Let me begin by saying this is an open letter to the Society and all those other paid up members?these are my beliefs and thoughts about factual situations and scenarios.
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I love being a Podiatrist; I have worked for many years in both the NHS and private sector. However, I feel there is a major injustice being done to all Podiatrists / Chiropodists (will use the term Podiatrist) right now.
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Let?s begin by looking at Podiatrists. We are a special breed of people.
Any of us who work in the medical field will agree you must have a special personality and strength to work with people. We don?t just have the strength and the personality; we also have the underpinning knowledge and skills, which make us excellent diagnostic practitioners.
Each one of us has our own special*qualities that*make it possible for us to be*unique care givers. Some of us are good at MSK biomechanics, some are great a wound care, some are great all round general practitioners with a wealth and breadth of knowledge, some are your go to person for any dermatology question you can think of.
In all we each are a piece of a puzzle that provide specialised care to you, your family and friends. We go to work and spend our day, counseling and ?fixing? patients.
We clean up unspeakable things all while reassuring someone*it is ok. You can?t do this job and not be super human.
We stand up for our patients and do everything possible to keep them safe. Always making sure we do no harm.
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However, out there, there seems to be a growing emergence of what is termed ?Foot Health Practioners? who do not hold standardised and recognized educational qualifications. Some may have 2 weeks ?training?, some may have 6 weeks with 1 day practical, some may have no training at all. *This group actively advertises to the public that they are ?specialists in Foot Health. In fact, this group has begun a voluntary register overseen by the Professional Standards Agency, who oversees the HCPC. So you can see here the quandary.
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The HCPC also advertises societies and organisations to which Foot Heath Practitioners (FHPs) belong, on their website.
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Personally, I signed up to grand parenting within the HCPC because this was sold to me as a solution to unregulated and minimally trained practitioners. This has not worked; these people have now rebranded themselves and remarketed themselves by changing their name. They are still as active, probably more so, than ever before.
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If you feel that it is not bad enough, it is common knowledge that Podiatrists who have been struck off the HCPC register are running the training schools and organisations annotated on the HCPC website.
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The scope of practice of UK podiatrists on registration after obtaining a degree in podiatry includes the use and supply of some prescription only medicines, injection therapy and non-invasive surgery e.g. performing partial or total nail resection and removal, with chemical destruction of the tissues {"Conditions of practice". Health Professions Council (UK). Retrieved 2010-01-30.}
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Podiatrists complete about 1,000 supervised clinical hours in the course of training which enables then to recognise systemic disease as it manifests in the foot and will refer on to the appropriate health care professional. Those in the NHS interface between the patients and multidisciplinary teams. The scope of practice of a podiatrist is varied ranging from simple skin care to invasive bone and joint surgery depending on education and training { http://www.hpc-uk.org/assets/documents/10000DBBStandards_of_Proficiency_Chiropodists.pdf}
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Now that we have the definition and basic scope of practice I will provide some defining points.
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According to definitions Podiatry or podiatric medicine is a branch of medicine*devoted to the study of diagnosis, medical and surgical treatment of disorders of the foot, ankle, and lower extremity. If this is the branch of medicine devoted to this we do not need a separate branch of medicine devoted to this. In my opinion, if someone wishes to diagnose medical and surgical disorders of the foot they need to be a Podiatrist. If someone wishes to provide non medical interventions, nail cutting on the non risk patient, nail painting, skin beautification?.then go ahead, be my guest and continue along the path of NVQ trained Beauty Therapists. An NVQ is a standardized assessment protocol. *I believe Beauty Therapists have training in the normal function of the skin and its appendages and are expected to refer on to specialists such as Podiatrists if it is so required.
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The fact is we have Podiatrists operating within the scope of practice of diagnosis, medical and surgical treatment of disorders of the foot, ankle, and lower extremity*but we also have another group coining the phrase ?Foot Health Practitioners? able to do exactly the same thing. These ?practitioners? have no restriction on scope of practice. Fact. http://www.cofcp.co.uk/what-is-the-difference-between-a-chiropodist-and-podiatrist/
*These ?practitioners? are not required to work to a standardized level of training. Fact.
Education is standardised for a reason. Standardisation concentrates on the most efficient, humanised sequence for each process. It is the foundation stone, providing a solid base to build the never-ending continuous improvement. Standardisation provides optimisation, consistency of output. Provides direction, improves communication, improves efficiency, improves safety, improves quality, improves capacity, and reduces time.
I feel that most applicable here is the improvements in safety, quality and communication.
If we all want the best for our patients, then we should want standardisation of education?. which is what a BSc Podiatry provides.
A 6-week correspondence course will not provide the same safety and quality outcomes.
A 3-month course will not provide the same safety and quality outcomes
A 1 or 2 year course will not provide the same safety and quality outcomes
A 3-YEAR DEGREE IS THE STANDARDISED PROFESSIONAL QUALIFICATION FOR DIAGNOSIS AND TREATMENT OF THE FOOT.
Within this degree we may cover pathomechanics, pharmacology, pathology, biochemistry, psychology, etc. etc. etc. all of this content is selected at a standardised degree level to provide an underpinning knowledge base on which to build our professional practice.
It is simply not good enough, in my opinion, to dilute this. *I personally have had patients make appointments for callus removal that have needed to be treated for osteomyelitis, VPs which turned out to be malignancies, nail cuts in which there were underlying ischaemic and infected ulceration?. this has happened, time and time and time again. I cannot reiterate enough how much underpinning knowledge has provided a safe and timely avenue for treatment. It simply is not good enough to say, but we refer on?.refer to whom? How much time does this take? Do you have the knowledge to deal with undermining or infected wounds in the meantime? Do you really understand the complex biomechanics behind callus or corn formation? *Do you really know what you are doing when debriding tissue and applying a dressing?..is this enough? Should you not be giving the patient a comprehensive diagnosis? Do you really have that detailed knowledge of pathology or pharmacology etc. to be able to provide a safe, timely and reliable treatment?
My guess is no you do not. As a FHP you do not have this standardised knowledge base or capability to treat or prescribe! If you have not completed a BSc (DPodM) then you are not at this level.
Worryingly, I have contacted MHRA *( Medicine and Healthcare products Regulatory Agency) who suggest that FHPs can now administer within the course of their work duties any pharmacy medication.
A podiatrist may cut nails, a dentist may polish teeth. Both are health professionals with underpinning standardised knowledge base. The nail cut is not all about the nail, the same as the tooth check or polish is not all about the aesthetics??.it is about the ability to recognise / diagnose and treat or prevent further issues. In this current climate of aging population with a worsening health ?..this is important. Most people can cut their own nails, fit and healthy people. This is about the recognition and prevention of potential issues in vulnerable patients with underlying medical conditions. I personally do not know a single podiatrist who does not perform *health education, screening and assessment at every single contact?..with the underpinning knowledge base it becomes second nature.
I believe the way to tackle these issues and provide protection of the public and a standardised level of education is to protect function. Hearing Aid Dispensers and Dentists are amongst a group of practitioners with protection of function. Dentists have assistant practitioners, however, Dentists diagnose and treat.
The Farriers Registration Council (FRC) was established by the Farriers (Registration) Act 1975. This is an act to prevent and avoid suffering to HORSES by unskilled persons; to promote the proper shoeing of horses, to promote the training of farriers, to prohibit the shoeing of horses by unqualified persons and for purposes connected therewith.
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Now, I don?t know about you but I personally do not rate the health and safety of a horse above that of a human being!!!!!!
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I am not an expert in the legalities of this. This is not for us to decipher?..this is something which must be *put to our Society and legal team.
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Hopefully there will be enough people stirred up that will agree with these sentiments and we can get a group operating to take something like this forward?.feel free to join Podiatry UK?a discussion forum on Facebook for Pods only!
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Hopefully people will also wake up to what nearly just happened at the AGM .
Votes (150 all told).
All of the first 6 ordinary motions went through apart from Chris Hunt?s, which he withdrew after debating - the motion did not really have a conclusion but served to illustrate that Scalpel use by assistants had considerable opposition in the room.
Special resolution 1 - Voting rights for Assistants had 59 votes for and 117 against so was defeated. Special motion 2 was therefore withdrawn.
Special motion 3 - Size of Council had 101 for, 55 Against and 25 with held (needing 75% of the vote to change the articles this was also defeated) so the status quo remains - Council already can determine the size of Council between 15 - 24. Special resolution 4 was carried as it was simply complying with mental health regulations.
No doubt next year will bring forth interesting issues but at least the 32 people in the room did not have the power to over ride the wider use of proxies
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This means in basic terms that there was a proposal within the society to accept assistant practitioners as full voting members. If this had happened, then Pods could quite easily have been outvoted. We know that FHPs are applying to the Society as assistant practitioners.
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The most recent August Podiatry Now Page 6, noted that the outcomes from the Society?s AGM special resolutions to admit Podiatry Assistants AND assistant Practitioners will be remitted to the Strategic Planning Board for consideration. What does this mean? A board, a group of people, who plan strategy. Hmm. I thought this had been democratically voted on and been defeated. I would like an explanation along with clarification of the definite roles of Podiatry Assistants AND Assistant Practitioners.
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In my opinion, before we take in APs as anything other than associate members we have to protect function and not rely on their word for it that they won't set up as FHPs. There seems to be a move from within the SCP to push not only APs but also Apprenticeships. Members in management of NHS presumably see these grades as being a cheaper way of dealing with work that they believe is somehow 'below' what a podiatrist should be treating?..see above paragraph patterning to ?nail cuts? . I feel the Society should not be offering voting rights to non-graduate Podiatry Assistants or Assistant Practitioners. This should be discussed, openly, and deconstructed and if that is what the majority of 10,000 members want?then I will be quiet, because that is the democratic way to do things. Where are the articles in the journal? This, in my opinion, is major policy changing stuff, and it doesn?t even warrant a big double page in the Journal? *Information MUST be openly available. If this occurs then our profession will be changed forever.
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I believe we should cover the whole spectrum of foot health and in Private Practice you cannot afford to turn away business. The problem then is there are less NHS jobs for new graduates and the existing NHS employees are in real danger of down grading other than a select few at the specialist end. SCP should represent the views of its membership, as it is a membership organisation.
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The real issues here though are protection of the public from harm and protection of our hard earned skills and qualifications. There is plenty of evidence out there of harm to the public. What have the Society been doing about this over the last 5 years?
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My feelings are that people should either have a standardised level of education or not be able to practice. We had grand parenting, which was wrongly sold to us as closure of the profession?.this has evidently failed. I personally feel that we should not allow a phased level of scalpel use whilst upgrading to the degree either as this, I feel, could affect our graduate employment with the NHS being able to utilise a cheap labour force. This also will not protect the public.
I have recently also been informed by the Society that Branch CPD may be attended by FHPs at the discretion of the branch. But, it was my understanding that some of the courses *put on by branches are partly funded / subsidized by the Society.
If this is the case, that means that my money, in the form of membership fees is going towards the education of FHPs. I would think that not very many of the 10,000 members are aware of thus nor would they support it, if they were.
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Remember these are my personal thoughts and an insight into situations I have found whilst researching. I would encourage you all to do your own research, make up your own minds, become more informed and most of all vote for what you feel is right.
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Yours sincerely,
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Fiona McGeough BSc (Hons) Pod HCPC Reg MChS Cert Diabetes (Warwick)
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