Agenda for Change

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Netizens

In the UK there is a new structure for NHS employees and this includes podiatry The links will fill in the missing gaps for those not familiar with the UK System. What is interesting is the structure and job roles for podiatry in the future. The UK University programs cater for private practice as well as public sector vocation, and because the vast majority of their graduates seek employment in the public sector then there is a distinct slant to meet associated competencies within the educational system. This restructure will impact not only on the current pre-registration but also the post registration programs, because their is a clear and stated career pathway.


Some have argued the introduction of this new system will herald a reduction in the number of practitoners required by the NHS. Intersting to hear your comments.

Because of professional reciprocity what happens in the UK influences the Commonwealth and hence the reason I bring this to your attention. US subscribers may be interested in seeing and commenting on the new UK public system , as this represents the biggest change in podiatry in the first decade of the 21st century.

Agenda for Change

http://www.dh.gov.uk/PolicyAndGuida...Training/ModernisingPay/AgendaForChange/fs/en


A guide to staff

http://www.dh.gov.uk/assetRoot/04/09/08/59/04090859.pdf

Job Profiles

http://www.dh.gov.uk/assetRoot/04/09/45/52/04094552.pdf

What say you?

Cameron

 

A4c

This is a troubling time in the NHS for all because of this and real pay cuts are possible for many. Senior II into Band 5 dont fit. And with 50% or more of NHS staff being this grade it is a big future blow if that how is how it goes. You're talking a £1500 a year pay cut. Sorry pay freeze.

I dont see it changing the workload any day soon just paying the staff less to do it. That is the reality.

Will it increase specialisation? It will increase the desire for specialisation perhaps in some practitioners but the ones most affected i.e. in the job for 10-15 years with kids or elderly parents to look after when have you got time for Masters level training? Who pays for it?! But that said the "routine" patients wont go away. "De-emphasising" elderly care/C+C/Core Podiatry in preference to specialisms causes increased written complaints in the short-term and thats what drives local if not national agendas. It may just be their toenails but when you're 65 you've got a fair amount of free time to write to your MP!

In our area specialisms, scope and higher gradings are sloooooowly coming but as a result of extra funding not divertion of funds or jobs.

 

re AFC

Dear All,

THis is proving to be a disappointment for many NHS employees.

The NHS has problems recruiting staff in the world of Podiatry.

This challenge has not lessened since the introduction of the Degree as graduates seem to be more motivated regarding career progression so will not wish to do basic Podiatry.

So if the NHS wishes to recruit well educated motivated Podiatrists then BAND 5 is SO NOT THE WAY TO GO.

With so many jobs available staff retention will become a larger problem as these staff will migrate to areas which have handled AFC well.

So those that have mishandled it will have to advertise those posts lost at Band 6 just to get some interest.

Which begs the question why grade at Band 5 to start with.

Or is it a precursor to reintroduce Helper grades in expanded roles on Band 3/4.

So as i understand it:

Band 5 : Fresh out the factory no or limited experience. Works under direct supervision and case load is allocated by that supervising staff. Person is on 6-18 month induction with rotation through the specialities.
(Basic Equivalent)

Band 6 : Autonomous Practitioner with own caseload. Aseeses pts makes diagnosis formulates t/t plans implements and modofies t/t plans.

May have an interest in a speciality eg diabetes so is part of the Diabetes team. has a full roll to play in dept etc etc.
( Senior 2 equivalent)

Band 7 : Clinical Lead eg head of diabetes (team) and acts as the lead to all colleagues in that role of Diabetes lead. Responsible for provision of Diabetes services Pod wise for the dept in the community.

Also Clinical Specialist eg Diabetes part of Hospital Team working with Hospital colleagues in provision of diabetes services in the acute unit.
Liases with the community team lead.
( Senior 1 , Chief 4, Chief 3 equivalent)

Band 8 : Writes cheques ( ie handles budget for dept)
(Chief 3 ,Chief 2, Chief 1 equivalent)

Band 9 : Could be pod surgeons , could be very sen heads of very large dept with Pod Surgeon as part of dept.

THis one is really out to lunch on the argument. Thus is very contentious but is a possibility. As it is clinically a Consultant level of post. Do Consultant pod Surgeons count as Medical Consutants?

The above is my undersatnding of AFC .

I could be proved wrong.

In several instances Sen 2 have been banded 5.

But in other areas Senior 2 is band 6.

So why the disparity when this is supposed to be a fair and equitable system to ensure national parity across roles????????

As an assessor for Job Matching for AFC for my area i do not see how Sen 2 is Band 5.

Certainly the panels i have sat on have been very professional in the implementation.

So just going by Knowledge and training , and freedom to act Sen 2 should be band 6.

Certainly the Physios in my area are expecting what i have suggested above.

They are even more mobile than pods so they will move to further their career.

So the end result of this poor implementation will be less Pods in the NHS.

Those that are there will go for the Higher responsibility posts and that will leave those poorly managed depts with no service provision due to no staff.

Also i believe many will look to the Southern Hemisphere for their future

regards David.

 

David

Can I just reiterate something Cameron wrote the other day; we have to recognise that there is a bigger picture running at present and if podiatry is to emerge at the final curtain with some semblance of autonomy within the foot health market, we need to start thinking the unthinkable in terms of education, career structure and progression. Otherwise we’ll be left standing around poking ourselves in the eyes and wondering what has happened to us.

I attended one of the HPC’s consultation events tonight. One of my questions to Marc Seale ran along the lines whether he had confidence in the due process surrounding grand-parenting new applicants onto the register.

He gave a comprehensive answer outlining what grand-parenting was, what its intended objectives were and how it was conducted – but made no comment if he had any confidence that it offered sufficient scrutiny to ensure public safety. When he was pressed on this he simply said that no process was perfect but we needed to understand that there was a political dimension to the whole issue and that much of that was governed by the needs of the NHS.

David, the needs of the NHS are manifestly different from the needs of the profession or the needs of the Society – or any other ‘representative’ body for that matter.

Let’s set aside all the arguments and differences over social –v- medical care in podiatry for a moment and look at this ‘market’ from another perspective. Health, in recent times, has become the primary political battleground. It is a major part of our daily lives. The NHS in particular is both the delivery room and the graveyard of political party fortunes. Remember the Labour slogan in 1997 – ‘24 hours to save the NHS’. It could be argued that this Labour government has enjoyed a protracted honeymoon period with the electorate, but most people will realise that we’re almost at the midnight hour as far as the NHS as an institution is concerned. What government – of any colour - certainly do not want, is the kind of problems that exist in our area of competence where demand simply overwhelms what it is that the NHS can deliver.

It doesn’t matter if it’s cancer care or dentistry or toenails in the elderly. The government’s daily battle with the media determines the political agenda in more ways than we appreciate. They don’t give a rat’s toss about ethics or morality when framing policy; rather it is public perception that matters and the way it’s presented. Underlying all of that is money and whether its possible to deliver the perceived changes within a finite budget.

Podiatry has always been near the back of the queue of public funding. In my twenty-three years in the profession, we have singularly failed to make an impact on the public and political perception of the value of good foot health, and by association, our place in the ranking order of public services. Although unpalatable to many within the profession, what we are seeing now is a political solution to a little crisis, nestled amongst a much larger calamity in healthcare, which the establishment, of which this government is a part, is trying desperately to address.

They see an easy solution to our problems. The issue is capacity – it usually is when it comes to servicing demand – and government will address that in any way or means as it can. You, yourself David, have made much of wasting skill mix in patient care. You think the NHS should only treat medically related problems and that simple ‘social’ care such as elderly foot-care, should be delegated to the private sector. Government doesn’t see it that way. The elderly problem is becoming another major political issue – the grey vote is a powerful lobby, much more so than podiatry for instance. The NHS podiatry profession may have discarded elderly care in recent years, but government has no intention of allowing that trend to continue. We will see therefore, in the very near future, the emergence of new grades of clinicians who will attend to the needs of the elderly, and these clinicians will come from outwith the current parameters of the profession and at a much lower grade to boot! Assistant grade practitioners, trained within the NHS, for the NHS, undertaking what we all recognise now as general chiropodial practice, is the new order of the day. Within a single generation – 20 years – podiatry could have a whole new meaning in the healthcare arena. Care to hazard a guess how many will be working within its environs?

As Cameron writes, it is pointless tearing ourselves apart over the issue. I’m afraid that what will be, will be. At this point in the game we are no match for what government throws at us. We are not an autonomous profession like dentistry; we do not enjoy the same protection of practice under the law; nor can we break away from the NHS and dictate our own destiny. Because of the demographics within podiatry we will always be a second-career profession, and as a result, we will never (in the near future) have the drive or passion for self-determination that we need to establish the profession to stand alone. Marc Seale tells me that the HPC is looking to approve 325 new learning establishments for health and social care of which APU is one of the first batch. If I were a betting man I’d wager that in ten years time there will be less than four dedicated podiatry schools in the UK – established, independent or otherwise – which will cater for a contracting specialist profession.

Look at the impact Agenda for Change is having and tie it in with the new regulatory format set out by the HPC and you begin to see the whole picture. This is professional redesign as opposed to service redesign, quietly undertaken by government, aided and abetted by some within the profession.

As Uncle Bob once sang, ‘Times they are a changin’.

Mark Russell

 

Netizens

I hope Australian colleagues are following this conversation because the consequences of the new order in the UK will inevitably impact upon them. Whether through mirroring, reciprocity or mass emigration what is happening here now, is driven by a political agenda, which has left the professional associations toothless. Change in both the workplace and the education system is imminent and under the new generic therapist paradigm, mono disciplines with self-autonomy are passé and likely to end up like, the dodo. A magnificent bird, which just could not survive. In the UK, somewhere along the line of evolution some of the profession lost its ability as to control its own destiny.

Meantime the eduction system will survive as it continues to service the needs of its clients. Interprofessional collaboration and skill mix will further blur demarction ofrestrictive practice as the therapists' role expands. .

Cameron
Hey, what do I know?

 

I am following the whole Agenda for Change process with mixed feelings. I say this because one aspect that so far I have not heard mention of, is the number of pods who have left the NHS because of dissatisfaction with their working life. In particular, the huge numbers of patients demanding treatment & the lack of time and resources. However, for me one of the biggest frustrations has been the number of podiatrist colleagues who cannot be bothered to formulate, let alone implement, proper treatment plans with the aim of actually providing some long-term outcomes for patients! I still hope that this may yet be a good thing to come out of AfC.

My major concern remains the fact that so much of the job matching process relies on local evaluation. Geographical variation seems to me to be unavoidable.

I am also interested in the idea that specialisation is the way forward. In the Trust that employs me (while I wait for my Aussie visa to be processed) we are aiming to get Senior II posts into Band 6 by virtue of the fact that Snr IIs will be expected to be 'specialist generalists', providing a broad range of service to patients at several locations. This is in contrast to the current situation where patients travel up to 40 miles to see specialist pods. The intention is to try to recruit & retain more staff by making available a range of training & experience, & of course to make effective podiatric intervention available locally to more people. Of course, the demands of service provision in a rural, mainly elderly population are difficult, but we continue to pursue our aim! (I'll probably be having fun in the sunshine of my beloved Aus by then of course! )

I do wonder what other Trusts are up to - are we alone in our attempts to secure a reasonable position for ou team of pods? (Too much fresh air methinks!)

 

Ain't it remarkable that a business like ours, with all that demand for our services, is still languishing somewhere between road-sweepers and nurses in the earning stakes. That's what happens when you cede control of your business to your biggest customer.

Yup. Care to hazzard a guess at the number of graduate pods whose level of clinical practice is the same as a foot care assistant? 8-out-of-10? The culture in the NHS does nothing to motivate or incentivise and in private practice it is good business sense not to provide curative long-term outcomes. We've brought this folly on ourselves in many respects...now we reap the 'rewards'.

No. The gradings have been determined at a much higher level than local Trusts. As Cameron rightly said yesterday - blame Tony Blair (but save some for your colleagues who aided and abetted the whole process)

Specialist generalist? There is no such animal and never will be. Senior II's will be replaced by generic therapists or foot health nurses. The gradings that are now being set are simply a disincentive for graduate pods to remain in the NHS. In time, it is likely that Band 4 will be used for the generic therapist, which will allow the NHS to employ a larger workforce at the same cost as present.

What's the betting the Ozzies will follow suit?

 

Agenda for Change.

Hi All,
Well there is a thing! I was about to attempt to start a new thread away on the comparison of various public bodies removing the initiative from out of the hands of Academia and politico's on the one hand and the highly paid over qualified staff for the work carried out on the other!

The old argument of highly qualified staff on the one hand and highly skilled technicians on the other. The powers that be could very easily have a hidden agenda of increasing the employment statistics while at the same time removing higher paid staff, (Civil Service???).

In the retail world it is the well known rule of 2 for the price of 1, and if you are really luck in some cases it could be 3 for the price of 1! You could look possibly at nursing? One degree level nurse and not enough nursing staff to clean the Ward or allow the use of the bed pan on demand? In fact to quote one story that was going round my local area a few years back now was a student nurse being asked by Staff to give a person a bed pan was answered with, "I'm sorry Staff-nurse but that is not in my contract." (Or so the story goes?). This would automatically have been done without question before 'Academia' had taken hold years ago!

Another good historic model can be found in my local library. As a child I would walk into my local library and speak to the Librarian looking down over the counter at me, (Yes she was a fully qualified librarian at that time. All the staff were!).

Now when I walk into my library it is just possible the senior member of staff is a librarian holding that degree. The rest are assistants, granted in most cases with a degree, but not that one owned by the librarian. The rule has successfully Been applied, "2 or 3 for the price of 1" and no apparent loss in efficiency can be detected!

When 'Academia' hi-jacked chiropody in the mid.1970' it was as sure as night following day that impractical higher archaic structures would follow. B.Sc. Pod.'s. with their heads down cutting toe nails that forty years previously were done by chiropodist with a diploma if they were Lucky! Just maybe there is a use for FHP.' after all but of course they will be trained and controlled by NHS educators I would strongly suspect!

Now I must leave and do a new patient who has not been able to get anybody from the local hospital for the past five/six months? (I'm back and his wife has told me that she has just been told that the podiatrist has just gone sick! The implication is that they have not got another one to replace her?). The powers that be are not usually stupid and I'm sure that it has not passed them by that if they train Foot-carers in nine months they will be able to employ two to three Foot-carers instead of one Podiatrist! Then if somebody goes sick they will have one or two replacements this time next year???

Therefore, I might just be redundant before my time? I'm counting on you Podiatrists in this thread and Elsewhere to defend yourselves with dignity and anything else to hand so that I may not have to seek early retirement contrary to this Government's new retirement age which I believe would not be good for me either!

Regards,

Colin, (Still trying to be a realist?)!

P.S. - Is this part of Mr. Brown's plans to get rid of to many people employed in the Civil Service and fellow travellers in the very near future whilst employing other grades to split up skilled occupation? It worked in the Industrial Revolution!

 

AFC banding

Well i was right on one thing .

People wil move to the Southern Hemisphere.

As an aside.

I heard recently that in a nighbouring trust 2 OT Tech's had got Band 5.

I could not believe this as a OT asst is band 3.

Anyway had lunch with the 2 guys today and we discussed this .



I said as Asst grade you should be band 3 . They said oh no as they are time served chippies. So i replied that under afc Apprenticed Tradesmen are band 4 as are Plumbers elecs etc.

They replied that as they go out to houses do risk assessment decide what adaptios to the home are needed . They then purcahse the equipment neede and then fit it as they see fit based upon the original assessement that they made. They stated that what they do has absoultely n input from an OT.

So this means that under freedom to act they are autonomous practitioners and so will go into band 5.

They were job evaluated and the outcome was band 5.

They also agreed with me that they ae now unemployable and if they left for any reason they would not be replaced as an OT would do the abve and the works dept would install as per prescription from OT.

They aslo said that during the evaluation that unless they got band 5 they would resign.

So there was a bit of argy bargy involved in the evaluation.

So the outcome is a grade of staff that is not sustainable and would not be replaced.

What a dumb situation.

They also stated that if things do not go well then they are off to building houses and a big fat pay rise.

I asked why dont they go now and they said that their job has its advantages not related to money.

So i asked how they felt about Health staff being on the same scale and they replied tha most heath care staff are not financially motivated and this will go against them.

How right they are.

So what next ?

I do not know.

I will have an A level student sit in with me soon who is considering accepting a place at Northampton School Of Podiatry this Sept.

Do i lie or not???????

What do i say if asked about NHS lack of career structure?

regards David

 

Industrial Revolution, model for Agenda Change?

Hi All,
I believe I must expand my postscript in the message posted on the 24.2.5 above.

A Cornerstone of the Industrial Revolution was needed to stabilize and allow development in the structure and manufacture of goods. This was done by the removal of the skilled-artisan. This could only be done by replacing him with a number of semi-skilled workers (FHP'), which when added together equaled and replaced the skilled-artisan (Podiatrist?). Although more semi-skilled were needed to replace the artisan, the sum total wages bill could be less than the skilled independent worker, replaced!

Possibly the following are the main advantages of removing the Artisan,
1. It allows the Manufacturer control over the productivity of his work force!
(A skilled worker had the support and clout of his Guild (Union), The guilds by their rules and tenents prevented change!).

2. The semi-skilled workers could be trained up to the same level of skill as the sum total of the Artisan. (They would not be such a threat to the Manufacturer as the Artisan was, and still is!).

3. Removal of independent initiative in the workforce. This is always a threat to management!?! (Chiropody must be blended into NHS superstructures as with nursing, therapies, technical staff even up to scientist/biologist (HPC registration!).

Only Doctor and Dentist are able to hold out so far. They stand protected under Act and Statute, so far anyway! But don't worry the 'Powers that be' are working on it! Foreign doctors/consultants/dentists are being imported to break the monopoly!

The Industrial Revolution worked before so I cannot see why it can not work again! When you consider that the NHS podiatry management are now part of the Society! Resistance to change is going to be a very interesting thing to watch as conflict of interests in the Society take hold. Change is now inevitable! Is it? Will they be able to retain their independent initiative in face of these conflicts of loyalties? Do they want to remain independent when the bread and butter is in the NHS?

Regards,

Colin. (Could this be why I joined the Institute as a lowly member rather than joining the Society as an Associate???).

 

Hi David!

Tell her about the £1k+ per week to be made in private practice!

Cheers,

Robin.

 

'the sum total wage bill could be less'

Possibly, but the output was increased. Individual pay was less, training cost were less as the work being de-skilled required a shorter time to train. The Guilds were side stepped to be replaced by trade unions which are with us today. It required more capital and more risk, (even RR went bust) produced bigger markets and prices came down for the benefit of all.

£1,000 per week. Gross? To take that home after tax and costs you would need to take about double.

A patient from the Near Middle East advised me: " Luke. Never make. You buy, and you sell." Your individual output will always be limited and your earnings can only increase if you employ someone else to do the job at a lower rate.

So, will the new NHS structures benefit the public by satisfying a need which would not or perhaps could not, be met within the constraints of the budget? Quite possibly, but for the management.

Sorry to sound contentious but I just saw King Kanute.

 

King Canute!

Hi Luke,
'the sum total wage bill could be less.'

That's what concerns me with all that is going on in the NHS as I look in through the thin veil from the outside!

'So, will the new NHS structure benefit the public by satisfying a need which would not or perhaps could not, be met within the constraints of the budget? Quite possibly, but for the management.'

I believe the Management have been way ahead of the game years ago! (There might still be some hope for us yet!). Could the reams of words on Grand-parenting here and else where have been left to fester keeping our eyes away from the real ball game? I think the wise old Viking Canute must be laughing all the way to the bank!

Your posting sounds like I should have used it as a concluding paragraph on the end of mine? I cannot find anything to argue with! Sickening isn't it!!!

It makes me glad to be in private practice, however, but it is going to make an awful dent in the structure of chiropody, and it's services in the future! You know what they say about a large amount of 'CHANGE' hurting a lot of people. Still people are adaptable aren't they!!!

Regards,

Colin.

 

We're there A4C

Lincolnshire NHS Podiatry services

A4C Podiatrists graded 6 from Senior 2.

Why?

Because the department re-assessed its caseload a couple of years ago and on the basis of risk assessments, removed the l"low grade" , "cut and come again"
patients and the routine nail cuts.

I believe that the jobs were matched appropriately BUT BUT BUT its killed off
the previously graded senior 1 posts.

Not much insentive to evolve my recently appointed grade as Diabetes Specialist Podiatrist.

What with the HPC fiasco and A4C (which excludes Doctors and Dentists WHY)

What a year 2005 will be in the UK!

 

re afc

Dear M Staines,

How recently were you appointed.

Was your job description based upon AFC guidelines or Whitley?

If you are the Diabetes lead for your PCT therefore deemed to be the lead practitioner and the dept specialist then should you not be Deemed:

BAND 7?????

I know that in my PCT where i am the lead clinician for Diabetes and Nail Surgery in my patch im hoping for Band 7.

I may or may not achieve this.

But as you have said that there is no incentive to develop your skills knowledge and scope of practice.
So if your employer does not value its staff then the staff could migrate to an area which does.

The adjacent trust to mine has recently banded its Pods but i do not know the outcome.

It will be interesting to see what happens.

Had an interesting discussion on a job matching today for a band 5 staff nurse.

This was around analysis and interpretation of results.

Does the post holder record results and report to a senior staff .

or

Do they in fact interpret the results and change the t/t plan according to that interpretation.

the instant was administering dangerous drugs via IV and the nurse had to do th calcs for the doseage and flow rates and could adjust based on the interpretation of the results.

I voted for this which was agreed by panel members . This resulted in a Variance increased the total scre but did not take the post out of band.

So this is what i am enjoying about job matching.

Having a positive input into the outcomes of the matching to ensure that the staff are rewarded for their skill responsibility and training.

regards David

 

Reply To Davohorn

Dear David

We have a County-Wide Lead Clinician for our PCT who was banded 7

I have appealed for re-assessment. My grounds are many but one argument I have, is that I am effectively lead-clinician for my PCT which covers a quarter
of Lincolnshire.

Its really a question of interpretation. Thats the weakness, or strength of A4C.
I suppose its the "divide and conquer approach" (a cynic would say)!

Lets hope you get the grade you deserve.

Strange that all our attention is diverted to A4C at the same time that the goverment is pushing through Pension reform.

Yes I am a cynic

Regards Mike S

 

Interesting comments. Good to see conspiracy theorists are alive and thriving in the podiatry community! I wonder why? Colin, you wrote:

I believe the Management have been way ahead of the game years ago.

I’m not sure I would quite put it like that as it infers some sort of intellectual superiority over the rest of the profession, but I would say they have acted without consultation or negotiation, perhaps to the detriment of those not engaged in public care (and perhaps also to those who are).

Assume for a moment that we have a unified professional body in the UK – a British Podiatric Medical Association, if you like - that represented clinicians from every quarter.

Should NHS managers be allowed to sit on its Board or Council (as they do with the Society), or do contributors consider there in an inherent conflict of interest between the two roles?

 

Management ahead of the Game!

Hi Mark,

'I BELIEVE THE MANAGEMENT HAVE BEEN WAY AHEAD OF THE GAME YEARS AGO.'
'INFERS SOME SORT OF INTELLECTUAL SUPERIORITY.'

A definition of intellectual superiority could be,

'A group of people intellectually superior in leadership as an interest group having a common aim and purpose to act together.'

Notes to above def.,
1. Management are by nature a group of people with a common aim giving them a common purpose!
2. Could the common purpose be to self perpetuate their own statues in management?
3. Common purpose leading the group into and strongly influencing the SOCIETY by amalgamating with them. An excellent move if you want to stabilize a large part of Podiatry. Management appears to have foreseen troubled waters ahead, now confirmed by A4C (Change always hurts and brings rebirth/renewal and improvement of the original status quo!). Does it?

In answer to Marks, 'A UNIFIED PROFESSION...........A UNIFIED PROFESSIONAL BODY IN THE UK,' I have visions of our wise King Canute trying to get through to his people that he was not God Almighty and that Caesar is dead. (Well maybe after the first week in May, perhaps?).

Miracles can happen but I'm not sure I will see unification in my time. Wounds in my private sector are still healing! We are still here because we enjoy the work and I still can set aside forty minutes to a patient when it is needed because you see I'm in charge and the philosophy has always been heal them even if you loose them afterward! They will always tell others in a similar plight about you, concerning their feet.

I bring this posting back to earth here with:- FEET FIRST, PODIATRIST SECOND AND CHIROPODIST'S FOREVER!!! Much better than going back to a lost cause regarding grand-parenting! The REALITY is in what is happening in the NHS now and what the Management can do to steer the changes through now! (Trusting that this group of Professionals have the where withal to take on this leadership? I'm sure they have!)). You, however, should be in a better position to argue that than I could ever be looking inward from the outside?

Regards,

Colin.

 

Colin,

A similar debate is taking place concurrently on the SCP forum. I reproduce a reply I gave to Stephen Moore regarding professional changes in the workforce and the relationship of grand-parenting through the HPC, as it has relevance to what you wrote.

Mark Russell

>> Stephen

When closure of the profession was first muted through the Health Professions Order some years back, I assumed that new applicants from the unregistered sector would have been granted some form of provisional registration from the HPC for a specified period whereupon they would then embark on a grand-parenting (or mentoring) process with an approved individual/institution/practice. During this period I thought an assessment would be made of their skills and scope of practice, with the predominant focus on their ability to deliver safe and effective care within their competencies. Upon completion of their mentoring, my assumption was that they would be granted full registration with the regulator and likewise full membership with the professional body. I agree with you that this could also be extended to graduate podiatrists in much the same way as the trainee scheme operates for dental practitioners.

Such a process would be similar to the residency/preceptorship programs that run in the USA, which podiatrists must complete before applying for Board Certification in the State where they wish to work. If such a process had been constructed here, I believe the profession would have been greatly strengthened, and, if it had been structured through the Society, the existing schools, the NHS and accredited practices, we could have achieved unification without any acrimony whatsoever.

Instead what we have is a mess. The grand-parenting process is a shambles and in no way gives confidence to the public on standards of proficiency. I accept that many of the new registrants practice to an acceptable standard – indeed some will practice at a standard far in excess to many within the existing registered sector, including a fair few employed by the NHS. By not offering the new registrants such a process at the outset also undermines their ability to assimilate with the graduate practitioner on equal terms and that is also unfortunate. It is simply the result of bad planning exascerbated by corporate expediency.

To return to the impact on the profession of all the various issues at play – grand-parenting, regulation, workforce planning and the NHS Plan. What members see at present are individual components of a much larger picture. It is difficult to comprehend some of these changes in isolation and without overall consideration of their interplay with each other. What is becoming abundantly clear is that the government, through the NHS and the Modernisation Agency, are driving the professional agenda in a way that suits their own narrow political goals. The objective is to establish the NHS as the primary body in healthcare provision where care is provided ‘free at the point of source’. This includes the delivery of foot health services and if achieved, will have a significant effect on the livelihoods of everyone within this profession.

Correct me if I’m wrong, but I sense there is a professional redesign taking place in a way that suits the government's agenda. General practice podiatry [or routine chiropody] is to be structured in a way that care will be provided by non-graduate assistant grade clinicians – the generic therapists – rather than graduate practitioners in future, with graduate podiatrists undertaking only specialist roles within the organisation. Could this be why many Trusts are offering low bandings for Senior II podiatrists under Agenda for Change. Nothing like a pay freeze to disincentivise the workforce, huh? Such a move may well sound good on paper – you get a larger workforce, which will increase capacity, for the same costs as you pay the current graduate workforce. There may be an element of de-skilling, but you could argue that the existing workforce in the NHS is over-qualified for the work they do already.

If you do take that line to justify proposals for assistant grades, you might also want to consider the argument that graduate practitioners are inhibited from delivering their full scope of practice within the NHS because of the practice environment and the nature of employment the organisation offers. The endless bureaucracy, restrictive practising rights, incessant management initiatives, poor career structure and lack of financial incentives, all play their part in providing an environment that contributes to poor professional standards. De-skilling and increasing the size of the NHS workforce will not address these problems; but changing the model of employment, just might.

When you consider the impact these measures will have on the profession in future years, you might have assumed there would have been a process whereby the Society advised members of all the implications. Instead members have to work it out for themselves, piecing together all the various parts of the jigsaw until the full picture emerges. We lose our independence and autonomy; general podiatry practice is set-back four decades; and the profession is inextricably tied to the NHS model of salaried employment for the foreseeable future.

Which party do these measures serve best; the government and the NHS, or the profession of podiatry? <<

 

To Keep Taking the Tablets!

Hi Mark,
Yes regarding grand-parenting, your way would have been the sensible way to proceed but it hasn't happened, and it isn't in the thoughts of HPC now. The window of opportunity has passed and closed! It isn't what is important in the present scheme of things or state of play! Grand-parenting is history as we approach July and the Powers that be are happy to let it rest. Happy with results even if others are not!

A4C is the real keyword and it is the redesigning and new grading of chiropody. When I used the Industrial Revolution model above it was this I envisaged happening,
1. De-skilling the work force by sharing the skills of the artisan (Podiatrist) out among other workers happy to do their own part of the whole!

2. Closing down of the majority of the podiatry schools. Thereby producing a smaller post-graduate nuclei of degree-podiatrist.

3. Chiropodists/FHP' doing the day to day nail,corn,etc. work in the NHS. Trained in the NHS or schools approved by HPC? (Two for the price of One).

Problem solved for the Government and they didn't touch a thing!

N.B:- If there were more problems in Podiatry. It is solved by,

1. Nurses.
2. Voluntary organizations.
3. FHP in a new section of the Register!

Yes it sounds like all gloom and doom? How did I arrive here? I'm not even in the scheme of things! Who opened this can of worms? Then as one would say if one was brave enough, 'What do I know,' I can only watch the old guard being organized by outside forces. (Could they have lost the Initiative somewhere?).

Yes and I thought I was the target!!! Never mind Mark be like me, just keep taking the tablets.

Regards,

Colin. (And I haven't even been cautioned!).

 

Colin -I've just upped the dose!

 

Hi Mark,
After listening to myself typing that last one of mine and seeing where CHIROPODY might be going, your not the only one that has upped the dose!

Regards,

Colin.

 

Agenda for change will impact on the profession of podiatry with ramifications and ripple sent across the Commonwealth. this is not as a deliberate act to get one professional group but instead but a political incentive to meet client-articulated expectations. John Reid has pulled off a mammoth coop across the NHS.

Separation of ‘cut and come again’ from specialised care will ensue and the future could be grim for some as has been alluded too previously. Mind you it is fare to say that the best laid schemes of mice and men go wrong to paraphrase Robert Burns. As a prime example the concept of the NHS in the late 40s as a public health care system to eradicate disease, failed miserably because more and more need was identified and had to be met. In a similar fashion I believe the need for chiropody services to the elderly will blossom in the next decade as the ‘Bulge’ ages and Trusts may find instead of reducing their waiting lists these will boom. All hands to that deck is likely to become a serious drag on resources for specialised posts.

Who may fare less well out of A4C will be the specialist grades.


What say you?

Cameron

What, do I know?

 

It's notable that the profession, in the NHS at least, has spent the last two decades trying to dictate to the public what care they actually need, ignoring the obvious demand and tried to manipulate the market to a preconceived notion of what podiatrists should actually do. Dentists, on the other hand, have recognised the advantages of servicing actual demand hence the refocus on comsmetic dentistry during the last 10 years and the wholesale withdrawl from the NHS. The question I would ask is: "Is the NHS good for the profession's future well-being, or should we seek to remain fully independent and service the foot health market on our own terms?"

I used to think a chiropodist was a specialist in his/her own right. Seems we were wrong!

 

health and social welfare

The trouble with our health and social welfare system is simple.


It was founded post war to improve the then lives of many people for whom life was hard short and wracked with fatal and debilitating diseases.

So here we are 60 years later and it has been a dramatic success.

So dramatic that

PEOPLE DONT SEEM TO DIE.

So many people who have disease can have that disease managed successfully for 50 years.

So when pension day comes there are far too many people collecting.

Also the buggers collect it for nigh on 20 odd years.

So the NHS is bankrupt due to ever more medical interventions becoming available to prolong life (this is different to quality of life ) so that you and i fund the t/t's for ever longer periods of time.

In the good old days you worked till you dropped.

If you made it to pension day you did the decent thing by going toes up within a couple of years from a major heart attack or stroke .

So you paid in for 40 years and got one or two back.

We hav another crisis looming and that is in the no of paediatric conditions that 10 years ago were fatal , today the child can have his life prolonged almost indefinitely. Sometimes even when that child has insufficient organs to support independent life.

So where are we going?????

In the 50/60' there was a grueome film about the rapid decline of Homo Sapiens due to progressive genetic abnormality due to por breeding policies such that the whole of mankind was dedpendent upon technology for his survival.

Naturally in the film something interfered with the technology so that he became extinct in very short measure.

For the current generation of children whereby we have 55 year old 5 year old Type 2 diabetics what are the chances of these making old bones?

Slim i would have thought.

Will they even be able to breed and have viable offspring.

Imagine an 18 year old grossly obese kidney failure heart failure etc etc trying to get his todger up to try and impregnate his equally obese hairy male hormoned female partner.

Joy.

So where do we go now with our system .?

regards David

 

Cynical

We could try the old Avian Flu trick!
The CJD takes too long and the sudden increase in STD's doesn't seem
to kill the population off.
Tb and syphilis are on the increase and MRSA only seems to kill the old and
weak.
Its not warm enough in the UK for Malaria but global warming could sort that out.

Supersize It

 

>So here we are 60 years later and it has been a dramatic success.
So dramatic that
PEOPLE DONT SEEM TO DIE.

Have you read The Great Divide and The Black Report? Both excellent books on the histo-sociological perspective of the public health and the health care system in the UK. Neither would support your argument.

> So when pension day comes there are far too many people collecting.
Also the buggers collect it for nigh on 20 odd years.

Ageism apart, the socio-economics of the UK and Australia will require some pretty swift footwear to allow “the Bulge” to grow old with grace. The Bulge were the kids born after the second world war and have been the source of revolution throughout the ensuing decades. Now entering Grey Power I doubt whether they will die without a fight.


>So the NHS is bankrupt due to ever more medical interventions becoming available to prolong life (this is different to quality of life ) so that you and i fund the t/t's for ever longer periods of time.

NHS, seems according to the political pundits prior to the election to be in dire straight not because of the reasons you cite, but because of very poor executive management and unsupported government interventions and edicts which drain the very money which Blair has given over to the NHS. What resources remain support a top heavy administration and payment of external consultants, non-medical leaving very little moneys to trickle through to the clinical services. Not too clever a system to add Agenda for Change with any expectation of a paradigm shift.


> In the good old days you worked till you dropped.
That was the bad old days and wars were fought to change that. But it is sadly true many working class people will not reach their old age to claim their pensions that they have contributed to throughout their working lives because unacceptable high levels of morbidity and mortality continue to plague them due in many cases to poor public health and health care.

Cameron

 

re the meaning of life

Dear All,

there was an interesting article in one of the papers this week on the drug Aricept and its use in the t/t of Alzheimers.

The writer was writing about the ongoing tragedy of her mother.

Her mother got Alzheimers and the deterioration started. The progression was reasonably rapid so the mother was prescibed Aricept at £2.50 per day cost to you and i.

The writer stated that this drug gave them another year with her mother.

But sadly her mother DIED 8 yeras ago.

Trouble is is it is the brain that died 8 years ago. The body is still alive.

The writer describes the pain she feels when she visits her and there is no recognition at all .

Just a look of fear etched on to her mothers face as she stares into space oblivious to her surroundings.

8 Years of the above .

This is a tragic scenario and one that is played out routinely around this country.

Aricept is not generally available as it has not been approved by NICE so is subject to the constraints of the PCT's.

There is a lot of anecdotal evidence as to its efficacy, but research is inconclusive hence NICE lack of approval.

£2.50 a day is not a great sum if it is effective but is a waste if it is not effective.

Hence the reason for the article, highlighting the disparity in availability nationally.

I agree with most of the other comments from others on my pevious post.

But we as a Society seem to be saving peoples lives and then abandoning them afterwards. I work in a rehab Hospital and have to go on to the wards to meet the victims of serious disease.

Most of them are the living dead due to the severity of the damage caused by their disease process but their hearts keep on ticking along.

One chap has had half his skull and brain removed so is in a permanent vegetative state, and has been for about 7-8 years.

Surely this is not acceptable to any reasonable person.

But it is happening.

If you became seriously ill what would you want for your future?

Surely QUALITY OF LIFE IS MORE IMPORTANT THAN QUANTITY.

J. Clarkson of Top Gear fame put it very well.

He has been advised to give up smoking as it will extend his life by 5 years.

He said if he could be

40 40 40 40 40 then 41 42 etc he would do it.

But the reality is 71 72 73 74 75 .

SO Sod That !

A simple analogy of a sensitive subject.

regards David

 

A Quote from Cameron (5.3.5).

Hi All,
'PEOPLE DON'T SEEM TO DIE.' (Or was that DAVOhorn?).

Good thing to! I've being ducking and diving, trying to avoid it for years! I don't mind working till I drop but it has to be doing something useful?,

1. Removing a corn and the acid damage from a frightened old lady's foot who was in great pain, today, without adding her to the 'PEOPLE WHO SEEM TO DIE.'

2. Useful:- Being helpful: Serving a practical purpose. (Chambers Comp. Dict.). Could it be a Chiropodist helping and comforting a patient who has something minor in my eyes but major in hers! 'PAIN CENTRE'S THE MIND?'

3. Missed opportunities :- Having one of my old wishes fulfilled that at least one of the many murder victims I have watched, as I stood beside the Home Office Pathologist doing his utmost. At least one victim who had been murdered by being shot or stabbed in the foot so I could have studied real Anatomy. Selfishness of the podiatrist maybe? (The trouble now is I'm not sure that I could stomach watching it just at this moment in time if the opportunity was there!!!).
Are we by chance digressing away from A4C here or am I missing something, (No not that!)?

Regards,

Colin.

P.S. I've always said, "To heighten the status of Podiatry one needs to have more death and death threatening ailments of the feet to make the Government sit up and take notice! I'm writing this before house arrests start to happen for those who dare to speak back to Mark Antony!

"But what do I know, I'm only a CHIROPODIST or something like that!"