Independent prescribing rights

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Hi,

Just a general question.

I'm a pod student based in the Uk and i've been hearing about the independent prescribing rights for us UK Pods. I've been curious to know, what that would mean for podiatrists working in private practise and how that could effect the podiatry profession in the next 10 year?

I presume it would be a good thing and move podiatry more in line with dentists and optomitrists out there.

Thanks...

 

Well, truthfully, in private practice I do not Pod POM, for the simple reason that the majority of my patients are elderly. A good deal of them do not know what meds they are on (so always double-check with the GP prescription), and some pts do not know their medication allergies. On the other hand, the GPs/ Pharmacies/ Hospitals are linked with one another (private Pods not included), GPs/ Pharmacies/ Hospitals have most up-to-date info on the pts meds and med allergies. Therefore, if POM are required, I contact GP surgery to organise it.

As a student, when you dealing with pts and asking about med history and pharmacy list. How many times have pts said all is fine Blood Pressure, cholesterol, etc all fine....and then you start asking about meds and they take meds but do not know their names or what they are for. Then you have to start asking questions in a different way to attempt to illicit what kind of meds they could be on, e.g. blood pressure, statin, asprin, etc. So really at the end of the day, I work on the side of caution, and if patient requires POM, I just contact GP surgery to prescribe POM. I just feel it is safer for the pt.

POM is best for NHS Pods who have access to up-to-date med info on pts (just my personal opinion).....

 

Hi UKA Pod

I am the Communications officer at the Society of Chiropodists and Podiatrists, saw your thraed asked my collegue Matt Fitzpatrick to anwer this, here is his replay:

Dear colleagues,

In answer to the question from UKA Pod the advent of Independent Prescribing (IP) for the profession is one of THE most important advances we have made. This is similar to local anaesthesia in potentially changing the way we can assess, diagnose and then treat our patients

The benefit will be that with our specific knowledge around podiatric pathology we can tailor the treatment accordingly. There will be a number of governance, training and qualifying safeguards in place and this will not be attained on undergraduate courses but via post-grad level training. The details and progress along with entry criteria, course locations and the general requirements of practice will be highlighted in a paper soon in Podiatry Now as well as on the Society's website.

This is an exciting step but one that must not be taken lightly as I am sure you are well aware.

Thank you for your excitement and anticipation of the future. I am sure in 10 years we will look back and think this is all just normal and what was all the fuss about !

To LoveFeet....I take on board your comments and the need to have a good history of the patient is vital, but this is the case for any treatment not just medicines, The moment you take a scalpel to the foot and you are not sure of what medication or other concomitant issue / pathology a patient has then this is not good practice. I appreciate the potential risk with prescribing or treating a patient with a medicine that may combine with another carries concerns but we must make sure we are working to gold standards.

The benefits to patients pathways, reduced waits for intervention, less pressure on GPs and other services the releasing of both time and money in to the NHS and or private setting for our patients is immeasurable.

There is no difference in NHS and Private settings as access to records is equally a challenge across services. Also this is very different to our POM access - which is sell, supply or administer. The IP access is full prescription and will have the secondary checking and support of pharmacy colleagues too.

The impact and equality analysis are available:

www.dh.gov.uk/health/files/2012/07/Podiatrist-Consultation-Summary.pdf


http://www.dh.gov.uk/health/files/2012/07/FAQs-Independent-prescribing.pdf

Hoepfully these will be useful reading to you and others who see this post.

with best regards

Matt Fitzpatrick


Mr Matthew T.J. Fitzpatrick FCPodMed, FRSPH, FFPM RCPS(Glasg) Professional Advisor, Medicines Officer, College of Podiatry Member of the Project Board - DoH, Independent Prescribing

 

matt fitzpatrick, thank you for patonising me. You a silly man if you think for 1 moment I perform podiatry treatments without knowing the medical history of patients, then it just goes to show you obviously not a podiatrist...

I get the feeling you upset that I do not share your enthusiasm of presctibing rights for pods in private practice as it is more complicated to put into practice than those in NHS.

Matt, The Society of Chiropdodists and Podiatrists is absolutely useless with regard to the private practitioner. Why don't you go sort out promoting pod on your website. Inform folk on the 1st page the difference between FHP and Pods,would make a difference to those in private practice.

Its just such a shame that pods in the UK are lumbered with The Society as their trade union......

 

[
The benefits to patients pathways, reduced waits for intervention, less pressure on GPs and other services the releasing of both time and money in to the NHS and or private setting for our patients is immeasurable.

There is no difference in NHS and Private settings as access to records is equally a challenge across services. Also this is very different to our POM access - which is sell, supply or administer. The IP access is full prescription and will have the secondary checking and support of pharmacy colleagues too.

The impact and equality analysis are available:

www.dh.gov.uk/health/files/2012/07/Podiatrist-Consultation-Summary.pdf


http://www.dh.gov.uk/health/files/2012/07/FAQs-Independent-prescribing.pdf

Hoepfully these will be useful reading to you and others who see this post.

with best regards

Matt Fitzpatrick


Mr Matthew T.J. Fitzpatrick FCPodMed, FRSPH, FFPM RCPS(Glasg) Professional Advisor, Medicines Officer, College of Podiatry Member of the Project Board - DoH, Independent Prescribing[/QUOTE]

Oh yes, I do see you are a podiatrist. Interesting that you thought it your place to patronise another podiatrist - it was a silly thing to do.

To reiterate what I said before it is a lot more challenging for private podiatrists, we are not linked up to the central computer system within the NHS and pharmacies. So in my opinion you trying to promote something that is actually not easy at all for private podiatrists.

 

Lovefeet,

I would suggest if you want your posts to be taken seriously, then posting with your name may help.

I seriously doubt that Matthew was trying to patronising anyone. It was a fairly generic statement and I am pretty sure he wasn't actually suggesting that you are an unsafe practitioner.
Out of interest, what have you done for the profession? I know that Matthew has worked tirelessly on independent prescribing for quite a while and I am pretty sure this has not been for his own gain. It is frankly absolutely ridiculous to refer to him as "a silly man".

Maybe you should be more concerned about promoting yourself and your practice rather than worrying what the FHPs are doing. If you feel that strongly about it, write to the society or better still, seek insurance from elsewhere. It is not compulsory to be a member of the society. And before any assumptions are made, I am not defending the society and personally have my own issues with them.

Also, I work in an acute hospital, I do not have access to a "central computer system" where patients' details are shared, nor do I have access to any GP notes. I never have had in any of the posts I have held. I am unaware of any colleagues that actually do. If any do, I would imagine they are in the minority.
I would imagine that most of us rely on our own comprehensive assessment and if in doubt, make a phone call to the GP practice.

Independent prescribing will be a massive step forward for this profession. Of course there will people whose practice will remain unchanged and to whom it will have little if any impact. However, is it too much to ask that people see recognise what is best for the profession rather than just for themselves?

Maybe I am missing something but I don't quite see what the big issue is here or how this subject could actually be associated with negativity?

Ryan

 

Hi Guys,

Thanks for all your feedback, I can see from both sides the positives and some negatives. But I can definitely see the benefits. In regards to Lovefeet, I know that for our university clinic, we normally have the up to date patient meds from there prescriptions they bring with them. I also know that dentists and optometrists don't have access to this central computer, but they can still independantly prescribe.

I personally think that it would gain us more respect within the medical profession, and separate us form these FHP's I've been hearing about, as they seem to be advertising the same treatments that we can do , with the exception of LA.

I personally can't wait to become a more experienced practioner once I've graduated, so that I can attend this post graduate course, which will ultimately make me a better practioner.

 

Ryan, Mathew was patonising me. Ryan, there are NHS Trusts out there who are computer centrally connetcted to hospitals, GPs, etc. Lets just see if they come forward and post on this web page.....I know our NHS Trust is.

Ok, Ryan, in answer to your question what have I done for the profession. I campaign for the private practitioner. I have contacted The Society on numerous occassions to educate the public on what the difference is between FHP and Pods, I request it get done on the front page of the The Society webpage. This helps the Pods and it also educates the pts. Guess what nothing gets done about it. I subsequently discovered a FHP advertising on the accredited pod section of The Society......This FHP had never been HPC/ HCPC registered. Now you tell me how useless The Society is, because they did not bother to continually check if the folk on their accredited section were pods or not. How dangerous was that for the public!!!!!!! So what have I done about it - I winge on Podiatry Arena, to raise awareness of the situation...So basically, private Pods cannot even rely on The Society to assist them in private practice....

Now moving on, the HCPC do not want to tackle FHPs when there is only a phone number for the FHP,, that totally contradicts what the HCPC is supposed to do. What have I done about it, I winge on Podiatry Arena website to raise awareness of the situation. Once again showing the difficulties that private pods are facing.....

UKApod, I am so pleased that you are looking forward to graduating. I was like you up until recently (enthusiasm for my profession), and was rudely awakened to a reality check in the private sector.

I do not prescribe, that is my choice......

 

I'll agree to disagree with you on the patronising part. I am struggling to see how anyone could have been offended by what he said unless they were particularly easy offended. I'm sure Matthew is perfectly capeable of defending his own words.

I am sorry but I cannot imagine that many patients actually look at the society's website. When I was in part time private practice a number of years ago, I cannot remember a single patient telling me that they came to see me after consulting the society website or even mentioning that they had looked at it. People came to me partly due to the good location of the practice and also because of word of mouth. How much educating of the public is realisticly going to be done from the society website? I'll repeat what I said in my last post, you may be better off focusing on promoting yourself and the good work that you may do rather than worrrying what anyone else is doing and placing blame elsewhere.

Anyway, this is not a thread about Pod Vs FHP and personally speaking, I don't really give a sh*t about that debate. It is about independant prescribing.

Like I said, if anyone has access to a central system then I would have thought they would be in the minority. That notwithstanding, whether you do or do not have access to a patient's medical history taken by someone else, there is nothing stopping you taking your own comprehensive history and if in doubt, ask for help from someone else. To say you do not have access is certainly not a good enough reason to dismiss the potential benefits and importance of independant prescribing.

As for the whinging, people don't really want to hear it. We all have our problems and I fail to see the positives of spouting off on a thread started off by a soon to be qualified colleague. Let them and anyone else enjoy their enthusiasim. This is after all an educational forum.

As a correction, you do not choose not to prescribe, you are unable to prescribe.
Regards,
Ryan

 

Ryan, things have changed, the recesssion has hit hard,...

I tell my patients what the difference between FHP and Pods, but they cannot double-check the information because it is not on The Society website. Then I look as though I am telling my patients porkies.....

Ryan, I choose not to prescribe....my choice!!!!

Yes, agreed let UKApod look forward to his future in the profession....however, its always good to see that it is not always a bunch of roses.

Ryan, I do not trust someone on the other side of the telephone at a GP surgery telling me about patients allergies.....Unlesss I can see it in writing from a GP or hospital what allergies are (if any), I protect my patient and myself, by not prescribing....keep it simple!!!!

 

How could you prescribe (if you chose to) when podiatrists don't have prescription rights in the UK?

I adminsister/supply drugs on a daily basis to my patients and to be honest, the drugs I administer are pretty much the same every day i.e. steroid injections, antibiotics, low molecular weight heparins, and local anaesthetics. I am yet to come across a patient who hasn't been aware that they are allergic to any of these (considering most of the UK think they are allergic to Penicillin it must be exceedingly rare). What else would you be unwilling to administer (or prescribe as you say) that's got any significant liklihood of anaphylactic risk?

And why wouldn't you trust them? They have access to patient records from their practice database; the database that you would rely on yourself seemingly. Unless of course you don't trust that they could read correctly? A very poor excuse if you ask me.

I often think with some podiatrists (not specificly you before you think I am patronising or offending) who are so limited in their scope of practice due to an unwillingness to use any type of drug, or get involved with biomechanics, it really isn't any wonder that patients confuse FHPs and pods. To say you are so much better or safer just because you have done an undergraduate degree is bollocks. The undergrad degree is only a framework upon which we should be building otherwise this profession will get swallowed up. It is not a devine right to claim superiority and sit back because lets be honest, if your scope of practice is the same then the only real difference is whats written on a piece of paper.

I feel this discussion is starting to verge on ridiculous and I've had my rant for the day so I'll leave it at that.

Ryan.

 

Ryan I do not prescribe/ administer Pod POMS when I do not have written evidence of their allergies. If you want to administer meds on a daily basis go for it - if something happens to your pts that is your responsibility not mine.

With regard to BMX, I absolutely love it and enjoy making orthotics.....

Anyway, I am glad I did my Podiatry degree, but to be honest with you it was a complete and utter waste of time, Has it been able to provide me with a salary of minimum of £25K per year....absolutely not.....Am I doing something wrong - definately - I am working as a HCPC Podiatrist in private practice in the UK,....says it all!!!!!

Before wasting 3 years of my life studying Podiatry, I was working in the banking world and getting good money.......Why I thought a Podiatry degree would be a good thing to have to be my own boss....only god knows. But we all make mistake in life.....And despite been fairly old at least I am young enough to go to uni and retrain as a medic.....

 

in reality prescribing will make very little difference the nhs computers are not linked up iam in front of a gp computer as i write this post i can only see the medical records of our own patients not another doctors and the local hospital is not linked to our emis system . so that myth is dispelled .easy access to medical records does not exist nhs pods will have almost as much trouble as private pods. most of the pods who currently have prescribing rights only write scipts for dressings nothing else most of them never write scripts i know of many nhs pharmacists with independant right who work in hospitals guess what they have never written a script .my wife is doing it at the moment a day a week for 6 months cost of course thousands benefit to patients time will tell.

 

"in reality prescribing will make very little difference"

This is just a ridiculous statement. Whether or not the ability to prescribe will have any bearing on your day to day practice will be completely determined by your area of practice.
Sure, if you practice only in routine care the liklihood of needing to prescribe anthing is going to be pretty slim.
How about those working in diabetic care? Is it not possible that they would benefit (or more importantly their patient's would benefit) form the use of a greater spectrum of antibiotics? Those in MSK work using various types of analgesics and in surgery antibiotics, anticoagulants, steroids etc etc...

I actually find it quite depressing that some people cannot see beyond the end of their own noses!

And please don't start again with the whole computer system! What si the need for it again? Are we completely unable to actually figure out if a patient has allergies or not? How do you think a GP figures it out?

Ryan

 

the pods i know with prescribing rights, already work in hospital diabetic clinics top of the tree. guess what the junior docs on the multidisciplinary team write the scripts its not about allergies its about knowing what drugs the patient is taking how do the gps figure it they prescribe all the medicines cos the patients are thier patients and they are the only ones at present who add to the list and they dont like other morons adding to thier problems . i am living in the real world i write and print scripts but the gp checks and signes them hopefully we wont kill anybody .you just might. you seem to be suggesting pods should prescribe anticoagulents i dont think that is likeley pharmacists who work on anticoag clinics presribe warfarin and heparin i cant see pods doing the same but perhaps im thick ant cant see the big picture . ill bet in 10 years nothingwill have changed. how many pods can get a day a week off to attend uni only nhs employees who are sponsered for the time plus the 3 grand in fees

 

Fishpod you are wrong. Firstly I am not going to answer all your mistaken words as trying to read your posts induces a grand mal.

However, Podiatrists WILL Rx Heparin / LMWH etc come IP. I know at least one group of Podiatrists (Podiatric Surgeons) will Rx it for thromboprophylaxis.

 

You know what, if you want your opinions to be taken any way seriously, I would suggest using your actual name and also making use of the shift and enter keys on your keyboard once in a while so that your posts are actualy verging towards resembling something educated.

Who are the morons you are referring to?

I work full time in surgical practice so if I didn't consider the use of anticoaguilants where appropriate then I might actually kill a patient if they go on to develop a PE. So thanks for the concern but I don't actually need to be warned that I might kill a patient. Taking into account that you absolutely nothing about me, it is outrageous to suggest something so daft!

I didn't for a secons suggest that podiatrists should be walking round anticoag clinics altering patients' medications. All I have advocated is the use of appropriate medicines in the appropriate settings but appropriately trained persons. If you are not interested in prescribing or if someone doesn't feel competent in doing so it is simple; don't do the course!

Ryan

 

Right there!
That sentence just cost you my sympathy vote.