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How would Protection of Function work

Discussion in 'United Kingdom' started by skigirl, Mar 5, 2014.

  1. skigirl

    skigirl Member


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    Hi

    I am just wondering how protection of function would work in terms of other professions who work with feet.

    Of course there are Foot Health Practitioners who have their own Voluntary Register now, but additionally what about the nail industry where 'feet' are big business - cutting and filing nails, reducing callus etc. And then there is sport massage - and normal massage - lymphatic drainage massage of the lower limbs, circulation boosting massages, paraffin wax treatments etc.

    I have often wondered about this but not posted, but have now taken the plunge!

    Thanks
    Karen
     
  2. anthony watson

    anthony watson Active Member

    hi
    I wonder if at the end of the day the local councils will end up providing a form of licence to work in the area?

    In canada it seems different qualifications are needed depending on the state.

    Imagine you had to be licensed to practice by the council in the area you worked.

    That's an idea!

    Thanks
    Anthony
     
  3. wdd

    wdd Well-Known Member

    One good (from the point of view of graduate level professionals) model of functional closure would be the dental model.

    Legally the only person (apart from doctors, and yourself) who can put their fingers in your mouth is a dentist. That is why all dental hygienists are associated with dentists, ie the dental hygienist is working under instruction, (her professional existance depends upon the 'yae or nae' of the dental profession), from the dentist.

    If it was possible to adopt this model it would give the graduate part of the profession total control and domination over anyone wishing to make a living from doing things to feet.

    The conjunction of historical features that facilitated dental closure is 'never' going to reccur and currently it's difficult/impossible to see anything that could create professional leverage in the direction of functional closure.

    It would be interesting to see this thread generate reasons why there should be functional closure of the profession and what form it should take. Always remembering that, "I want functional closure to protect my status and income", is unlikely to constitute a successful argument even though as an 'unintended' outcome, it has worked well for law, medicine and dentistry.

    Bill
     
  4. rosherville

    rosherville Active Member

    Hi

    I'll stick my neck out and say that functional closure for Podiatry/Chiropody will never happen whilst the medics have neither functional or title protection.
    I have yet to hear of any model that could work in practice.

    With the protection of title the public have the choice to seek help from either regulated or non regulated.

    The fact that the HCPC is not fit for purpose (where we're concerned) is a separate issue.

    The argument that a registrant can be struck off but continue to treat in another capacity is really a red herring. The same applies to any other profession, in the event the damaged individual has recourse to litigation. Society cannot and should not give 'total protection', when that occurs freedom goes out of the window.

    ps. I'm gathering info on the question of invalidated insurance and hope to post later today.

    Regards
     
  5. Simon Ross

    Simon Ross Active Member

    I would say that one way to deal with the problem would be to say that anyone offering nail cutting, hard skin removal, corn removal, verruca treatments, must use a steriliser, single use tools, or CSSD, and that there are inspections on premises.

    Some people would be put off by this! but the ones doing it, would take their business seriously!
     
  6. Do you really want to see a profession that has "cutting toenails" as a protected function? Or "removing hard skin"? Somebody tell me the comments on this and other similar threads are not representative of Uk Podiatry....
     
  7. Crikey John, that was brave. And the insurance query today too. You'll be having an early night after all that excitement! ;)
     
  8. There should be functional closure for the reasons outlined by Dan Poulter on his letter posted on the Regulation thread. As he writes, you need functional closure to supplement protection of title when the profession has private sector providers. You cannot protect the public otherwise.

    The problem is - and I suspect one of the reasons there has been so much reluctance to bring in this layer of regulation is that it would benefit the profession by giving it almost exclusivity to the foot health market. That comes with responsibilities - not to exploit the position or to make it inaccessible to members of the public. To be honest, Bill, I don't know if the UK profession is sufficiently mature or educated enough to attain that position.

    The primary demand for foot health care is cutting toenails. Do we really wish to reserve and encumber this function for podiatry? We could devise a system of care - free or low cost - with government support - to provide such a service that we design and take responsibility for, but it comes back to the same situation that we are in presently - demand and supply. Let the profession train suitable clinicians - assistants, whatever to provide a foot care service - sure, whatever. But surely reserved functions for podiatry need not include this basic personal care?

    Just sometimes, I feel a complete fraud for arguing the case for functional closure.

    Mark
     
  9. Quick reality check. There are a number of professions currently regulated by the HCPC whom, for example, use foot orthoses as a treatment strategy. So, who's "function" is this- podiatrists, physio's, orthotists...? On a personal level, I know of a number of podiatrists who would be eclipsed in the prescription of foot orthoses by certain physio's and orthotists that I know; that is why protection of function to a single professional group should never occur.

    I seem to recall a governmental white paper from around twelve or so years ago which was basically suggesting that each professional group should have to evidence that they were the "best" at delivering a given treatment so as to define their limits of practice (might have been within "An NHS of all the talents"). Who's the best at "ulcer debridement" for example, whoever is the best gets the gig (not on an individual level, but as a profession). Personally, I don't think we would want to go down that route since obviously there are people with particular skills and talents across the professions. Be careful what you wish for, you might just find yourselves limited to cutting toenails and hard skin for a living, and nothing else. This is laudable in it's own right and might suit some people, but personally I wouldn't want my scope limited to this, thank you very much for asking.

    Ultimately this debate is about patient care and what's best for patients, not about trying to protect scope of practice in the deluded hope that this will make you as an individual financially richer- right? Ask yourself that one, then sleep tight, y'all.
     
  10. rosherville

    rosherville Active Member

    Simon

    Could not agree more. Can you imagine the medics, who have neither functional or title protection, going along the route of functional closure; we could find ourselves completely marginalised, and who would care !

    Regards
     
  11. It's not the medics you need to worry about, they are not regulated by the HCPC. I'd be more concerned by, for example, the physio's who have a single national professional body and significantly out-number podiatrists on the register (they'd out-lobby podiatry in the blink of an eye).

    Question: how many "extended scope practitioners" specialising in the foot and ankle are there within the NHS? What is the proportional breakdown of professions that occupy such posts? Guessing- the majority will be physio's and that tell's you everything you need to know.

    I stand here and say, hand on heart, I gave up on UK podiatric politics ages ago, it's a complete and utter joke; an embarrassment to the profession.

    To paraphrase Bill Hicks:
    "If you're into UK podiatric politics... kill yourself."
     
  12. Yep, quite agree. I think I'm also at the end of the line on that one. As regards your other point re professional territory - it is quite simple. We are regulated under an umbrella group which increasingly is populated by private sector providers - more so when the NHS is fully broken up. The appropriate structure is a mix of title and function protection within a hierarchal order - identify key functions then attach to a primary and secondary tier of providers - across the professions. It's called legislative subservience - medics can perform functions restricted to dentists under the dentistry act - but we - and members of the public cannot. Clearly you wouldn't have speech and language therapists performing matrixectomies, but podiatrists may have rights to secondary functions like joint mobilisations - secondary to physiotherapists and osteopaths/chiropractors. Such an approach would set a baseline - that is all. That is what we do not have presently.
     
  13. Dream on, Mark.
     
  14. Nothing better..
     
  15. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    The best legislation that I recall is the old one in New Zealand (which they do not have now), but the law governing podiatry effectively said that "podiatry is the treatment of the foot for fee or reward" ... which meant that if you treated the foot and got paid for it (in $ or other means), then you came under the Podiatry Act!

    This also means that if someone cuts grannies toenails, then they do not come under the legislation. If they get paid for it, they technically do!

    So, anyone who treats the foot came under the podiatry legislation. This means that you had to be registered and obviously have the qualifications to get registered and subject to the disciplinary actions etc of the Board.

    Another part of the legislation exempted certain people from the requirements of the Podiatry regulations - ie those who are a registered medical practitioner, registered physiotherapist, registered nurse, etc

    Under this act, someone claiming to be a "Foot Health Practitioner" would never get off the ground as they would be covered by the Podiatry regulations (ie "treatment of the foot for reward) and they are not covered in the exemptions section.

    I do not know why the NZ govt dropped that legislation a number of years ago and replaced it, but that is how you protect "function".
     
  16. rosherville

    rosherville Active Member

    In name only !
     
  17. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    No sure I get what you mean. That legislation prevented anyone treating the foot who were not registered as a Podiatrist, medical doctor, physio, etc.
     
  18. rosherville

    rosherville Active Member

    Craig

    It demonstrates that you cannot protect function for Podiatrists but you can for Podiatry in the generic sense, granting rights to other groups or excluding groups.
    hence, in name only. That's probably why it stopped as more groups were included it became pointless !

    Regards
     
  19. Claire72

    Claire72 Active Member

    Hello
    Mark, when you refer to nail care as an encumbrance on podiatry, it puts me in mind of the nursing profession which some have suggested has turned its back on delivering the basic level of care for patients - leaving much of traditional nursing care to health care assistants.

    Now that some competencies such as phlebotomy and catheterisation are to be taken from nurses and given to trained health care assistants, I wonder if nurses will resent their diminishing scope of practice.

    Claire
     
  20. And is what I understand is being considered here.
     
  21. I guess that depends on what is happening at the other end. I think many nurses might argue their scope of practice has increased markedly over the last decade.
     
  22. Simon Ross

    Simon Ross Active Member

    I`ve been thinking, if there was ever protection of function, how effective would it be, how would it be policed ?
     
  23. rosherville

    rosherville Active Member

    Simon

    An interesting question but I doubt we can expect functional closure of our profession and I wonder if it in fact it would be desirable. What surely is important is that members of the public seeking treatment can make a choice of who they consult. If Bill the Butcher is also known to make a good job of cutting toenails, should I not be free to get him to cut mine ? Society today is veering away from ‘closed shops’ and ‘cartels’ so provided we can identify the standing of ‘practitioners’ we can make a considered choice. Even with a reputable practitioner we are asked to ‘consent’, as liability is not absolute.

    So is protection of title sufficient ? It could be, the public would know that a Podiatrist was regulated and had maintained a certain standard; the fact that the HCPC is not fit for purpose, where our profession is concerned, is another issue and does not alter the principle. Remember, the medical profession has neither protection of title or function, it is only the title ‘Registered Medical Practitioner’ that is protected. A de-registered medic can still offer treatment but not claim to be registered (there`s one in my area).

    I do of course have sympathy with those who have practised for years, with a chiropodial/podiatric qualification, being told they can only continue if registered with the HCPC. I`m sure their objection is not to being regulated but regulated as a generic therapist, a dedicated Council would be more appropriate and therefore more acceptable.

    The argument that the public is not protected if a registrant is struck off and then practises as a FCP or such, is at first consideration valid but as we have already established there is risk at every level. The damaged individual has the protection of recourse to litigation, applicable to all professions. If professional organisations spent more of registrant’s fees on public information we may feel happier that the public were able to make a better informed choice.

    What has annoyed us intensely has been ‘short course’ individuals misrepresenting themselves as being ‘fully qualified’, this will always be a problem. There will always be an individual who seeks to deceive by misrepresentation and to ‘get one over’ for gain or vanity. It isn`t restricted of course to the untrained.

    I recall, many years ago, a registered chiropodist who went about claiming to be a Doctor, Consultant and Foot Surgeon, no professional indemnity to show, deliberately misleading the public and colleagues, getting up to all sorts of antics. A sad unprincipled individual indeed, but dangerous. Fortunately these are rare, I suspect they get a buzz or something, but would laws stop them ? Only vigilance can protect us in such cases, not a protection of title or function Act. For the type of character who has these personality problems only a custodial sentence would work, how likely is that ? Caveat Emptor !
     
  24. anthony watson

    anthony watson Active Member

    how did it work in the USA?
    anything to learn from them?:D
     
  25. Podess

    Podess Active Member

    Anthony,
    I can't tell you how it works in the USA but here is another idea for you.

    Why are ladies hairdressers not registered/regulated? They use strong chemicals on a part of the body. We have all seen articles in the press about the problems caused by misuse of these.

    When I chatted to my MP about this she said that, defining their function would be too complex, the cost of regulation/enforcement would be too great, aggrieved customers had a right of redress through the courts anyway, and market forces would force the poor performers out of business.

    So there you have it !

    regards

    Podess
     
  26. wdd

    wdd Well-Known Member

    In one or two posts the idea of increased scope of practice has arisen with respect to nursing.

    In many ways their scope of practice isn't necessarily increasing or decreasing, as when a new activity is added they stop doing something which has traditionally been central to the definition of nurse. Therefore the scope of practice doesn't change but the level of 'sophistication' increases.

    Of course the same is true of podiatry. As the scope of practice 'increases' podiatry seems to be trying to move away from those activities that historically have defined it, ie management of nails, corn and callus.

    On a spectrum of less sophisticated to more sophisticated or low status to high status what is happening is that podiatry is shifting its interest to the more sophisticated and away from the less sophisticated. If there was an equal desire within the profession to retain the less sophisticated that would constitute an increase in scope of practice but I seem to see signs of success in practice being measured by how little nails and callus constitutes part of professional activity and by those undertaking more sophisticated activity a desire to jettison the less sophisticated work altogether?

    Can a profession throw away one central part of its activity without undermining the base of its own professionalism and making it vulnerable to the professional aspirations of other groups?

    Bill
     
  27. rosherville

    rosherville Active Member

    WDD

    A good point. Clearly, if this happens the door is being left open for others to 'supplement' basic activities.

    It also demonstrates the importance of protection of title over function, which is almost an impossibility in practical terms !

    Regards
     
  28. wdd

    wdd Well-Known Member

    I get the feeling that the future of distinct medical professions is limited.

    I can imagine a time when titles such as doctor, dentist, physiotherapist, radiographer, podiatrist, pharmacist and nurse become confined to history.

    My prediction is that we will soon see the emergence of the fully formed pick and mix medical professional who does a bit of this and a bit of that and who in many cases finds it very difficult to categorise themselves using traditional titles.

    Exciting times or a quagmire of confusing possibilities and easy wrong turns?

    Bill
     
  29. anthony watson

    anthony watson Active Member

    Hi
    this is from a recent job add on the nhs website.
    Just wondered what if all foot health treatment had to be done by pods meeting the nhs min standard?
    Just a thought

    You must possess

    2:2 or above in BSc Podiatry
    Diploma graduates must be able to demonstrate post graduate study of working experience of relevant specialities within the last 2 years

    Anthony
    Car owner / driver essential
     
  30. rosherville

    rosherville Active Member

    Anthony

    'post graduate study of working experience of relevant specialities'

    As I read that it tells me that no work experience in relevant specialities is required ! Although I think I know what is meant.

    With that level of communicative skills my English master would never have allowed me to sit O level English Language !

    Regards
     
  31. Podess

    Podess Active Member


    I think the first "of" should be "or". It makes more sense that way.

    P
     
  32. rosherville

    rosherville Active Member

    Agreed but probably the 2nd 'of' should be 'in'.

    But can we be sure that's what was meant ? I think we should know !
     
  33. W J Liggins

    W J Liggins Well-Known Member

    Interesting that this was probably written by some seat polisher in the 'Human Resources' Dept. Ironic that practitioners are sacked (or reported to the HCPC and struck off, which amounts to the same thing) for comparatively minor infringements when the clerk here clearly demonstrates that he/she is 'unfit for purpose'!

    Bill Liggins
     
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