Feet for Purpose report

I have a great deal of sypathy with the points made by George and Mark et al.

Sadly, the fact is that until functional closure is acheived neither the NHS or PPs can employ suitable support staff without the fear that they will set up in competition - it happened with a FCA in my own Trust.

This is surely an area which all the main bodies could agree a common strategy, but leadership is entirely missing; could Mark be right about vested interests????

Johnpod, I am sure that we'd all be interested in the source of your information that AC are charging eleven quid if you would kindly post.

many thanks

Bill Liggins

 

We provide a service at 26 venues such as
GP surgeries, community venues, sheltered
housing, and two health buses, primarily in rural
Oxfordshire plus the City of Oxford.
Foot care coordinator, Age Concern Oxfordshire.

There are different service models in place across
the country, which reflect the difference in local
context, available funding and Age Concerns’
relationships with their PCTs and local authorities.
Some Age Concerns host a private chiropodist
to deliver a service at a central point such as a
drop-in centre or other venue. Because of the
number of clients the chiropodist can see, this
arrangement is quite cost effective and the cost to
the client can be reduced to between £8 and £12.
Sometimes chiropodists’ charges to the client are
further reduced by a subsidy provided by some Age
Concerns from their fundraising.

The above is a copied extract from page 19 of the Age Concern Feet for Purpose Report. I learned a new word from it - dystopia. Surely they mean dystoepia?

 

this is not AC charging £11 for work by a volunteer.

 

No, it is not, Andy. I regret that I have lost the source of my first information. However, AC is plainly running an alternative to the NHS using volunteers in many situations - and is charging for the service. As such AC is undermining any and every private practitioner in the country.

Why reserve criticism of skill levels for Smae and other graduates and accept ACs use of volunteers, nurses, etc.? Again, why would Chiropodists volunteer services for AC? They should be too busy working in the NHS or in private practice. By volunteering to work for AC they are undermining their colleagues.

 

Thanks for the quotation John.

As far as 'dystopia' is concerned, I suspect that they are going 'Yankee' as in 'paytriotism', 'for free' and any number of meaningless/misdirected words and phrases.

Bill

 

i read this as the chiropodist charging fror his/her service and AC subsidising the fees, not dissimilar to the state model mark russell suggested ( and quite possibly a nice little earner, enterprising ).

is AC volunteers cutting non pathalogical toenails not akin to the red cross cutting non pathological fingernails?

 

Dear All,

Why can we not use the dental model.

After all they are rich and successful and regularly introduce new tt modalities to draw in ever more revenue from their skills.

The fee structures they use reflect skills and outcomes.

There is an NHS dental service which is confined to very specialised and the Social Inadequate .

If we were to take on this model then we could have thriving practices with real revenues to invest in the latest technologies etc etc.

When i was with my UK Dentist in Suffolk it was one of the largets Private practice groups and i was an NHS Patient.

Still my 6 monthly checkup descale and polish cost £25.00.

So why cannot we have the established dental model where by we are reg with local NHS PCT and patient is registered with the practice and cant flit from one surgery to another.

There is partial NHS subsidy for identified groups eg Pensioners children disabled. Total subsidy for those with medical risk eg advanced pvd and diabetes r/a etc and the NHS pod clinic was where the specialist high risk care and intensive care that is not feasible in private practice.

eg a PP with diabetes gets an infected Neuropathic ulcer and requires intensive care from the AT RISK FOOT CLINIC at local hospital. After resolution of this episode pt returns to your clinic for ongoing care.

Clinics would be accredited and approved by SCP and local PCT prior to being referred NHS patients and being able to maccept patients into system for partial total funding.

When the current system is totally unable to meet the DEMAND then a new system which gives pts choice and flexibility is needed and also meets the needs of practitioners is required.

Will this happen ????

NO

The govt do not want another group of wealthy successful health care practitioners .

regards David

 

There's that strange sense of déjà vu again. Actually David, it's not the government that's the problem - political considerations aside. Such a model would bring greater choice, capacity, competition, increased standards and of course wealth creation - everything a government whatever its colours would wish to promote. The greatest barrier is much closer to home. When the government announced commissioning a patient led NHS, who opposed it? The unions including our own SoCaP. The Society is geared primarily as a trade union - it is supposed to represent all members equally and fairly, although many would suggest some are treated more equally and fairly than others! If the profession was to adopt the dental model, then the activities of the employment relations department would change dramatically from that of a public service trade union. In fact, the Society in entirety would have to change to become a more commercially focused representative body. Given the controlling interests - the reliance of the present NHS structure for education (our colleges are funded by the NHS), employment (some 40% of members are directly employed by the NHS), podiatric surgery (the overwhelming majority of podiatric surgeons are trained and employed in the NHS) - I doubt that a change of such a magnitude of a devolved dental model of practice, would be actively encouraged by the professional body - even though in the long term it would be of enormous benefit to the patients and profession alike.

What is even more concerning is that some Primary Care Trusts are now entering the private marketplace and providing chargeable podiatry services for patients who do not qualify for free care. Central Surrey PCT recently announced they will offer a private podiatry service to former patients who they recently discharged at a cost of around £33.00 per treatment. None of these patients have been advised of other colleagues in the independent sector who offer the same service under the same statutory regulation. The NHS have always declined to provide patients with a list of registered private practitioners as they say it is unethical and improper - they much prefer to advise patients to attend unregistered volunteers such as Age Concern - but now, in central Surrey at least, they appear to be able to withdraw care from patients then offer it back to them at a cost!

I doubt very much whether individual NHS practitioners will benefit from this service (consider the value the NHS placed on its clinicians with Agenda for Change) - we shall have to wait and see what terms & conditions apply - but the impact on existing independent practices will be substantial. Everyone in private practice knows the overheads involved in running a modern podiatry service. To have a monopoly state provider entering the private health economy is the worst outcome possible for the profession - except of course for the managers who will run the service.

What view has SoCaP taken on this development? Has the employment relations department voiced their opposition? The silence has been deafening! Why?

I refer you to the answer given in #40 above.

PS - One of the most honest reasons given to me why a dental model will never be actively promoted by the Society was by a podiatry manager after a briefing session in the Scottish Parliament. He acknowledged the benefits of such a model for patients, capacity and, of course, practitioners. But he and the Faculty of Managment (and by association, the Society) would always oppose it vehemently. Why?

Therein lies the problem.

 

What of the ethics of PCT personnel discharging patients from podiatry services and picking them up immediately as private patients?

 

Hello Dave

Whilst (as a podiatric surgeon - we'll fit in somewhere, Mark), I do not disagree fundamentally with your scenario, I will be grateful if you will answer a question. Mark and others have previously propounded the model which you suggest but why do you find it necessary to propose the involvement of SOCAP? In point of fact 'accrediditation and approval' by SOCAP, ICP, BCCP or any other professional body is totally irrelevant. The Dept. of Health have no interest whatever in these organisations which as Mark mentions above are regarded at best as trade unions, at worst as self-serving specialist interest groups. The benchmark will be HPC registration, the introduction of which SOCAP (and other bodies) wholeheartedly supported.

Meeting(s) were held as long ago as 2005 for existing service providers ie. managers of NHS chiropody/podiatry departments to encourage them to form companies to supply services where deficiencies did, or would in future, exist in the current system. In the near future PCTs and CTs will be 'commissioning only' bodies and will not supply services; this will be arranged by groups of G.P. practices on separate contracts.

The current situation in Central Surrey is the shape of things to come. Why not ask SOCAP about it?

All the best

Bill Liggins

 

Are you absolutely certain about this Bill?

If as you say the Dept. of Health have no interest whatever in these organisations then all private practitioners including FHPs would now be having to seek out CSSD for instrument sterilisation.

Thanks to the sterling work of SCP Professional Practice Officer, the DoH have accepted that bench top autoclaves provide a suitable method of instrument sterilisation.

So now all Podiatrists, Chiropodists, Foot Health Practitioners and Voluntary Nail cutters have a choice of methods of instrument sterilisation to suit their needs and pocket. Our NHS colleagues were advocating that CSSD was the only suitable method of instrument sterilisation and the shape of things to come.

Yawn. Seen it all before.

BUT​

Perhaps a little research into how many NHS Podiatry managers are members of SCP and perhaps a wee bit more research into how many Podiatrists are actually managers of PCT Podiatry services is in order before anti SCP activists start lobbing bricks into this arena.

Bless you all,

GB

 

True......but another SCP member, previously the Society's H&S representative has set out a particular set of standards to the HPC in a recent hearing http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=4109, which may yet impact adversely on many practitioners in private practice. A case of joined up professional policy?? Je ne pense pas ainsi, juste un autre baisez vers le haut!!

 

I understand that the H&S representative you refer to resigned his position within SCP. Perhaps this was to avoid a conflict of interests? Perhaps we shall never know.

But again to quote Bill

Perhaps the now resigned SCP H&S representative knew where best his cookie doth crumble?

GB

 

Hello George

Yes, I am sure that the Dept. Health (and the government(s)) at large see special interest groups as the 'opposition'. The game of gentlemanly conduct between them is, I suspect, long gone.

Let me make it clear that I am not an 'anti SOCAP', or an anti anything activist. I just want the best deal for the profession and am on record as having argued long and hard against the profession joining the HPC mess.

As far as instrument sterilisation is concerned, it was nor 'our NHS colleagues' who were advocating that CSSD sterilisation was the only acceptable method but the powers-that-be such as the Healthcare Commission. This, I understand is still the case although it will not be rolled out for some time. I suspect that the practicalities of enforcement in the dental, podiatry and other private practices have a great deal to do with this, although if representations by SOCAP, IOCP and others were involved - more strength to their elbows! It is certainly the case that at least two companies are now supplying basic sterile disposable instrument sets together with contracts to collect the used sets and dispose of them; so yes, I do think that this is the future.

I'm sorry that you have seen the activity in Central Surrey before and find it tiresome. In over thirty years I have never seen a similar situation and I find it very worrying. If I was a PP in that area I suspect that I would be extremely worried and wanting some questions answered.

Only time will tell whether you are I are correct in our assumptions but the commissioning papers have all been published and I expect that the next 5 years will see implementation.

All the best

Bill Liggins

 

Bill, so when a patient advises you that they have attended the local NHS hospital for a procedure they have paid for privately and have paid for the facilities, the surgeon and the same hospital bed as a patient obtaining the same service free at the point of contact why isn't there the same outcry?

Why is what is happening within Central Surrey Podiatry facilities so very different?

If it is the shape of things to come then prepare for it. This has been identified as a threat to the stability of all private practitioners, include it in your business plan. Develop unique selling points. Think and act commercially. Do not rely on your professional body to think for you. SCP does not do commercial. Maybe the other professional bodies do.

So when my local PCT decided to offer cut price chiropody to all NHS/PCT staff and I lost custom, what do you think I did? Moan, winge? No. Saw the threat and developed a strategy to deal with it.

It is a free market out there and however ethically wrong some see the Central Surrey situation as being, it is down to each and every private practitioner to develop a stratgey to make potential clients chose them.

Does a PCT based private practitioner really have an advantage? What cost is the rent on one of these places? The last place on earth I would want to go for my feet attending to at a cost to me is a busy PCT health centre along with hoardes of other people, where I can't park conveniently and there is zilch ambience especially when I'd just been told I'd lost my "free" service.

Sorry.

GB

 

Dear All,

Something similar was running in my old area 30 years ago.

The then District Chiropodist challenged the practice of some of the PP who were tt pts in their own surgeries and being funded by the local Heath Authority.

Several had their contracts terminated as they had been merrily seeing many patients long after their sell by date.

They had been buried or cremated sometime before yet were still in the care of the practitioner.

Many other fraudulent activities were taking place and were stopped by the District Chiropodist by challenging and looking at pt records and patient health status.

It was by all accounts a fun time in that area.

Looks like we are going back to this.

THis was about 30 years ago and those involved are most likely no longer with us.

Still with the new idea in Surrey i bet the eligibility criteria for NHS care will be shall we say CHALLENGING.

So lots of monied Surrey Pts stumping up £30 odd quid .

I wonder where the monies generated will go???


Into the Pod Dept or the pct's managers beer fund.

Interesting times OOOPPPP in the northern hemisphere.

Just back from PALM BEACH SYDNEY after watching a beautiful lunar eclipse.

regards David