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Foot & Hand Carers & FHP's

Discussion in 'Australia' started by Beverley, May 13, 2008.

  1. Beverley

    Beverley Member


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    Hi

    I wonder if anyone can help please. We are possibly emigrating next year and at present I have a Uk Foot Health Practitioners qualification. I am looking into studying for a podiatry degree in WA, but wanted to know if anyone knows anything about the Foot and Hand Carers Association, if you do can I ask:

    1. is it the same qualification as fhp's?
    2. are they classed as podiatry assistants?
    3. what is their role? do they work for a health practice or independant?
    4. is the role of a foot/hand carer a help to the podiatrist?

    If anyone can point me in the right direction of who to contact in Australia I would be very grateful.

    Many thanks for taking the time to read this posting

    Cheers

    Bev
     
  2. Trent Baker

    Trent Baker Active Member

    Bev,

    This is a reasonably contentious issue here in Australia at the moment, at least in NSW where I am. At present there is plenty of resistance to foot carers/Podiatry assistants, to the point that the NSW Podiatry Association won't register Foot carers as members at this stage. I'm not sure what's going on in W.A., although here there is still plenty of debate as to the role that will be played by Podiatry assistants.

    Trent
     
  3. Admin2

    Admin2 Administrator Staff Member

  4. Stuart Blyth

    Stuart Blyth Active Member

    Hi all

    Its also important to note that although Pod assistants can, in some states, treat patients on a limited scope of practice, they can only so so to full fee paying patients.

    Currently all 3rd party payers (Private health insurance funds, DVA, Medicare, work cover,TAC etc) will not pay on a consult that has been performed by, or in conjunction with, a pod assistant.

    There have been several instances that I am aware of where health funds have demanded repayment of benefits because they used pod assistants to render care.

    Medicare are also aware of this and ensuring who provided the care to a patient is part of their current random audit process.

    cheers
    Stuart Blyth
     
  5. Trent Baker

    Trent Baker Active Member

    As well they should. I think this is extremely important to ensure the safety of patients with high risk foot types under Medicare and DVA.

    There is probably a place for Podiatry Assistants, however I think we are in danger of damaging this profession's image in the process. I'm happy to clip nails and debride callus if it means ensuring the ongoing health and safety of my patients.

    Regards
    Trent
     
  6. cornmerchant

    cornmerchant Well-Known Member

    Trent

    I couldn"t agree more. Here in the UK it is also a very contentious issue as you will realise if you read some the other podiatry arenas. In fact it is more than that, it is a complete mess with no closure of the profession even though the actual title of Podiatrist is protected. It just means that practitioners spring up with alternative titles, but ostensibly selling themselves as doing the same job!

    I like the idea of the insurers being the driving power in some states to stop paying for treatment unless it is by a Pod. Maybe that is an area we should be looking at over here .

    Regards
    Cornmerchant
     
  7. Trent Baker

    Trent Baker Active Member

    This is really interesting Cornmerchant. With the debate in full swing over here at the moment, feedback like this from an environment that has been exposed to Podiatry Assistants for some time is really important.

    I think that some Podiatrists need to get over themselves a bit and be prepared to do the less financially rewarding aspect of the job. We all knew that we would be clipping nails when we entered the profession. Get on with I say, rather than trying to palm off the less exciting work to unqualified workers.

    Trent
     
  8. RStone

    RStone Active Member

    Hi

    I find this a tricky but interesting issue. As a podiatrist I have no problem with cutting toenails - no matter how simple because I believe we're the best qualified and it provides a high level of care to those who need/want it.

    However, as a podiatrist in a rural area with no other close podiatrists it is difficult to juggle the simple nail cutting with the high risk patients - neither group have anyone else to turn to. I need to do both but don't want to lose someone's foot because I was doing hundreds of simple nail cuts.

    At the same time I have worked in rural areas where members of the community have some training in nail care and have done a fantastic job for a number of years. However due to the lack of available podiatric time and space it is easy for them to succumb to community pressure and start to branch out into high risk patients - problems arise and as there is no one "regulating or supervising" these hand and foot carers the patients and the profession (by association and not being able to do everything) can really lose out. There needs to be accountability somewhere.

    Personally I have found that a close working relationship with major groups like aged care facilities can really help - by having clear outlined expectations of an assistant to move patients, clean rooms, organise paperwork etc I find I can manage a lot of routine patients and still have time for a lot of high risk. Inevitably there are glitches.

    In the end I'm still very undecided - I'm happy to do everything but that isn't possible in areas that underserviced. The whole issue of who cuts fingernails in an underserviced rural area is totally beyond me.

    Would love to hear other opinions as to how this could be managed.

    RStone
     
  9. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Hi there

    An emotive topic.

    However, I feel it is important to remember that as a profession we cannot condone anticompetitive practices. This is the same as orthopaedic surgeons being outraged that podiatrists do invasive procedures, or GPs getting upset that we can prescribe drugs.

    The simple fact is that there are not enough health care providers to go around. This may not be the case in inner metropolitan areas, but is usually the case an hour or so away from the centres.

    Cutting toenails does not require a university degree. Any child can be taught by their parents to do this.

    It is also not unreasonable for a grown adult to be taught variations on this task if someone has gryphotic nails or diabetes, and how to feel for pulses, and how to use a monofilament. These are not difficult conceptual activities, and can be picked up in a day or two of observation by anyone with an IQ over 50.

    If podiatrists feel strongly about this, they should be bringing foot hygienists under the banner of podiatry, just as dentistry has done. This way we would have "podiatric hygienists" working alongside podiatrists, and with the ability to cross refer and look after the best interests of the patient.

    Then podiatrists with up to 4 years of university training can be more productive in diagnosis, advanced interventions, ordering radiology and pathology, drug prescribing, and surgery.

    This doesnt mean you can't cut someone's toenails. You would just be too busy doing a lot of other work to be concerned about it.

    My 2 cents,

    LL
     
  10. Tuckersm

    Tuckersm Well-Known Member

    I agree with LL,
    In no state of Australia is the practice of podiatry protected (just the title) so we can not limit the practice of FHPs, pedicurists, etc. We can though establish guidelines and policies of how podiatrists should work with assistanst that they supervise. The Victorian Podiatry Board is currently developing such guidelines, to ensure all parties (Pod, assistant and Patient) are aware of who does what, and that the doer, is competant.

    RE: Stuart's comment. A number of private pods are using assistants to treat people in residential care, where the nursing home picks up the cost
     
  11. markjohconley

    markjohconley Well-Known Member

    .. or to debride callus or enucleate corns ..
    50?????? com'on Lucky
     
  12. Tuckersm

    Tuckersm Well-Known Member

    Mark,

    it is about competence, If an assistant is judged independently to be competent to perform a task, under an agreed supervision model, then the service will be provided in a safe manner.

    Your argument is the same one that the AMA have been using to limit the increase scope of practice for podiatrists into surgery and the use of restricted medicines, we have been arguing back that if we are competent, what is the problem
    We let 2nd year students debride callus, and I took my 1st scalpel to a patient in 2nd semester of my 1st year (20 plus yrs ago) and with the supervision that accompanied this it was safe
     
    Last edited: May 15, 2008
  13. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Mark

    I'm not really sure where the "line in the sand" should be. I don't think dental hygienists put fillings in, so that might be an apt example to use.

    I also think that if a "podiatric hygienist", or whatever, was interested enough, then there should be a mechanism for continued learning towards getting a base podiatry degree, and then on to a specialty qualification in podiatry if interested.

    Continuous life-long learning! Non-discriminatory and transparent pathways for a career in foot care.

    This is the essence of the NHS Agenda For Change, which our UK readers will be familiar with.

    LL
     
  14. twirly

    twirly Well-Known Member

    Not wanting to start a bun fight but that seems to make perfect sense to me.
     
  15. RStone

    RStone Active Member

    Hi

    I see no reason why other people can't do what we all learnt and practised in first year uni (ie toenails and calluses) and I certainly don't want to be anti competitive and restrict our profession into a corner. My concern is how to ensure that basic standards are met once the course is over and they are practising on the public.

    If we as a profession are willing to oversee and/or manage this area of healthcare I have no problem with that but we need to be very aware of the responsibility that we are taking on as a profession.

    What happens in areas (eg rural & remote) where there are no podiatrists or not enough to oversee the Foot & Hand Carers/ podiatry assistants/ foot hygienists?

    What often happens in my experience is that some of the local nurses who have retired from nursing start cutting community nails for a modest fee - afterall nurses are very aware of the public need and lack of podiatry available to address the issue (not to mention the lack of public podiatry and the cost & instability of engaging a private podiatrist to do such work). Some of these do a fantastic job and I have several in my area that have been helping out the community for years when podiatry was not available or failed to meet the need when it was. Don't think that I'm devaluing their contribution for one moment.

    However with a nursing background it is very easy for them to start giving "opinions" in regards to skin lesions, wound care, infection control, diet and so on. Because they have a nursing background (and have been known as a nurse for years) patients will act on these suggestions. At the moment "see your podiatrist" for woundcare, diabetic foot problems, sports injuries and child development is not the advice or "opinion" that is forthcoming.

    Do we need to include basic foot care as part of the nursing profession as well as podiatry - most nurses who aren't interested in feet will probably never use it but plenty of them would in rural areas and aged care facilities. If this happened we as a profession we would need to significantly improve our working relationship with the nurses. Unfortunately there are a heck of a lot of health professionals out there that still have no real concept of what we do - just the other day my husband had to attend the local hospital and when the subject of podiatry came up he was advised to see a "real health professional" about foot problems not "an uneducated quack". :eek: (Yes I obviously have a lot of community education left to do!)

    At the end of the day I want to make sure the public are receiving high quality and accountable foot care for their own health and safety.

    RStone
     
  16. Beverley

    Beverley Member

    Hi

    Reading everyones postings this is a healthy debate that will continue for a long time. If anyone is interested this is how I work since I qualified. Does it help atall or give confidence in how a fhp operates. (I appreciate this may not be the course for all fhp's)

    I qualified a year ago and have set up my dom business and at present treat over 200 patients. Most is routine care, cut and filing nails. debriding callous and encleating corns. I take detailed medical history and keep detailed records of everything I do on each visit. My patients are mainly elderly who are unable to venture out due to age, disability or ill health.

    I contacted a podiatry clinic in my area who were and still are very supportive. There are 4 who work in the clinic, 2 work part time and for the NHS (1 as a diabetic specialist and the other specialises in bio-mechanics). For the past year I have regularly visited the clinic to observe and assist the pod working. (cleaning and steralising, cleaning clinic, looking after patients). On occasions they get me to diagnose patients feet before they treat them, asking what I think, how I would treat or would I treat knowing the limits of my ability.

    I have had the opportunity to observe and assist on nail surgery (looking after patient during LA, timing phenol application, timing the tourniquet).

    I have shadowed them on their dom visits and have seen a wide spectrum of conditions from routine to very high risk.

    I feel I am extremely lucky to have this network, I don't think I would have the confidence or knowlegde and understanding that I have now without it. I absolutely know what I can safely treat and know when to query, question and seek advice when something is not as it seems. I have referred my patients to the clinic for treatment outside of my scope and in return the clinic refers patients to me for home visits that are routine.

    They don't get anything for the time they give me (except I'm not allowed in clinic without supplying coffee and muffins!!). I have complete respect for their position and I think that they too respect mine. its a relationship that works and is very productive.

    When I move to Australia I hope that if circumstances prevent me from going to uni I will have the opportunity to operate there as I have done here.


    Bev
     
  17. Stuart Blyth

    Stuart Blyth Active Member

    Interesting point, I am only aware of clinical settings, you say the home picks up the cost but is it funded by some external body eventually or is it it covered by the residents themselves as part of their fees?

    Cheer Stuart
     
  18. markjohconley

    markjohconley Well-Known Member

    Stephen,
    Love your input (always read your posts), however, I wasn't presenting an argument, I was merely adding to Luckys comment in the first part, as foot and hand carers do debride here in canberra, and the second part I was merely questioning the IQ figure Lucky used.
    I personally am thinking of "down-grading"? to a foot and hand carer (IQ 127, I'll cope methinks) to get to a much simpler place, less insurance, less bureaucracy, less b-s from some of my "private" podiatry peers. Mind you if I had a better grasp for the biomechanics I would set up shop as a "orthoses manufacturer", if I was competent, that is.
    All the best, Mark C
     
  19. twirly

    twirly Well-Known Member

    Hello all,

    I know FHP threads usually spiral into a UK bun fight & I am grateful people have been considerate in replying to Bevs request for information RE: working in Australia.

    This is certainly an issue which encourages debate. When I was employed by the NHS Podiatry assistants worked in much the same way which Bev described.

    Patients were initially assessed by a qualified pod & if deemed to be low risk, requiring routine nail care only (although not sharp debridement) then they were transferred to see pod asst. This may have been for a h/v or in a pod asst. clinic.

    The patient would be reviewed annually by the podiatrist although if any concerns were noted during a visit to the pod. asst. then they would be referred directly back to the Podiatrist.

    All the best :drinks
     
  20. RStone

    RStone Active Member

    Hi Twirly & Bev

    Just wondering if there were any issues or points that you think need to be considered or addressed if guidelines or positions were to be drafted - it seems you both have experience with a system already in place whereas we're still deciding which direction to take let alone how we're going to get there. Is there anything you would set up or do differently from your experience?

    Cheers
    RStone
     
  21. twirly

    twirly Well-Known Member

    Hi RStone,

    The current situation in the UK is (IMO) less than ideal.

    Instead of those wishing to provide foot health services being treated as professionals who are educated to assess, diagnose & treat pathologies of the lower limb, many individuals have paid for a basic course in foot heath. This allows those individuals to provide a foot health service to the public using the title foot health professional.

    Podiatry in the United Kingdom is carefully regulated (as indeed it should be). Podiatrists must be registered with the Health Professions Council to entitle them to practise.

    The HPC demands the highest standards of professional conduct of its members with stringent adherance to its policies. Failure to comply to the HPC regulations could mean the removal of an individual from the register. Thereby preventing further practise using the protected title 'Podiatrist/Chiropodist'.

    Those individuals who provide foot health services using other titles eg. FHP are not governed by the HPC & are 'self regulated' . They are not subject to the scrutiny of the HPC.

    The lack of a recognised governing body leads to FHPs being seen by some as less than professional providers. I believe many FHPs adhere to sterilisation, continued professional development etc. but without the underlying scrutiny of the HPC then many regulated professionals feel less than satisfied with the current situation of Podiatry in the UK.

    I agree with LuckyLisFranc:

    If this were to happen then instead of the current less than ideal situation where those wishing to provide professional foot health services pay a private provider large sums of money to attend a course to become an FHP, a recognised qualification, following a moderated course at university would provide them with the recognition they deserve.

    Again, just my thoughts.

    I would be less than happy to find I had paid money to provide a service only to be treated badly as some FHPs are.
     
  22. Beverley

    Beverley Member

    Hi RStone

    I agree with the comments Twirly made.

    FHP's have a recognised qualification in terms of they are able to get insurance to practice, they have their own association which at the moment isn't recognised by our government. The Association of Foot Health Professionals work to support and encourage cpd and to ensure we practice in the same way I'm sure a HPC podiatrist does (in a safe and sterile manner).

    There needs to be change from a higher level, i.e government, HPC etc to acknowledge and accept that we offer a service that is in such demand and that we are not here to compete with but can support the podiatrist and work together to provide a professional service, and more importantly we have been trained by podiatrists who are HPC reg so what better reccomendation than that.

    In an NHS Hospital you have different levels of nursing i.e auxcillary which supports and has a role along side qualified nurses. In dentistry there is a support network to the dentist, so I think that in our profession there can be found a system whereas we can under the right guidelines and regulations support and work together to provide the best service and care.

    I have complete faith that this will happen one day.

    Bev
     
  23. Tuckersm

    Tuckersm Well-Known Member

    Stuart,

    For Low Level Care Residents (Hostels) the resident is usually responsible for the cost.

    For High Level Care Residents (Nursing home type) the facility will pick up the cost, with the money ultimately coming from the Commonwealth funding of the agency. Current accreditation guidelines for residential care facilities, require that an annual care plan is in place re; a residents foot health needs, which should be completed by a podiatrist, but the podiatrist does not have to provide that care, so as the funding is based on the care plans, which all put together (Medical, nursing, allied health etc.) calculate the funding the facility recieves, if foot care services can be provided cheaper, they save money
     
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