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Nail Cutting Service

Discussion in 'General Issues and Discussion Forum' started by alvin, Mar 21, 2011.

  1. alvin

    alvin Member


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    I have been working as a chiropodist for over 13 years now. It has recently come to my attention that apparently some people are permitted to cut peoples toenails without any formal qualifications. They offer what is called a 'toenail cutting service'. I don't know how they are allowed to do this without any training. I wonder how they get insured? Can they sort out Helomas, Verrucas, etc. Where does their remit end. I bet they work on the cheap, which some members of the public will opt for just to save money. Did I do all my training for nothing. I would be interested to hear other members opinions on this subject, from abroad as well as the UK.:confused:
     
    Last edited: Mar 21, 2011
  2. manmantis

    manmantis Active Member

    Pedicurists have been around for decades, surely this is not news.

    Moreover, trying to legislate against people cutting toenails would be impossible if not pointless.

    Well, only if you're just cutting nails. Your qualification no doubt covered more than that. You should celebrate & promote the difference between what can you do and their limitations.
     
  3. Brummy Pod

    Brummy Pod Active Member

    Alvin,

    Legally, any Tom, Dick or Harry can offer to cut toe nails, treat callous. treat corns, do verrucas. You are only in trouble if you call yourself a chiropodist/podiatrist when you are not on the HPC register.

    And there are people exploting this loophole.

    The only way to legislate would be to make it illegal to advertise these services, or take money for these services, if the person doing the treatment is not HPC registered.
     
  4. Katie123

    Katie123 Active Member

    There are many concerns with nail cutters who have no consideration of patient requirements especially with high risk patients, they usually have little or no training.

    I know of a social enterprise where people have 1 days' training and are then permitted to work on all nails types including involuted nails leaving nail spikes etc. Sure they ask a series of about six health questions but I don't think they know what relevance the questions have and patients certainly do not get treated any different whether they have diabetes or not, or whether they are on warfarin or not!

    Some of the people employed took it upon themselves to start giving out footcare advice including putting germolene on a lesion and filing down corns.

    I know they are listed as chiropodists in the yellow pages as they used to have a podiatrist working for them and people assume they are fully qualified chiropodists and podiatrists when they visit nursing homes and they never correct them.

    Don't even get me started on the cold quick wash sterilisation in barbericide!!!

    I think it makes a bit of a joke of my efforts in getting my degree and complying with HPC registration, CPD etc and then trying to compete with their tiny charges for a home visit.

    Anyway rant over!
     
  5. fishpod

    fishpod Well-Known Member

    welcome to unregistered britain anybody can do anything. hpc is a joke .however if you are good at what you do you are not in competition with these bandits as they are all cheap. done on the cheap, corner cutting a holes.
     
  6. George Brandy

    George Brandy Active Member

    Manmantis

    I don't believe that Alvin has particularly expressed himself too well on this issue.

    Let me share this link with you which is hailed as a successful model for foot care service provision:

    http://www.caremart.co.uk/

    From this you will see a crucial statement;

    “The East Lancashire service now provides footcare to over 1200 clients and complements the existing service provided by the NHS Podiatry department it was developed along the lines of a social enterprise model and has now reached sustainability, it is the intention to use the same model in each of 5 new target areas”.

    Not only does Caremart compliment the NHS Podiatry department, the company is a partner with the NHS and can use the NHS logo within their promotional material. At point of NHS discharge, patients are signposted to Caremart nail cutters as the preferred service provider. In my opinion this is all a touch misleading.

    The clients of Caremart are some of the most vulnerable people in society and are being discharged directly into the hands of those with no formal training and are being charged handsomely for this treatment. There is no direct access to Podiatry services and these patients may go year on year with no formal foot assessment.

    Should we Podiatrists care? Should we be bothered?

    In a word yes.

    No I don't particularly want my business to become bogged down with nail cutting, I don't give a damn about those patients who want cheap but I am concerned that patients within the Northwest of England are being discharged without appropriate advice, knowledge of their new service provider and choice of where to receive podiatry led foot health care. Patients should be given choice based on information and knowledge of who is their new provider of foot care treatment. If someone has chosen to attend a Pedicurist for their foot care then this, I am sure, will have been an informed decision but I do question if directed discharge to a partner with the NHS providing a service to compliment existing NHS podiatry services can be an informed decision.

    Many of those being discharged into the hands of unqualified and unregulated nail cutters do have a foot health status that can change in a blink of an eye. I wonder what is being missed and how this will impact on the health of our elderly folks in the long term?

    Indeed let us celebrate our skills but let those who need our skills join in the party.

    GB
     
  7. markleigh

    markleigh Active Member

    How do they cover costs charging only 7 & 10 pounds?
     
  8. George Brandy

    George Brandy Active Member

    What overheads?

    GB
     
  9. markleigh

    markleigh Active Member

    Overheads? Do they sterilise instruments for example?
     
  10. Katie123

    Katie123 Active Member

    Each person is asked to purchase a pair of nippers and a file at their first visit which they keep but in nursing homes sometimes 2xpairs are used for the whole home rinsing them through in barbericide in between patients!
     
  11. Ive asked this before why do a Podiatry department in the NHS recommend a non-Podiatry private practitioner to do this type of work.

    If a patient has initially been deemed to require the service of an NHS podiatry department, the NHS podiatry department makes the decision that the patient is not high risk enough to require Government funded service and that the private sector can do this job.

    Why would you send it to a less trained, unregulated sector when there are PODIATRISTS working in the same area who happens to be in private practice.

    I do not get it - it undermines the profession, makes the unregulated sector stronger.

    Do NHS pods and Private Pods hate each other that much that they would undermine to whole profession because of where they work ?

    It seems from my understanding that some blames the FHP for this, but it seems to me that the people discharging patients from NHS podiatry departments are to blame - why are people sign posted to Caremart nail cutters or the like in the 1st place, and if they are as the preferred service provider by Podiatrists working within the NHS - maybe one Podiatrist can explain to me so I get it why you would do such a thing.

    I´ve said this before - UK Podiatry divide and destroy from within.

    Do not get it
     
  12. George Brandy

    George Brandy Active Member

    No.

    As is the standard with these kinds of services the patients buy, maintain and store their own instruments. These have to be purchased at the 1st treatment session for a one off cost of £10- £20.

    This makes that first treatment cost comparable to a Podiatry driven assessment and treatment within this region. Many Podiatrists then offer a nail cutting service anywhere from £10 to £15 - but once every 8-12 weeks. Very cost comparable with one massive difference.

    But like I say, I don't want to become bogged down with nail cutting.

    GB
     
  13. hamish dow

    hamish dow Active Member

    Personally I consider that for any part of the public sector to engage in any form of private work as it is ultimately funded somewher within its makeup by the genreal pubic, some of these contributors providing the subsidy will then have to compete with an organisaton that was/is subsidised partly by themselves. It is like a business helping a competitor set up, it undermines the existing market by unfair competition. I only have anectdotal tales of people quitting the NHS sometimes from an advanced position then using the conacts established from within to get funnelling of business,again unfair competition. Never going to get it to stop but all the same a corrupted process. As has been said what is it that seems to prevent those in the NHS recommending that a colleague in pp should be sought out? It is all a nonsense a a tpical British mess. Can't see the SCP resoving any of the issues properly, because acting primarily a Union they have a conflict of interest with PP.
     
  14. G Flanagan

    G Flanagan Active Member

    In regards of caremart and East Lancs. The SCP are having a meeting with NHS East Lancashire soon.

    George
     
  15. I think we need to accept that the work we do as qualified podiatrists has two extremities: basic nail care on the easy end, and highly skilled diagnostic interventions on the difficult end.
    The majority of our elderly population probably only want the 'easy' end, and that end of the market will always be challenged by social-enterprise/nail-cutting services. For at least a decade, services like Age Concern (now Age UK), and other regional welfare charities, have offered a regulated service at a reasonable price, often set up with the help of a local NHS podiatry service. Our profession should encourage this, and get involved where possible, so that there is a quick referral to fully qualified practitioners for anything beyond the scope of basic nail-care. All qualified private podiatrists in the area should then be trusted with three options: 1. To sort out a temporary problem and return the patient to Age Uk services.
    2. To offer the patient continueing treatment if the problem more long-term. 3.To refer to the NHS Services after assessing that the patient is at risk, and qualifies for State-aided treatment. This might be a positive way to help hold our profession together.
     
  16. George Brandy

    George Brandy Active Member

    John,

    Want or need?

    I think we have only seen this in the last 5 years since the publication of Best Foot Forward Older People and Foot Care and the subsequent shift of footcare from health into social care.

    Please define regulated in the sense of Age UK and other regional welfare charities.

    Some of our professional leaders did encourage this without understanding or considering what its national private practice colleagues had to offer, what they were prepared to offer and at what cost. Age UK should have had this information to hand in 2005 but our professional leaders did not gather this until 2008. By then the damage had been done.

    Oh come on. Nail cutting is big business and highly profitable for unregulated (by law) providers.

    There are major problems with your suggested solution - your assumption that Age UK service providers are capable of assessing Podiatry and/or footcare needs of their clients, that they are capable of recognising temporary problems, that they are capable of recognising subtle changes in the health of their clients; that the service users have the means to pay not just once, but twice for resolution of their problems...

    I could go on.

    GB
     
  17. George Brandy

    George Brandy Active Member

    Mike

    Have been thinking about your questions much of today and I don't get it either.

    What follows is based entirely upon my own opinion.

    I am certain that you will realise that the NHS just doesn't have the budget to continue treating patients with low risk needs or nail cutting requirements only. Fair enough and understandable.

    Traditionally once upon a day when a UK resident hit retirement age they could hand over all responsibility for their foot health to the Podiatrist whether they needed to or not.

    Without investigating the historical changes in great detail, the NHS criteria for state funded Podiatry care changed in the early part of the new century and the large scale discharge of nail care only patients commenced in or around 2004/5 and more recently service reprofiling has meant the discharge from NHS care many with low risk Podiatry needs.

    Our Podiatry Service Managers coined a new catch phrase - "Podiatrists do not cut toenails". Say it often enough to the young, impressionable or inexperienced and they will start to believe. But when the private podiatry providers objected to their colleagues blanket declaration and its impact on our continued desire to provide holistic service provision quite serious rifts developed - certainly within an environment that could have influenced the future of nail care at a national level.

    Unfortunately those service managers who could declare that we "don't cut toenails" the loudest had a great deal of influence on developing local and national policies regarding the shift of nail care and basic foot care out of healthcare into social care opening the floodgates for unregulated providers.

    I have already eluded to a document published by Help the Aged in 2005 http://www.ageuk.org.uk/documents/e...ch/best foot forward (2005)_pro.pdf?dtrk=true

    I think this may go someway to explaining why we have so many charities and Social Care Enterprises providing unregulated (by law) foot care. The Society of Chiropodists and Podiatrists endorsed this document via a press release which essentially confirmed that its own members were providing foot care that was not affordable for the elderly.

    This next document describes how the Department of Health now defines foot care:

    http://www.dh.gov.uk/prod_consum_dh.../@en/@pg/documents/digitalasset/dh_103153.pdf

    This was published in 2009 and whilst it defines various service models for providing low risk nail cutting, there does seem an absolute trend in engaging with Charities or Social Care Enterprises (SCE) for this kind of service provision rather than the traditional private sector. Why?

    Is it that dreadful word profit? Profit being my take home pay after tax, but profit for Charities and SCE's being allegedly ploughed back into community projects. Is this the Governments get out clause for engaging with charities in providing a cheap private service to thousands of elderly when foot neglect attracts such emotive response from the public?

    Yes it does undermine the profession and I am saddened to read that you would even consider that NHS Pods and Private Pods hate each other. This is just not so.

    I stress that this is entirely my own opinion and I feel that we have such poor leadership that nobody will challenge the direction that the DoH and Government have dictated for Podiatry. I can understand that without strong professional (body) leadership and on a local level that NHS podiatrists are forced to follow policy therefore discharging to the preferred service provider (but I am not certain that they always do).

    What I do not understand is why NHS Podiatry service providers have not challenged the DoH, their managers and local policy. Do they really believe that this is the right way to progress the profession?

    GB
     
  18. George, Thanks for your quick response. I would like to add a couple of facts and a couple of ideas.
    Firstly, it was in 2002 that Portsmouth NHS trust got into trouble for discharging large numbers of nailcare patients. At the same time the Service Managers, both there and in Southampton, were setting up a Nail-cutting provision through Age Concern. I worked briefly for this service in Hampshire after qualifying. There were other qualified pods as well as myself. We each had a proper contract of employment and a reasonable pay-structure.

    I have since been involved with the Bournemouth PCT where nailcare patients would routinely be referred from the NHS to PRAMA Care, a local Charity. All the Footcare assistants who worked for Prama Care had received a basic training in BASIC nail cutting from a highly trained Footcare Assistant working in the NHS. The limits of their practice was well defined, and referral pathways back to the NHS were clear.

    IDEAS
    I don't see how the lid can now be put back on the box which first allowed unregulated cutting of toenails. For the majority of those needing help it is a social, rather than a medical, need. As I suggested previously, nail-cutting is the 'easy' end of our profession - but we are the only ones qualified to recognise the complications and know what to do about them.
    Therefore, as a profession we should be more pro-active in offering our services both in the proper training of these new nail-cutters, so that parameters are clearer, and complications more efficiently referred back to us.
    Secondly, it should be made statutory that big organisations, such as Age UK, pay for the services of qualified podiatrists, so that new patients can be properly assessed, and so that the nail-cutters have someone fully qualified on hand in the organisation they can refer to when in doubt. This might even create some interesting employment opportunities for qualified podiatrists!
    John
     
  19. Hi George thanks for that - hate maybe not the best word. Dislike or don't respect maybe, but you get the idea.

    John or George again maybe an old question but what is social nail cutting. In my world anyone who can not cut their own nails it will become a medical issue pretty fast.

    89 year old Mr Smith no health issues a little deaf and can not see as well as he used to, but can not bend to cut his nails.

    Mr Smith best mate, they meet at WW2 no issues at all with cutting his own nails, supple as a rubber band always has been always will be, but is type 2 diabetic.

    Who gets help from the NHS I understand its more complex.

    In Australia where Im orginally from they would both have a special veterians card, go to a private Pod to get their nails done and the Pod gets money from veterians affairs dept.

    Now if these 2 were not war veterians they would use their private insurance got the Privete Pod get their nails done by a Pod or maybe a Pod assistant who works for th Pod (part of the requirments) the private health care covers some of the cost they pay the rest. Most have private insurance. If not they pay the lot.

    Why can not this type of system work in the UK

    NHS for diabetic ulcers and the like
    Children assessment and treatment

    Private with governemt, private insurance or full paying for the rest.

    FHP must work under direct control/guidence from a reg. Pod.

    Nhs waiting lists down, better care for all, the FHPs brought in under the wing of Podiatry so education, treatment role etc better controlled. Also FHPs in the whole should have better working eviroments and many may retrain to become Pods.

    Thoughts
     
  20. starfish3211

    starfish3211 Member

    One could go on Ad nauseum about this . Things are no different here in Germany even though there is enough legislation , rules and reluglations!

    A pedicurist goes through an old age home/clinics at 8-10€ a pop with two files and nail cutters soaked in a anti-viral and fungal solution. Never mind that instruments needs a minimum of 15min to decontaminate. The cheapo's are happy and if anything happens, sueing them are pointless. Too expensive and they acted out of free will. These people do not claim to be professional. They can help those who cannot afford better. Take it or leave it attitude.

    Despite these "nail cutters" , there is more than enough work for us out there. We can never keep averyone happy but we can give our best, charge our worth and enjoy our chosen careers without unecessary stress.:dizzy:
     
  21. dsfeet

    dsfeet Active Member

    Nail cutting services in Australia, (particularly relevant to NSW) are provided by footcarers and pedicurists...that is other than podiatrist and podiatry assistants.

    Footcarers do a 3 day TAFE course, orginally designed for RN's and EN's to provide a service to Hostel and nursing home patients. Now this course is available to anybody, and they can and do work in the community for a fee charged privately to the patient, mostly via home visits or in hostel and nursing home facilities.
    Pedicurists do nail cutting as part of their beauty therapy course.

    Both are unregistered professions(?)/ industries and are not regulated except under the Unregistered Practitioners Bill and the Skin Penetration Act, which does make mention of infection control standards. However this is mostly for skin penetration procedures for which nail clippers are NOT considered as an instrument that has the potential to pentrate the skin (?).
    Some nail salons also provide a "blading " (razor style instrument) technique on callous's and/or dry hard skin. Most reputable beauticans have stopped providing this service but the practice does still occur reguarly. This blading technique Does and can penetrate the skin.
    There is no law or Act that prevents this service and infection control procedures are not policed. Previously the only restrictions on the services provided by beauticans, footcarers or other' person was the Public Health Act 10AH that prevented patients with pheripheral neuropathy or PVD from being treated by any one other than a nurse, gp or podiatrist . However since National registration this Act was replaced by the Health Practitioners Registration National Law no 86a, which no longer prevents any person from either nail cutting or scapelling.
    When the health dept is questioned on regulation of these services , the comment is: that you can not rule against a "potential' adverse Health outcome!

    One positive for the publics safety is hopefully an increase in infection control procedures by environmental health officers. The difference between disinfection and sterilisation needs identifying when skin pentration has occurred, as currently there is a lot of confusion in these industries and the current skin penetration act and reference to infection control is poorly monitored.

    hope these comments clear up the facts relevant to nail cutting/ blading techniques .
    whether you agree or disagree, this is how it stands.
     
  22. fishpod

    fishpod Well-Known Member

    well said mr weber nhs podiatrists discharging to unregulated companies /or bodies and not to their professional colleagues this is a national disgrace. the nhs workers assume the pts cannot afford a proper fee but they smoke fags costing nearly 7 quid apack and dont give it asecond thought apack aday is 50 quid aweek. think on all my nhs colleagues they can afford 20 quid to get their nails cut. nhs managers have and will sell us all down the river given half achance.
     
  23. George Brandy

    George Brandy Active Member

    I understand your sentiments.

    I really don't see the need to put a lid back on the box of nail cutting providing patients on discharge from the NHS and/or when choosing their private provider are fully informed of who is providing the service and what they are getting for their money.

    Unfortunately business propositions have been made and developed as a result of the shedding of nail cutting from the NHS and service tendering. Whether these are classed as charities or social care enterprises should not disguise the fact that the aim is to make a profit - in the case of Caremart I am certain that the company secretary and directors do not perform their tasks voluntarily.

    If you look at the history of the development of these nail cutting services the main criteria has been to provide a low cost service. Once you introduce a Podiatrist into the equation then costs and overheads escalate due to regulation. Perhaps this is the reason why the service of Podiatrists within these nail cutting schemes has not exactly been embraced? If overheads go up then obviously the low cost service can no longer be low cost or profit is negligible.

    So my opinion remains that our patients are the victims of a cost cutting Government and we allow them to be. Very fortunately I am not employed by the NHS and therefore unfortunately am not in a position to challenge the NHS managers from the inside.

    GB
     
  24. nicholashoar

    nicholashoar Welcome New Poster

    Age concern offers a nailcutting service in parts of Somerset. Speaking as a chiropodist, I do not see this as competition.What troubles me is whether or not the operator is insured, should matters go wrong. Fearlessness in the face of a diabetic foot ,or one that should be treated as such derives from ignorance.When asked I agree that my fee is a lot of money to pay just to have toenails cut,however I have never had this suggested to me by member of the public whose pain and suffering has been alleviated by my efforts.

    I have lost patients to this service but most return recognising they require something more.I believe in live and let live.
     
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