Should 12 months NHS be mandatory

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Ive been recently surprised by reading that there are a considerable number of UK Podiatrists who would recommend a 12 month stint in the NHS be mandatory.

I qualified over 12 years ago and worked for the NHS for the first 4 years. The first two were horrendous . The last two were ok but I still became de-skilled in many areas such as nail surgery and biomechanics as there simply was not the opportunity to work in these areas. When I qualified Podiatry in the UK had the biggest 'burn-out' in allied health medicine (i.e the most number of new grads leaving the profession within 2 years of qualifying). I do not blame the NHS for this but believe that if you take a new grad who has been exposed to wonderful areas of their profession at uni and put them on 'doms' or in a clinic where they are not challenged it must influence their decision by demotivating them.

Yes I have friends who work in NHS and are happy to stay there and I understand there has been alot of re-structuring of NHS Podiatry for the better but I am confused as to why Podiatrist would think that NHS work should be mandatory. We have employed new grads straight into private practice, offered them support, guidance, training and given them the opportunity in all areas of Podiatry allowing them to practice a full scope - this system works very well in Australasia.

In Australia and New Zealand the vast majority of Podiatrists will go straight from Uni into Private practice.

I would be interested to hear what others think about mandatory NHS work.

 

podpod,

you mention " offered them support, guidance, training and given them opportunity in all areas of Podiatry "

This is the key. Your employees are lucky. Many perceive the NHS the best place to offer this, however I don't believe this is often the case. I also believe the majority of Pod's going into private practice don't get this support.
Don't get me wrong there will be fantastic opportunities both in the NHS and PP offered around the country, but i see them being few and far between.

The solution in my opinion, is to have a pre-registration year with strict guidelines on support and exposure of newly graduated Pod's with no difference between them undertaking this year in NHS or PP.

 

That would be neat, like a residency program, in fact it could be something that was extended over 3-4 years to cover surgery, rheumatology and diabetes etc rotations. I wonder who would administrated this?

 

George,

This is exactly my thinking also. It works incredibly well for Pharmacy - there is no reason to suggest it wouldn't for us.

 

i agree, that sounds great!!

 

I'd be a little more hard line than that. I think the NHS is the place to cut your teeth. Although I agree that the manner in which you do so should be monitored rather closely.

The reality is that the toughest patients are found in the NHS. Somebody with an ulcer may wander into a private clinic but by and large the things which are a threat to life are NHS. I saw my first dry necrotic toe 2 months after qualifying. How long would I have waited in PP for that lesson? Or for the raging Charcot? Or the Cerebral Palsy biomechanics? NHS gives an unrivaled scope of experience.

However, I do think that this should be regulated rather carefully as a mentored position. Lobbing graduates into the hard clinics and seeing how many walk out the other side is not educating them. There must be support mechanisms for this pre registration year.

Regards
Robert

 

:good:

Not often Rob and I agree completely, but we do on this one.

 

Thats only because I learn so much more from you when we disagree old friend :drinks

 

hi i agree a pre reg year with structure and mentoring would produce better podiatrists but it is not a career like pharmacy my wife did pharmacy at manchester a few years ago most people in her group went to private school there was 100 applicants with 5 grade a s for every place no part timers no clearance places upon completion of her pre reg got a 50 grand ayear job locumming for hospital after 2 years locuming got a 8b position this is not possible in nhs podiatry a pre reg would be lucky to get a band 5 job scraping callus no promotions for the whole of eternity and one day if you are very lucky a band 7 2 kids and a ford focus some people crack the system but the district chiropodist who interviewed me 30 years ago is still the district head so a very stupid interview question ie where do you think you will be in 10 years answer oh in your job i hope well she will still be in the job after 40 years ill be retired thank god

 

I fully agree with this - at the moment though i think as a new starter, you get out what you put in - if your willing to take on the difficult patients, put yourself up for helping out with guidelines, research etc then you tend to get more backing from the upper tiers, if you want to take a back seat, then the chances are you will be stuck in that seat for quite some time

 

That said, the NHS does teach people how to use full stops!

True thing. Teaching someone who does not want to learn is like pushing treacle uphill with a stick. On a hot day.

 

Again we agree - and less of the old.

 

very sorry guys i cant type for ---- will try to improve

 

I SAID, I LEARN MORE WHEN WE DISAGREE OLD FRIEND!!!



:drinks

 

Don't on my account. Its all in good fun.

 

This is an excellent idea, time spent in the NHS on graduating can provide a supportive environment in which to develop skills and ask questions, benefitting from the experience of others. I , for one, did not know it all and still dont, but i was lucky enough to have a clinical mentor to advise me when i was in trouble ( you know who you are )Private practice can be challenging for the new graduate in several ways. Namely problem solving, referal pathways, money!, skills base and even emotional support to name but a few. Perhaps many of the new graduates posting on podiatry arena would not be asking for so much advice about setting up a PP if they had the opportunity to learn on the job. A little bit of confidence and experience can get you a long way. Just an opinion.

 

Good point.

 

Money, it's all about money.

Some NHS managers have funded training places for new graduates others don't. My own local trust got rid of all grade 5 posts in the recent review.

The idea of a post registration year has been kicking around for years but in the end who will pay for it. There is no funding. There are Graduate training schemes in Physiotherapy and Occupational Therapy but I don't know if they fair any better than the ones in Podiatry.

A grade 5 post is a grade 5 post and would offer no training advantage. A training post requires just that, training, mentoring, supervision, assisting etc all of which is non-productive and takes up someones time. And yes, that all cost money and no one wants to pay.

That's not to say it wouldn’t be a good idea. It is easy to make out a good case and the graduate might even be more productive for it. But there is no money, even the current three year courses are under financial pressure.

Sorry to upset you all.
Luke

 

i totally agree luke you are bang on the money if a good experienced mentor was to take on a trainee it would slow them down. gp training practices take on gp training the trainers are fantastic at the top of their game but guess what they get paid and not 1500 quid a year extra which is i believe what the average nhs trust pays. so as you say a good idea in theory but wheres the cash . some trusts would use it as a cheap labour scheme band 5 in at the deep end no training get rid in one year no job next trainee please so i am not upset.

 

I don't think too many people will be upset - this is a discussion forum after all, not some think-tank.

 

I'm not upset Luke (that was ground out of me many years ago).

The question we must ask ourselves is Why? Why have the medics (and Pharmacists) got it so good and we so bad? What did they do that we didn't? I suspect that the answer is partly history, but look what the Podiatric Surgeons achieved with minute numbers, no money and little influence. The point was that they stuck together through thick and thin (it was in their interest to do so), arranged their own high quality training programmes, worked out both strategy and tactics and finally, refused to take no for an answer.

Sadly, until the profession (in the UK) stops playing 'I can pee higher than you' games, decides on it's priorities - and a 'pre-reg' year might be a good one - formulates clearly laid out achievable plans and offers the challenge to the DoH then it will get nowhere.

Bill Liggins

 

the medics and pharmacists did lots that we did not pharmacy is a masters degree not an undergraduate degree they have full closure no training by the wombles no back door lots of peer respect . plus its alot harder to train as either adoc or a pharmacists and alot more competitive for a university place and the universities who run their courses tend to be better unis the differences are legion i could type all day plus they make more money a small matter

 

Any chance of some punctuation and capital letters please fishpod?

 

maybee

 

I think a preregistration year is a good idea. NHS would be preferrable as youre more likely to be able to monitor it effectively

 

Fair enough, by what means do you think the situation could be altered as far as our profession is concerned? Would not a pre-reg year go some way towards a Masters? Could that not be used to increase the pressure for functional closure - should that be deemed desirable? Would that not increase demand for uni places? Is not the fact that they make more loot related to the above?

You have to ask the right question before arriving at the right answer.

All the best

Bill Liggins

 

Hi again,

I think this is a professional issue and it might be doable. The object being to raise standards within the profession.

The engineering professions, architects and surveyors all have to complete a structured Assessment of Professional Competence APC after graduation and before receiving full professional membership or Chartered status.

My suggestion is then that on graduation you become a GradSoCP. You then undertake eighteen months to two years of structured learning where you demonstrate that you can put your degree into practice. This would be done through the structured APC which would involve the current core CPD areas. You would need a mentor and to keep a diary recording your progress just as you would for CPD. You may have to seek out shadowing to gain experience in areas outside your normal work experience, all just part of the process. On completion you would have a final assessment, where your portfolio is checked and you may be questioned about it. This would be conducted by the Society, paid for by the applicant and lead to full membership of the Society.

As a graduate you pay for your own APC, after all you are going to gain from it. To a certain extent those podiatrists involved in providing mentoring and shadowing are giving something back to the profession and this should not be seen as a an income source. Though they would be entitled to CPD for their effort and the candidate might meet their expenses. Other providers would be able to supply optional material to support the APC process to enrich the experience.

This could be done now by the Society without reference to any outside body. The graduate would still be able to work and pay for their APC. Allowances would have to be made for illness, unemployment and maternity leave. I am sure that everything has already been sorted out by the other professions so there should be no need to reinvent the wheel.

The completion of the APC could count in part towards a masters degree. Perhaps additional written work and exams over a further year of study. By this the profession would be better able to stand tall beside others professions who have already had this for many years.

In fact, I think this may be the wrong place for the proposal. It is such a good idea I might take it to my Regional Committee where it belongs. You too could do the same.

Luke

 

Ah Luke

You immediately bring 'politics' into the situation. Replace your references to the Society with the Institute and I might begin to agree with you.

In point of fact, given the rush for Masters degrees, I would prefer to see the APC overseen by one or more universities who might wish to include an element of research resulting in a Masters; or I am sure that it would be possible to frame the system as a taught Masters. This would then achieve the academic equality with pharmacy (as noted above) whilst carrying podiatry beyond other PAMS.

All the best

Bill

 

dear bill i wish podiatry was held in high esteem like medicineand pharmacy.I dont think a pre regyear would count towards a masters as docs do 5 years and pharmacists do 4and apre reg, they get amasters before doing a pre reg. i suspect functional closure would help. The other 2 professions attract a much higher calibre of candidate. WHY would a very intelligent youngster complete a 3 year full time course plus pre reg year to graduate and then compete in the market place with someone who has done a 2 week distance learning course it does not make sense. thats why these young people do not apply for podiatry . our profession is just not very organised or united i wish the facts were different. regards fishpod

 

nb bill podiatry will never achieve academic equality
with pharmacy im afraid you have to be brighter to get a place to do pharmacy even if you get afirst in podiatry it carries far less wieght than a first in pharmacy its like comparing a degree in maths to a ..degree in visual arts also like comparing manchester university with manchester metropolitan university the clue is in the title ie mickey mouse university

 

Well then, a defeatist attitude will at least allow us to wallow in our own misery. There's nothing like doing nothing to achieve nothing!

I refer you to my previous posting - look what Podiatric Surgery did with nothing but will power perseverance and skill.

Bill

 

Bill

Sorry, I had no intention to be political. Please feel free to insert Institute in the post wherever you like, and anyone else can put their flavour in if that’s what they want.

Luke

They could, they should, but I'll bet they don't.

 

its not defeatist bill its just a fact of life if you dont agree that its harder to get aplace in medical school or pharmacy school than at podiatry school then theres no point me knocking cos theres no one in its not a point of view to be debated on a forum just check what grades are asked for by ucas. we have to make the best of what weve got but unfortunately its not what they have got ps im not miserable and dont wallow. my wife is a pharmacist and my earnings way surpass hers but unfortunatly she is still way brainier than me and her job is way more responsible 4 kids died on her ward today

 

I vote SMAE (sorry - BCPA). Not all of us in the BCPA are FHPs.

 

You are misinformed. A 2.1 or First in Podiatry or Pod Med will get you into any Uni in the land to do a higher degree - or Medicine or Law if you fancy a change of career. You will need to do a good interview though.

It's also worth mentioning that Sunderland Poly (now Sunderland Uni - they give out the degrees for the Durham School of Pod) were notable for having a really good Pharmacy Course. I wonder if they still run it?

Otherwise I agree with your observations about the level of academic teaching in Pod in the UK.

I also agree with Bill about the defeatist talk - pull yourself together man.

 

sunderland take manchesters first year washouts to resit the 1st year

 

Very possibly nowadays. It was not always so.

Do you want to comment on the access to other courses a good Pod degree can obtain?
Specifically to the Medicine and Law Courses I mentioned, or the PhD's, M.Phil's and MSc's at Durham, Oxford or Cambridge?

 

I obtained my masters degree from Manchester Metropolitan University fishpod. Does that make it a mickey mouse masters?

 

if its anon russel group uni probably yes

 

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