Can't get NHS foot care

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The Hampstead and Highgate Express are reporting:
Arthritic and 82 – but barred from the NHS

Full story

 

I don't normally respond to articles suh as this, but IF this pt has RA, surely she should be considered at risk?

Before I moved into full-time Musculoskeletal, I considered RA to indicate a high risk level, due to deformity, pain, immobility, atrophic skin, footwear fitting issues, pharmacy etc.

any other opinions

 

She'd qualify in My part of the world.

 

This woman was misinformed.

According to my very favourite search engine

RhA is indeed a high risk factor included in Haringeys foot health provision. She needs to be referred by her GP.

Bigger text: A A A find us . contact us . links.

 

An MP has weighed in on this one:
Lynne's Parliament and Haringey diary
Lynne Featherstone is Member of Parliament for Hornsey and Wood Green
82 year old with foot problems denied care on the NHS

 

From the newspaper report:

From the politician:

I think somebody'd got it wrong! Lets blame the GP!

 

Are we sure she has RhA or is the reported confusing o/a with RhA the GP certainly does not make mention of this high risk condition.

It is impractical for the NHS to see everyone that wants help.

 

If its OA then she probably would not qualify. Which, IMO is a shame.

Podiatry is the only area i know of where "merely" being in lots and lots of pain does not count as a "risk factor".

If i had toothache and my NHS dentist refused to see me because i was not "at risk" of my mouth going septic and causing blood poisoning i'd be a bit narked!

And they keep chipping away at the group which can be considered worthy of treatment. Low risk footcare, low risk corns and callus, low risk biomechanics, VPs.

Pretty soon they'll be no-one left!

Robert

 

I believe that deformity through whatever underlying cause IS included as part of Haringeys criteria for podiatry provision.

I apologise for repeating myself

Is it not possible that 'wires became crossed'' at some point. Surely in any department a complaint such as this would have warrented an assessment from a senior clinician.

 

The Sunday Mirror are reporting:
'HELP THE OLD' CALL

Full story

 

IF she has R.A. then she would qualify here.

However we'd need to be sure she HAS R.A. not just "rheumatics" as is favoured by many of our clients to describe their O.A.

I've lost count of the number of times I've been told by my clients their feet are dreadful, only to see mostly non-path feet before me, with nothing that can't be correctd by changing footwear style.

 

i really agree with Robertisaacs, if we are to consider ourselves among a high status group of occupations such as dentistry- we have to reconsider so called 'non pathological painful' feet with oa and not refuse to treat. anything else is scandalous.

 

Two points:

i) Never believe what you read in newspapers (or see on TV)

ii) is the Health Secretary openly stating that podiatrists are necessary to cut toenails? If so, the number of NHS podiatrists will have to markedly increase with a sigificant decrease in Age Concern carers etc. activities

Bill Liggins

 

I qualified in 1986 and it great to see the debate still rages! Not that I want to be unsympathetic but...
What is she high risk for...pain...amputation? Did anyone actually do an ABPI (if poor circulation makes her at risk) and if she has critical ischaemia would she be better off with a vascular referral not a podiatrist.
What is our purpose as a profession....keeping people comfortable? or have we moved on to reducing the amputation rate yet. Where is our evidence for this for groups outside of diabetes. If I'm in pain I have to pay for services (who geta an NHS dentist these days in the UK?)
Perhaps the biggest debate is lots of elderly want footcare and unfortunately its still seen as our job to provide it. Is it? Years ago when criteria such as over 65, schools kids and other such pathetic spurious 'criteria' were invented for access to podiatry services from managers who knew nothing about podiatry apart from 'cutting toenails' allowed the flood gates to open to the elderly. Unfortunatley they get older and have very vocal relatives and no one is looking at other ways of dealing with the 'problem'.
Podiatry departments in the NHS are generally small and are out flanked by nursing staff in greater numbers but no one sees it as their job to do footcare.
Dare I suggest some people have had free treatment for years at the expense of the NHS when they should have not been in the system. These people get benefits to pay for services, is it the NHS's fault they see it as their spending money.
Any idiot can cut nails. The universities who train new students would do well to drop the nail cutting and concentrate on assessment of something more useful.
Anyone bother to read the Darzi report?
lets hear it for winging poms

 

don't agree with that (dave), surely pods are here to make people comfortable too??isnt that what other professions also do? a doctor gives a patient omeprazole for gastric reflux that is uncomfortable, but not necessarily painful. it is an immediate 'cure' to a problem, albeit benign, that is really linked to nutrition and lifestyle; eating the right food and getting exercise.

if pods can cut nails and it takes them two minutes, why cant we do it? and while we are at it take a neurovascular. to claim that older people are somehow 'taking advantage' is absurd, they have worked their whole life and deserve good treatment.

every trust should have a walk in clinic, and most do.

 

if the profession is to move forward it has to stop complaining about the menial jobs. take physio's, do you think they enjoy teaching patients to cough? holding things together as a profession and focusing on areas such as increased funding for diagnostic tools and more up to date equipment, pushing for increased scope of using meds and increased communication with the other allied health professionals would move the profession forward.

 

having thought about it, you are right pommypod. Why should a podiatrist with three years training only cut nails when a foot care assistant can do the same job!!!
We should be spending more time during training concentrating on biomech assessments, studying trad medicine/ possibly herbal/chinese medicine, and even possibly accupuncture??!!

 

Thankyou! unfortunately pods inherited a legacy from the past which only compounded toenail cutting. How much does a band 5/6/7 get paid these days...expensive service for what benefit exactly , some comfy feet? Diabetes is cleaning up so to speak, here we can make a real difference and we can prove it. What would you rather be doing?
Read Darzi, a chance for AHP's to use their best talents to make a real difference, thats if anyones got any room for talent after concentrating on years of toenail cutting!

If the profession is to move forward it has to STOP doing the menial crap. Lots of 2 minutes cutting nails adds up to hours and reinforces thats what we do, spend your time on vascular triage and setting up some decent lower limb assesment clinics.
If podiatry as a profession ended over night I'd like to think we would have a stream of our AHP's, diabetologists and consultants crying for our return. Not some blue rinsed Margaret Thatcher moning about toe nail cutting.
Get Real.

 

forgot to add my experience of walk in clinics is they walk in wanting toenail cutting! enough to make glass eyes weep

 

This is really sad, but I feel the nail clipping and wound care is the most easily result-quantifiable part of our job, compared to biomechanics of the foot and orthotic prescription. We just need to make it clear to our clients that we provide other services. It is very easy to slip into the nail cutting business when this is what the public expect, and is the easiest/safest for us to understand. Only we can control their expectations by providing them with our full care, using all testing/treatment as it may apply to the patient. I feel that if we had podiatry assistants where I am a lot of pods would be a)out of a job - as this is the most common reason for a visit or b) struggling to make ends meet and trying to attract younger clients for orthotic issue or c)podiatry assistants themselves - because this is their 'comfort zone' and have forgotten the majority of their unused curriculum.
I feel it's ridiculous to be charging high prices for regular nail cutting, but we have created this for ourselves. How do we just step away from it and create a future for all our practitioners if podiatry assistants are taking over the majority of our work?

 

Going back to the original post, I have seen this happen at several clinics in Australia - where routine pensioners were asked to leave clinics as they were not 'high risk' - This was mainly determined by diabetic neurovascular risk. There were definitely a few patients let go that were not diabetic but were certainly high risk - history of px ulcers from RA, very poor mobility etc.

Maybe we should be playing a larger part in fighting for funding to get help for these people. It seems like such an unfair distribution of services here. Some clinics are free, some $5, $28, $50 - surely we could get the government onboard to make this a bit more fair. I know the EPC -enhanced primary care packages from our health care system have helped - ie 5 free visits a year for high risk patients. If we could improve on this, and have our practitioners being paid a professional wage at the same time we may be onto a winner.

However, if we are simply going to have podiatry assistants doing the bulk of the 'menial' work, we should stop training new podiatrists. As I said in the last post we will be out of a full-time job if this occurs.

 

'However, if we are simply going to have podiatry assistants doing the bulk of the 'menial' work, we should stop training new podiatrists. As I said in the last post we will be out of a full-time job if this occurs.'

It should therefore be inherent that we need to move forward in time and adopt other treatment methods that are currently being validated by research. We should be applying modalities (physio), acupuncture (TCM) and joint manipulation techniques (osteopathy). It isnt for no reason they call it evidence based medicine!!!!

 

Even with so many treatment modalities, I dont know that we have enough musculoskeletal foot problems to keep us all in business in Aus (without our routine treatments).

 

I believe almost 30% of patients entering GP practices have a MSK/rheumatology problem. That is a lot of patients. The guidelines here in the UK are that we see high risk patients for nail cutting, but OA is not considered high risk. Try telling your dentist that you have pain and he retorts with...well it is only a bit of pain. We have to be able to treat and manage all the patients with OA.

i dont know perthpod the exact figures, no one does for sure - but my guess is that most patients (at least in UK) with a sports injury problem of the lower limb go to see a physio. That is what I have a problem with. We should be the BEST at treating ANY pathology of the lower limb. That includes the leg and thigh and hip. Why should we be keeping our scope of practice 'within' so called reasonable limits, when other allied professionals are begging, borrowing and stealing from wherever they can.

The problem we are having is a problem of perception (at least here in UK). Patients are simply not either being referred by GP's or do not see a podiatrist. The physios are taking all the patients!!! We need to be more progressive with taking on board other treatment methods. Surely it cant be just me that is thinking that!???

 

I guess the answer might be to bring a greater physical therapy section into our course at undergrad and postgrad level. I think there are a few pods over here using acupuncture/mobilisations to get results. I agree that the attitude needs to change about our scope. We are just as capable (given the correct techniques and used correctly) as anyone else. It would be nice to have the time and money to pick these up - I am inundated with regular low risk toenails .
For those pods that practice these techniques (needling/physical therapy) it may be matter of better advertising and cross referral - listing our services and talking to potential referral sources.
How much of the lower limb are you legally allowed to treat/manipulate/strap/needle/ultrasound/apply medicaments to in the UK?
Maybe we should fight for these rights if we are to go up that path. Who doesnt want a)more control to improve their patients health, b) more strings to their bow c) less menial labour d)greater respect e)new exciting techniques to work with.
Hope the physios are ready lol. Might be a tough fight. Nothing we havent been up against before though, as a profession, right?

 

Is RA necessarily 'high risk'? There are a number of variables. Sero negative or positive? On DMARDs? Biologics?

Dorsal lesions? GP could have ref'd. pt. to Orthotic Dept for bespoke footwear.
Plantar lesions? Is there not insole provision?

Surely the issue is not that a disease leaves the foot vulnerable but that damage done by a disease does so; is neuropathy present, vascular damage, compromised immunity??

Just a thought!

 

i just think that you treat the patients pain, with whatever possible.

'I guess the answer might be to bring a greater physical therapy section into our course at undergrad and postgrad level' this is what I would like to see, others might argue that the physiotherapists could do this. However if we want more interesting cases, it seems that that should be the way forward.

 

If anyone wishes to speak of adding extra components to the under or post grad qualification, and they are looking for a possible blueprint, then look no further than the inspired article by Dr Kilmartin in the most recent "Podiatry Now". Itis an inspired work, if only it would be taken on by those that we laughably call our leaders. Just a thought:wacko:

 

I havent read the latest Podiatry Now, simply because I haven't received it yet. However I don't quite understand your attitude when you refer to the 'leaders' with such disrespect. That type of attitude does not sit well with me, and I have had to defend against on numerous occasions.

 

you misunderstand it is not disrespect, but merely a desire to see a much needed change taking place in our profession sooner rather than later