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Regulation of Health Professionals (Scotland)

Discussion in 'United Kingdom' started by Mark Russell, Oct 27, 2004.

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    Dear Colleagues

    In view of the shortcomings of the HPC’s ability to introduce robust mechanisms to ensure new applicants to the register meet recognised standards of competence and fitness to practice, I have today petitioned the Scottish Parliament to ask that they examine why Scotland’s peoples should be exposed to unnecessary risk and danger from 'grand-parented' practitioners, whose only scrutiny or examination, has been self declaration.

    The Scottish Parliament has devolved responsibility for healthcare, yet it has no rights to ensure those, who are employed in its NHS, meet the high standards of proficiency we came to expect before the inception of the Health Professions Order 2001. Regulation of health professionals is a matter that has been reserved by the Westminster legislature.

    If the petition is supported and the Scottish Parliament secures the right to regulate the practitioners who work in Scotland, it is my intent to further secure an independent regulator and registrar for podiatry.

    If you wish to add your signature to this petition or make comment or start a discussion, you can do so by visiting the Parliament website at the following address.


    Yours sincerely

    Mark Russell

    <<Health is a devolved matter to the Scottish Parliament. Therefore the responsibility of providing Scotland’s population with quality, safe and effective healthcare lies entirely with the Scottish legislature.

    However, the Westminster Parliament has reserved regulation of healthcare professionals, which involves professional qualifications, eligibility to practice and control over standards of professional competence and conduct (G2 of Schedule 5 to the Scotland Act). Health professionals are defined for this purpose as: doctors, dentists, chiropodists and podiatrists, opticians, pharmacists, nurses, physiotherapists, clinical scientists, dieticians, operating department practitioners, orthoptists, paramedics, orthotists and prosthetists, biomedical scientists, radiographers, speech and language therapists, paramedics and art therapists.

    Two exceptions are specified to the reservation. The Parliament does have competence to legislate about what vocational training and experience is necessary for doctors before they can provide general medical services in the NHSiS (section 21 of the NHS (Scotland) Act 1978). The Parliament can also legislate to regulate the provision of general dental services in the NHSiS so far as that relates to vocational training and disciplinary proceedings (section 25 of the NHS (Scotland) Act).

    The Health Professions Council (HPC) is a new independent, UK-wide regulatory body responsible for setting and maintaining standards of professional training, performance and conduct of the 12 healthcare professions that it regulates.

    The HPC was created by a piece of legislation called the health professions order 2001 – a Statutory Instrument No 2, which came into force on 12 February 2002.

    Contained within this legislation was the power to protect the titles of the regulated professions. It was envisaged that protection of the titles would offer some safeguards to the public when making choices from the available competencies. For example, prior to the Act, any person could legally call himself or herself a chiropodist or podiatrist or physiotherapist, without having gained any qualifications in that discipline whatsoever. The primary objective of the HPC was to secure effective regulation of all practitioners who practice in their respective fields under the banner of the protected title.

    Those practitioners who were already in practice but had no formal or recognised qualifications could apply to be ‘grand-parented’ onto the new register and it was initially envisaged that some form of test of competence by applied to those persons, which would assure the public and the professions of their suitability to undertake safe and effective practice. This process however has become notoriously lax and there is no examination or test of competence to ensure safe and effective standards.

    Grand-parented practitioners, with no formal training or qualifications, now have the same legal basis for employment within Scotland’s NHS as a graduate practitioner. There is a clear and potential danger to the health and welfare of Scotland’s population.

    The Scottish Parliament may have the responsibility of providing healthcare to its population but it is powerless to regulate and uphold standards to those people it employs in its National Health Service.

    That is an anomaly, I respectfully submit, should be addressed without delay.>>
    Last edited: Oct 27, 2004
  2. Graeme Franklin

    Graeme Franklin Active Member

    Dear Mark,

    I understand your concerns but why not just gracefully accept defeat? The Health Professions Council, a government appointed independent regulator, has grandparented not only chiropodists/podiatrists but other healthcare professionals as well. It has happened and it is now time to move on. The practitioners have been deemed to be competent; is this such a big deal? The vast majority will elect to stay in private practice because it is what they are used to so they will not affect NHS podiatrists. However some may apply for NHS vacancies in which case the best candidate will be appointed regardless of background. Where's the problem?

    In truth this debate really harks back to the SRCh v non-SRCh debate and personally I am beginning to find it boring for the first time. I would rather be working, studying and treating patients rather than debating about it.

    As an aside this debate is similar to what happens in the bureaucratic NHS, and I sincerely hope this will not be misconstrued as a personal attack, some professionals busy themselves doing work for which they were trained for, and many others just want to talk about it (and still get paid).

    Best regards,
  3. Regulation of Health Professions (Scotland)

    Dear Graeme

    I’m afraid I disagree with your comments. I would like to start by saying that I hold no disrespect against those people who have come into the foot health market from the independent sector. I do not wish to inflame the SRCh-v-non-SRCh dispute that has been simmering for years. But the simple fact is that there is no benchmark for clinical standards for those who have taken this route. I accept that some of these people are responsible and practice at a level that ensures patient safety. But there are others who have had little or no training whatsoever and are clearly a danger to society.

    The problem with the ‘grand-parenting’ process is that it judges competence and fitness to practice on self declaration. The HPC only really becomes involved when there has been an adverse incident. It is reactive rather than proactive and that is a recipe for disaster.

    I had hoped that the HPC would have proved beneficial to the whole profession; that it would seek to protect the practice of podiatry in the same way as the Dental Act protects dental surgeons. But as we have seen, protecting titles is rather meaningless. People can still buy their scalpels, call themselves another name aside from podiatrist or chiropodist and proceed to wreak havoc on the public at large.

    I would have welcomed the independent sector trained clinician into my profession providing they passed some form of test of competency. I would have embraced them and encouraged them to update their skills with a programme for clinical development until hopefully they were of a standard that reflected their undoubted devotion and ambition. But alas that did not happen. For those people who have taken the grand-parented route, the lax legislation will only serve to alienate them further and that is highly regrettable.

    My first responsibility in my professional life is to my patients and that is the basis by which I submitted this petition. One of the most important pieces of writing on this subject came last month from a practitioner called Brendan on the JISC forum. I’ve provided a link here if you haven’t already read it:


    Perhaps you can reflect on what he says and if you still feel the same way I suggest you make your point on the Parliament’s website. It would be interesting to see if the public agreed with your sentiments.

    Kind regards

    Mark Russell
  4. Graeme Franklin

    Graeme Franklin Active Member

    Dear Mark,

    I can understand your frustrations and as a grandparented podiatrist I would not have objected to a test of competence, although in fairness it is easy for me to say this as I have already been accepted. I think the logistics of testing several thousand applicants would have been interesting, but the profession would still be divided anyway because no-one would agree on the standard and format of the testing. It is also a moot point because the HPC have set their own criteria.

    Regarding the HPC being beneficial to the profession, then I think we are in agreement as we will all be sorely disappointed. The HPC's only remit is to "protect the public" which basically consists of removing aberrant practitioners from the register when they have been proven incompetent or have brought the profession into disrepute. Perhaps this is where the much discussed General Podiatry Council may be of benefit to the profession, and hence the public.

    Thanks for the link to the JISC site; quite a good letter from Brendan. The point being, I think, is that being steeped in the NHS culture gives you a wider perspective, and this view has merit. Ultimately though, it depends on the integrity of the practitioner to continue with their studies, to do your best for the patient, and to refer cases when in doubt.

    Best regards,
  5. Regulation of Health Professionals


    The last time 'grand-parenting' was applied to this profession was in 1960 and the process consisted of a practical and theoretical examination which was conducted through the established schools of chiropody. My father was a grand-parented chiropodist, having done some training in the army during National Service in Suez. He retired eight years ago after nearly 40 years service in the NHS, finishing as a district chiropodist in Fife. Far from being seen as a barrier or divisive mechanism, it enabled those practitioners to become widely accepted by the 'registered' profession at the time.

    That has not happened with the HPC and I fear that people like yourself will always carry a great stigma in the eyes of the public and those who have taken the graduate course; that I think is regrettable.

    It would have been relatively straightforward, in practical terms, to set an examination process similar to that conducted 24 years ago. Agreement could have been reached by objective consultation between the respective professional bodies. And in terms of regulation, it would have been seen as proactive rather than reactive.

    At the moment, the public can only be protected after the event. There has to be some form of adverse incident before the disciplinary process within the HPC comes into play. It is simple to dupe the system at the moment; you could quite easily register a monkey as a podiatrist today by creating false documentation and declarations, and that does no-one any favours at all.

    Your last point I am in agreement with. It behoves every practitioner to maintain the highest standards of competence. There are many registered podiatrists practising today that I wouldn't put my tender toes anywhere near. I have always been in favour of some form of revalidation or recertification program - which entails a practical and theoretical examination every 5 or 6 years. Counting on attendance at CPD courses is a poor alternative as there is a world of difference between attending and learning.

    Both mechanisms tabled by the HPC - grand-parenting and CPD - sound the death knell for our entire profession; whatever route of training (if any) you took.

    Best wishes

    Mark Russell
    Last edited: Oct 28, 2004
  6. davidh

    davidh Podiatry Arena Veteran

    Mark, Graham and other interested parties,
    Re-validation would be an excellent way of maintaining standards. Unfortunately it is unlikely to happen under the HPC.

    I had hoped that HPC registration would provide some common ground for podiatrists - as time has gone on however, I see that it has merely been an expensive political sop - It hasn't even given the newly-registered any protection against other people "doing feet", who can give themselves any fancy title apart from chiropodist or podiatrist.
    Nothing against foot health professionals or others who have done some training and passed exams - I believe they have their place in the UK foothealth market. The answer now lies in a separate overall body who can make some sensible rules which work both for practitioner and patient. Over to you Mark!
  7. Robin Crawley

    Robin Crawley Active Member

    Hi Mark!

    Another interesting post.


    Please could you enlarge on this : "Both mechanisms tabled by the HPC - grand-parenting and CPD - sound the death knell for our entire profession; whatever route of training (if any) you took."

    Points I'd like to make:

    A Grandparenting process in underway for all of the 13 HPC regulated professions. When one profession is regulated by the hpc it has a 2 year grandparenting process, and so on. Like Graeme said, there are a lot of other grandparented professions as well as Chiropodists/Podiatrists, regulated by the HPC, Biomedical Scientists for example.

    Also under the General Osteopathic Council there are many grandparented Osteopaths, and there is no distinction between them and those with a BSc as far as the public is concerned either.

    As I expect you are aware there is the regulator of regulators called the CHRE - Council for Healthcare Regulatory Excellence, which is an Independant Body.

    They regulate the : GMC,GOC,GCC,NMC,RPSGB,GDC,GOSC,HPC and PSNI.

    There MAY also in the not too different future be a regulator for Complementary therapies ie Acupuncture etc.

    Norma Brooke said the HPC want to be the #1 health regulator in the UK. The legislation is such that they can include as many professions into it as is needed.

    The GDC are moving to regulate the entire dental team. This could happen with the HPC for footcarers of all types.

    So I think in years to come the world of healthcare is going to be entirely different anyway.

    To my knowledge there have been 1700 ish grandparented Chiropodists/Podiatrists so far. There may be a large influx in the next 7 months, who knows?

    I think the HPC is good thing and I am very happy with it. :D


  8. Graeme Franklin

    Graeme Franklin Active Member

    Hi Mark,

    I don't quite understand your comment about CPD. Just about every grandparented pod I have met, and there are many, are committed to CPD. I think CPD is worthwhile and is what the patients deserve.

    Best regards,
  9. Robin Crawley

    Robin Crawley Active Member

    Something else I was thinking about Mark...

    You say : "I had hoped that the HPC would have proved beneficial to the whole profession; that it would seek to protect the practice of podiatry in the same way as the Dental Act protects dental surgeons. "

    I actually asked Jonathan Bracken the HPC's solicitor about this when I met him in June. He said that the act of Dentistry is NOT protected, only the title is. There is nothing in law to stop me or you setting up as 'The Tooth Man' or whatever. What would stop us is the ability to get NHS patients, or any other patients for that matter who would have confidence in us. There would also be insurance issues and unavaliability of Anasthesia. There are very few medical actions which are protected in law, just titles.

    Similarly referring to Osteopaths again, manipulative techniques are employed by some Physios. Also some Podiatrists use Acupunture, without being members of the British Acupunture Council - I bet if the title Acupunturist was protected, then the BAcC would be similarly agreived. So these medical 'actions' aren't protected either. Hence, if you were to get the act of footcare protected (because footcare is a part of Podiaty) where would this leave Pedicurists?

    So for these reasons I feel your proposals are unworkable.

    Another thing: you want social nailcare on the cheap by volunteers or whoever, and you want the act of Chiropody/Podiatry protected. Do you not want your cake and eat it?


    Robin. :)
  10. Regulation of Health Professionals

    Dear Robin,

    You miquote me; I have never advocated 'social nailcare' by an army of volunteers and have never written so. I don't even recognise the term. But I have promuglated the opposite on many an occasion in the past.

    The grandparenting process is not equitable amongst the professions. It hardly affects some groups like speech therapists or art therapists in the same way as it does podiatry. It is within our profession that its impact is felt the most. That is why it’s critical to do it right.

    And yes I do want to see a Podiatry Act. It is essential for the future independence and well-being of this profession that we have one.

    What else should you do with cakes anyway?

    Best wishes

    Mark Russell
    Last edited: Oct 30, 2004
  11. grand nonsense!

    Dear Graeme

    I do believe postgraduate education is worthwhile; that is not an issue. But to use it as some benchmark to maintain and uphold standards without some test of comprehension seems rather silly to me. Life is full of testing times; what have we got to be afraid of?

    I don’t give much credence to what government says; perhaps it’s a question of trust. So as far as the point about their regulatory intent is concerned, I don’t really share your gloomy view. Like most other things we have to do this ourselves; being reactive to policy and docile with our response, isn’t really an option anymore. Not if this profession is to survive.

    Of course you have every right to disagree. But in time, I hope that I can prove you wrong.

    Kind regards

    Mark Russell
  12. davidh

    davidh Podiatry Arena Veteran

    Hi all interested parties.
    I've posted this comment elsewhere, but it's pertinent to this thread so I'm posting it here also.
    How come the leading UK professional bodies (SMAE and the SCP) are not joining in this debate?
  13. dmdon

    dmdon Active Member

    An interseting debate, but when oh when in Gods name will it end?!

    Its happened, its here to stay, all that will come of this particular issue, is a few individuals will get recognition from high places (maybe thats what they want) but at the end of the day nothing will change.

    On the odd occasion we will read somewhere that a non-graduated pod will be struck off or disciplined and people will say 'oh, I told you so' and vice-versa will happen and some will say 'typical'.

    I would say that about 90% of people working for the NHS probably arn't too concerned about what the public think about pods, and about that amount of public have absolutely no idea what all the fuss is about just so long as they can get a free service!

    I think it was Graeme who said lets just move on, and I quite agree with that, the only difference between the 'us and them' set up now is that some of us don't get a final salary pension!

    I think the reason that the SCP and BChA don't get involved is the fact that they have probably heard it all before, and like most of us are fed up with it.


    David D
  14. davidh

    davidh Podiatry Arena Veteran

    Hi David,
    Well, where do we move on to exactly?

    I don't get a pension (other than the one I've organised for myself). Mark Russell doesn't get a pension, and neither of us subscribe to an "us and them " situation. What we do recognise is that many in our profession need to be brought up to standard (both new HPC registrants, and old SRCh registrants).

    Here are two examples:
    1. In general practice it is useful (some would say necessary) to be able to provide local anaesthesia on occasion. The newly HPC registered (with one or two exceptions) do not practice this technique, nor have they been offered an HPC-recognised course to date.
    2. A former SRCh (who I know quite well) is practicing from a surgery. He has an autoclave (but it hasn't been used in months). He hasn't done any CPD to my knowledge. He's been qualified longer than me!! :eek:. Sadly he is by far and away not alone in this.

    The UK foot health market (NHS patients) needs to be opened up so that we all get a share of the work.
    Ultimately I don't believe the HPC are capable of looking after the interests of our profession. Indeed, it is not their remit to do so.

    I don't know why SMAE and the SCP are unwilling to become involved in public debate. Surely without this the profession has no possibility of unity in the UK?

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