink was too low, wrong taps, walls the wrong colour, sluice in the wrong place and that was before they got on to the disabled access, which had been given local approval. They are waiting for a second visit before they can open the doors to patients and already they have spent thousands trying to put this right.

    Thank You all

    TT
     
  37. perrypod

    perrypod Active Member

    It would be best practice if all podiatrists and FHP's in Britain were trained up to degree level under the same system and registered under a body called the podiatrist board. Doctors dentists and osteopaths are registered by their own professional bodies so why not us?
    The public deserve better than being hoodwinked by a multitude of titles and qualifications. The podiatrist board should comprise of podiatrists and also informed lay members to try to prevent the perceived evils of total self regulation.
    This could easily be achieved if the majority of us agreed to and demanded it.
    The problem is that there is a lot of pussy footing around. The real world is as good as we want to make it. Do we really need sub academically qualified professionals? University graduated podiatrists are quite capable of training assistants to work for them. We, in Britain, have a lot to learn from the U.S.A. who rightly present the profession as comprising of well trained foot doctors. Surely, only the best standards are good enough for the British public. It is our moral duty for all of us to pull our socks up (no pun intended) and unite in creating highly trained professionals to treat the public. The HPC has, as yet, failed both us and our patients in this regard.
    Hope we all can agree to such changes
    perrypod
     
  38. perrypod

    perrypod Active Member

    It would be best practice if all podiatrists and FHP's in Britain were trained up to degree level under the same system and registered under a body called the podiatrist board. Doctors dentists and osteopaths are registered by their own professional bodies so why not us?
    The public deserve better than being hoodwinked by a multitude of titles and qualifications. The podiatrist board should comprise of podiatrists and also informed lay members to try to prevent the perceived evils of total self regulation.
    This could easily be achieved if the majority of us agreed to and demanded it.
    The problem is that there is a lot of pussy footing around. The real world is as good as we want to make it. Do we really need sub academically qualified professionals? University graduated podiatrists are quite capable of training assistants to work for them. We, in Britain, have a lot to learn from the U.S.A. who rightly present the profession as comprising of well trained foot doctors. Surely, only the best standards are good enough for the British public. It is our moral duty for all of us to pull our socks up (no pun intended) and unite in creating highly trained professionals to treat the public. The HPC has, as yet, failed both us and our patients in this regard.
    Hope we all can agree to such changes
    perrypod
     
  39. cornmerchant

    cornmerchant Well-Known Member

    Mistertooth
    I think that we need clarification on the term 'Health professional" as referred to in paragraph 8 of the HPC code of conduct.

    For the majority of us that abide by the SCP code of conduct, the interpretation of this would be a "regulated" health professional ie not a FHP who at this moment in time may have a certificate showing that they have followed a training course, but are not actually regulated.

    Naturally, your interpretation of the term health professional is going to be totally different- you will claim the title health professional because that is what it will say on your certificate and it will allow you to practise unchecked.

    Yet again you amaze me with your name dropping of close friends who are ....ologists-
    I bet they wouldnt like it if Stonebridge started offering 5 day courses in their field of practise!NIMBY!

    C
     
  40. Dido

    Dido Active Member

    Perrypod,
    I could not agree with you more.
    Unfortunately we have the situation we have and it seems little can be done about it.
    IMO if FHPs had not arisen the "old State Registered Sector" would have rapidly assimilated the grandparented and all would have been well. Instead, the creation of FHPs to circumvent regulation and the support given to them by the professional bodies only reinforces previously-held prejudices.
    What else can I say?
    Dido
     
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