What is the answer to overcrowding in the NHS?

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Hi all, I have worked in the NHS for nearly three years now, and have already noticed that we (NHS staff) can not cope with the patient numbers coming through our clinics.



One answer and a simple one at that would be to employ more podiatrists, but the fact is that is not going to happen, where is the extra money going to come from?



It seems to me that most trusts are looking to offload the "simple" low risk nail cuts!is that the answer? or have we a duty to supply a service to these patients (in doing so, letting high risk patients wait longer in between appointments).



So what is the answer?

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The answer is so blindingly straightforward that someone must be putting much effort into making sure it does not happen.
Use existing private practitioners and their practices.
Keep the dedicated NHS clinics for high risk patients (more interesting work for you too if you choose to remain wholly in the NHS) - devolve the "bread and butter" work out to private practices. Mark Russell has already outlined the costings, and they are a drop in the ocean as far as the NHS is concerned.
There is rumour (and Mark may like to step in here, he is well-informed about these matters) that it may be possible to receive a practice start-up grant to finance the practice initially.
Regards,
David

 

David is quite correct in his view that the answer to solving the capacity problem in the NHS is to make more effective use of those practitioners who work in the private sector. This is often alluded to as the 'dental model' but in fact it is the same model of practice that general medical services operate under too.

If private practitioners were able to incorporate a component of NHS work into their caseload the capacity problem would be solved at a stroke. However, at the present time, contractual arrangements for utilising private practice are wholly inadequate from both the NHS perspective and that of the individual practitioner.

Before I expand on this I have asked the Society of Chiropodists and Podiatrists what strategies they have employed to promote such a policy to government. Once I have an answer I will offer my own view on how best I think the profession should structure future delivery in the UK healthcare arena - should there be any difference in what SoCaP offers.

Best wishes

Mark Russell

 

Your suggestions are valid and i agree with them, but the nhs are not going to support your ideas.

At the moment there answer(nhs) seems to be the use of non state registered nail care assisstants, which in theory sounds good, but the nhs, mainly due to insurance, and a lack of support from state reg podiatrists! limits the work they can do even to lower risk patient(which is for another discussion).there are only to do the "simple" nail cuts with no balde work, at the end of the day most areas have discharged these kind of patients, but we are still overcrowded!!

The fact is a high% of patients within the nhs are high risk or have biomex problems leading to there foot problems, i dont think the answer is to pass the "simple" nail care to the private sector because i dont believe these are the patients that are causing the overcrowding, the nhs is now being overcrowded by people with podiatric need, so are we now trying to get rid of them?

 

Succinctly put, and those are certainly the facts as I see them.
Rather than looking at the "NHS" as a huge entity in its own right, we need to start looking at who is stopping the idea of utilising exisiting private practices.

When M Russell's paper was first published in Pod Now, those most vociferous in putting forward reasons why "this could never work" were those who had a direct or indirect vested interest in maintaining the status quo of NHS podiatry. In other words it would seem that vested interests outweigh the screamingly obvious need to re-vamp the system .
Regards,
David

 

There are many ways to increase capacity in the current NHS set-up - changing the administration/scheduling systems and clinical methodology being just two. It is quite possible to treble capacity without increasing the existing workforce but even if you do, that will still prove insufficient. When you consider there are over 10 million elderly people, 2.5 million diagnosed diabetics and an estimated 1.5 million people with other contributory 'risk' factors such as rheumatoid arthritis, lower limb ischemia & etc, many of whom need podiatric intervention, then increasing capacity from 2.1 million patients to 6 million is simply not enough to meet the demand.

Whether or not NHS management are happy with the use of the private sector is irrelevant. It is the government that sets health policy not middle management (although that's what has been happening of late). What we as a profession need to do is to secure from government a commitment on what care they would like us to provide to society on their behalf (i.e. that they will pay for) and what care the public should bear themselves. It may be that we are left with a small core salaried workforce - for acute and specialist work based in hospitals or specialist centres - but there may also be some commitment for general practice podiatry and I would submit that this is best served through an independent practice network which can take on a component of NHS care. But we are a long way from that scenario at the moment - not least because the existing practice network in the UK is of such variable standards that it warrants serious concern should NHS care be so disposed.

What is needed is for government to support such a scheme in the same way that it supports general medical and dental services by way of practice grants and incentives (and of course, funding), but they will only do so if we can convince the establishment that podiatry has a social value – current and potential – and that those practising in this field are responsible and competent in their care.

When I see sight of the SoCaP policy I will comment further.

Yours sincerely

Mark Russell