Legislative change and podiatry's future

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I recently attended the Vic poditary association conference in Lorne. One of the sessions was titled podiatry yesterday today and tomorrow. It was quite interesting to listen to how far the profession has come in the last 10-15 years. One of the speakers talked about legislative changes that are immenent under the new labour government. These new changes formed part of a framework aimed at tackling the current and future strain on Australia's current health system. In part the new national registration forms part of this framework. However, along with the national registration comes the ability, in theory, to scope and mould the face of Australian podiatry for the next decade.
As podiatrists in Australia we are able to order ultrasound and X-rays and patients are able to claim federal benefits for our services, there is no specialist recognition at a registaration level for sports podiatrists, paediatric podiatrists, diabetic podiatrists etc. Soon we will be able to prescribe s4 drugs (hopefully). Podiatric surgeons still struggle to get theatre time, and only one state has a compulsary countining education scheme for registration.
How does this differ to other countries??
Which podiatry model should we be alligning ourselves with for the future? The DPM's in the states? the UK, Canada?
If legislative change is on the horizon surely us, as the profession, should have a say on which direction we take it.
I would be interested to hear what other international pods have to say regarding their profession and their position in the health care team respective to their country, and interested to hear what Australian pods think of the possibility of making significant changes to benefit the profession for years to come and how we might achieve it.

 

Andrew did a good job of that

There is more here on the National registration and accreditation.

Yes, that is unfortunate - NONE of them should have it! (see this)

I do not think we will have a lot of a say in the legislative framework that will eventuate - that does not mean we try.
I would be interested to hear what other international pods have to say

 

Pray tell, what new changes?

I have heard a lot of rhetoric about how Federal Labour *might* be reforming the health system, but these sound like empty threats...

Nicola Roxon has yet to release any formal policy that might encourage us to think differently, despite what the bureacrats say.

I hope and pray for a system that recognises the *service provided* rather than the *profession who provides it*. Only then will medical dominance over our profession be contained to some degree.

Bring on the UK 'Agenda for Change' position descriptions and payscales for a start.

Any other bright ideas for a 'Perfect Future for Australian Podiatry Manifesto'? What would be on your wish-list?

LL

 

I think he might be refering to the national registration changes that the previous Govt inititiated and the current govt is pushing ahead with.

 

Craig

I thought there might have been something new and exciting...

Although national registration and accreditation will be quite useful, they will do little to address the many and varied barriers to health workforce reform which plague our health system.

Most of these are legislative. Without proper, well funded and resourced lobbying from our national body this will be many decades away, unless the government initiates it, or we hang on the coat-tails of others.

Unfortunately I see our national body as a slightly impotent political organisation, and we will continue to be until it divests its responsibilities in such things as course accreditation etc., so it can get on with the real job of trying to emulate the per capita public policy output of the AMA.

LL

 

Well said LL !

Cheers Stuart

 

You may be interested in the nZ experience where all the health professions were put under the Health Practitioners Competencey Assurance Act in 2004 and are now required to maintain compliance with a prescribed competencey program as a prerequisite for annual relicencing

Below is a quote which summarises the intent,

"It is important to remember that while authorities are established to regulate professions and have their clinical decisions informed by professions, they are established to regulate professions on behalf of the Crown to provide assurance to the public and in that sense are not owned/responsible to professions. It is a matter of finding the balance of regulating in the best interests of the public while maintaining the confidence of the profession, something some authorities are struggling with and something we will look at closely in the review. "


although what maintains "competence" is a bigger debate and I wonder if the publics idea of the competence that " provides assurance" is the same as what we, or whoever decides that , thinks it is.

I am reminded of my undergraduate lecturer who held the view that the goal of the course was to produce graduate who were "safe". I think this equates to having the good sense to know when things were beyond my skill and/or confidence. I imagine that the public would be reassured by that.

I would like to think that when cpd programmes were created that this was the philosophy inherent in the programme.

I thnnk Craigs comments in other threads around "reflective practice/ review" are consistant with the idea of maintaining " common sense practice" within the profession.I see this as an invaluable mode of "cpd"

cpd is not only about learning the " latest thing" or turning podiatrists into rocket scientists. Or turning continuing education into an unending treadmill of points and conferences.

After that digression I have inserted below the abstract of an article, that may be of interest.


What happened on September 18th 2004:
Life after the introduction of the Health Practitioners Competence Assurance Act (HPCAA), 2003

Maggie Roe-Shaw
Project Manager for the HPCAA, Professional Practice Team, Ministry of Education, Special Education

ABSTRACT
This article provides an introduction to The Health Practitioners Competency Assurance Act (HPCAA) which took effect on the 18 September 2004. The Act was introduced to provide consistent accountability across health professions and make it easier for the New Zealand public to understand what health service each registered professional provides. To make this transparent, each of the health profession’s Authorities registered under the Act, has consulted widely with members to establish a scope or scopes of practice which the profession operates in. By making these scopes of practice transparent, health professionals will be limited to specific professional activities defined by their Registration Boards and there will be penalties for operating outside these specified scopes of practice. Thirteen district meetings were held in 2004 to provide information to field staff about what the HPCAA means for their practice and what they can do about shaping practice to match the requirements of the Act. These meetings raised issues from the field about provision of equipment, professional development, portfolios, competencies, complaints and reflective practice.



I'm happy to email the full text if you like, I can no longer find the weblink.

Regards
Greg

 

This is a big and difficult issue. Since you are fostering Canadian perspective I will attempt a quick but perhaps a somewhat simplistic and personal viewpoint from my neck of the woods.

Firstly there is no cohesive Canadian model to align to . . .. .. so do not look for one.

Each province has its own legislation, there is currently an attempt of the Federal govt to improve labour mobility, this remains unresolved, is a work in process which I optimistically feel will be resolved by objective measures rather than political self interest of parties from different educational backgrounds which to date has often trivialized the process.

My impression is that Australia is well served by a good academic podiatric framework which supports the profession, something which is sadly lacking here, at least with national consensus. There are similarities with having a Federal legislative framework which I understand also results in regional differences in practice in Australia.

From my own experience which was negotiating, developing and overseeing the current podiatry Act in Manitoba I noticed the following;

The process was slow and ultimately largely dependent on the will of several individuals. Serendipity in terms of timing, personalities of those involved, and the political landscape at any given moment was also a factor. The process was therefore ultimately unpredictable.

That political and civil service decision makers are rarely health care professionals and must rely on others to advise them. Ultimately who they choose and why those decisions are made may be invisible to the small and less influential bodies which represent podiatrists. In Manitoba, and I suspect this can be generalized, the College of Physicians and Surgeons was very influential in consultation processes and remains so, this is not surprising and I can say was welcomed by me because my experience was cooperative, objective and thorough.

Our new Act (it is several years old now) will allow our professional scope to evolve as individual practitioner’s education follows, this is however quite a separate issue from our inclusion within the widespread delivery of healthcare, which I see primarily a reflection of how our services are funded and currently is exclusively private practice. We remain much marginalized in terms of being included in big picture health policy planning despite a quantum step forward in legislation and scope of practice. I find it difficult to be sure why this is but suspect a couple of things. Health care dollars are scarce and funding to support podiatric programming is unlikely because we have no representation within the decision making circles. I am not convinced that any kind of “professional lobbyist” would be influential because I cannot see how they might be persuasive, our constituency is too small. More effective might be considerable effort from an articulate, personable, and well educated podiatrist to invest into the required “networking”. So far, within our small group this has not happened. I also see evidence of the legacy of some pretty mediocre at times awful podiatric practice over the years which has a negative effect on the viewpoint of other professionals and is difficult assess and if true overcome.

This may sound rather a pessimistic viewpoint and in some ways it is. Health care in Canada is a sacred notion, most people regard it as a human right and the belief in equal access and state funded provision is paramount and that resonates with me too. However in reality most people seem disregard the evidence that much of healthcare falls outside of this ideal and increasingly this seems to be the case. Podiatry in Manitoba has always been excluded from Medicare (the national income tax funded fund holder), in other provinces this was not always the case but increasingly seems to be so.

Personally my vision in the short term is to encourage others and to personally be the recipient of as much postgraduate education as I can find time for and allow our abilities over time to improve our profile. Long term if our knowledge and standard of practice is desirable people will continue to seek our care.

Education is the key, marketing may have short term appeal but rarely sustains an inadequate product.

I hope my ramble sits well


Cheers


Martin

The St. James Foot Clinic
1749 Portage Ave.
Winnipeg
Manitoba
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phone [204] 837 FOOT (3668)
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