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Personal Footcare (Draft Consultation) set out by Scottish Govt - they need your views

Discussion in 'United Kingdom' started by Lovefeet, Nov 25, 2012.

  1. Lovefeet

    Lovefeet Banned


    Members do not see these Ads. Sign Up.
    Personal Footcare these days is a hotly debated issue. The Scottish Govt, has decided to publish a leaflet regarding personal footcare, at the moment it is a Draft Consultation, so folk can still give their two pence worth.

    The leaflet outlines different approaches for personal footcare. The concerns I have is that this leaflet will have a negative impact on the livelihoods of private Podiatrists. Although, this Draft consultation is occurring north of the border, if it does get published as is, then it is very likely that the aame thing will be implemented south of the border by the English and Welsh Govts.

    Remember how the non-smoking policy in public places was started in Scotland, and then made its way south....well, this leaflet, if it does get published in its current form, will definately have negative impact on private practitioners.

    An example is point 4 of the document...."Independent podiatry practice - where people access personal footcare services (as distinct from podiatry treatment) via the private sector.

    What the blazes is that meant to mean, that only Foot Health Practitioners are allowed to cut toenails.:craig:

    If you interested in commenting on this Draft Consultation, here is the link:-

    http://www.scotland.gov.uk/Publications/2012/10/3194

    Oh boy, now watch all the foot health practitioners supporting it....;)
     
  2. DTT

    DTT Well-Known Member

    They can cover all the points by sending to independent private podiatrists who have the skill set to cover all eventualities in prevention, diagnosis and treatment.
    The problem as far as I can see is the costs involved to the practitioner of running a well equipped practice and the costs of keeping up attendance at CPD events etc something which I would have thought the professional bodies from all sides would have realised and supported but ...... obviously not:bang:

    Those who produce these documents I would assume are from the sheltered world of the NHS and are clueless to the reality of surgery running costs of private practice.

    They are suggesting THEY regulate our fee structure and this £10 a go keeps coming up in this document and in others after a first consult and assessment fee is charged. Not in a million years will it happen in my practice . It cannot be done to give a "proper service" at fee's like that. In the many years I have been in practice I have seen many try to cut fee's and start a war with other practitioners. Without exception ALL of them went under because they cut corners to match their fee and patients vote with their feet.

    The NHS commissioners will do the same as are the private health insurers all want it for virtually nothing and are not in the interested in the slightest about the financial viability of your practice. We will see how the hospital departments get on when they have to tender to the GP's for work, a rude awakening is due I fear.

    When that happens to use one of my wifes sayings "now you know how I feel" will become very clear.
    Cheers
    D;)
     
  3. Mr C.W.Kerans

    Mr C.W.Kerans Active Member

    Re Lovefeet's original post, it was in fact the Irish Government who led the way regarding the smoking ban in public places. Good for public health but a calamity for pubs. Nothing happens in isolation from the effects that it can cause.
     
  4. Tom Galloway

    Tom Galloway Member

    In answer to the original post

    There is a big difference between Scotland & England in the context of this subject and it is stated in page 6 of the main document
    “Personal footcare as part of free personal care and residential care
    Free personal and nursing care was introduced in Scotland on 1 July 2002 through the Community Care and Health (Scotland) Act 2002. Personal care is available without charge for everyone in Scotland aged 65 and over who have been assessed by the local authority as needing it.”
    So basically in Scotland, “Personal Footcare” should be funded by the State and not the patient. This makes it much more of an issue for the Scottish Government.
    Looking at the document I must say I am impressed by the calm logic and common sense of the proposals.
    I have long argued at Society Delegate Assemblies (to absolutely no success unfortunately) that the profession gives out too many mixed messages for the public (and legislators) to understand our training, scope and professional niche. By this I mean that the profession wants to say “we are highly trained professionals, we don’t just cut nails you know” but then the prevailing view is also “we should be the only ones to cut nails – it is a main “bread & butter” part of our income”.
    I would say that the statement in page 2 of the main document confirms this by saying;
    “There is some confusion about what is meant by personal footcare and the difference between this and podiatry”.

    An additional twist to this mixed message promoted by our profession is the “professional schizophrenia” demonstrated by wanting to use two titles “chiropodist and podiatrist” making any attempt at public education effectively crippled.
    Logic dictates that there are two main ways to ensure that a decent financial return can be gained from the professional skills one wishes to “sell”
    1) Be able to offer a highly professional service incorporating functional/technical skills at a level so obviously specialist and difficult to master (but also necessary to enough other people as to make them in demand) as to be worth enough people paying well to receive your services.
    2) Limit the competition to others providing the service for themselves and others so that you have a monopoly (or closed market) so that you can be sure enough people pay well to receive your services. Obviously option 2 only works if there is some reason why people cannot do the thing themselves.
    It is only logical therefore that it will always be difficult to try and make a professional living out of selling one’s time to perform a service which requires no specially acquired learned skill, educational training or technical knowledge beyond what any sensible person already has, i.e. performing tasks which they could easily do for themselves.
    Therefore the long held hope by a number of chiropodists/podiatrists that they can support a professional practice by charging chiropody/podiatry fees to perform regular “personal footcare” i.e. personal hygiene care for the foot is being shown as most unwise in the context of this document.
    Looking at Model 1, this is always going to exist and would continue to exist even if there was functional closure of chiropody/podiatry.
    In the UK of course, there is no functional closure of chiropody/podiatry and there never will be, therefore the other models outlined exist and will not go away.

    Apparently some people in private practice have pursued the sensible and pragmatic course itemised as Model 4, on page 13 of the main document and if private practitioners wish to retain this patient group it would seem the only approach likely to work.
    The case example states;
    “Private Practice Podiatry - Reduced cost service for personal footcare. There are a number of independent podiatry practices in Scotland that offer a reduced cost service for patients with a personal foot care need. At the first appointment the patient will be fully assessed and if their need is for personal footcare only, the patient will be offered future appointments at a reduced cost than what is normally charged in private practice.
    The first appointment will be charged at the normal rate.”
    Of course while maintaining “the bread and butter” within the practice (albeit at reduced level of income generation), this first example of Model 4 still falls foul of the illogicality of trying to educate the public that chiropodists/podiatrists are highly specialised clinicians with an expert functional/technical skills set which merits a professional fee; while at the same time promoting the use of a considerable proportion of the time applying those supposedly highly sought after skills to the provision of a service anybody could provide (or indeed do for themselves).
    Based on all precedents, the ideal model would incorporate the model inferred in a subsequent paragraph of the section on model 4
    “In some parts of the UK, a number of independent podiatry practices provide personal footcare. In some cases this is provided by podiatry assistants as part of the skill mix within a practice.”
    So if the profession was going to apply logic and common sense to providing the comprehensive foot health service that the public needs, it would be proposing the following version of Model 4 as the ideal;
    Private Practice Podiatry – incorporating a personal footcare pathway
    Independent podiatry practices in Scotland incorporate personal footcare at an appropriate cost for patients who need footcare but not podiatry.
    At the first appointment the patient will be fully assessed by a podiatrist and if their need is for personal footcare only, the patient will be provided this level of care provided by podiatry assistants as part of the skill mix within a practice. The first appointment will be charged at the normal podiatry rate and subsequent personal footcare appointments at the personal footcare rate.

    That version would successfully address the one genuine concern that exists in respect of people performing a service which requires no specially acquired learned skill, educational training or technical knowledge beyond what any sensible person already has; i.e. being sure that nothing out of the ordinary has been missed which would make this a risk. It does this by devoting the specialist professional knowledge to the initial assessment. In addition it would – where appropriate avoid the unnecessary use (and associated wasted cost) of the specialist professional knowledge and skill beyond the initial assessment by providing the personal footcare by means of podiatry assistants as part of the skill mix within the practice.
    Also if the assistant noted a problem they would be able to get a podiatry opinion there and then.

    The thing is none of this is new thinking.

    Tom
     
  5. Lovefeet

    Lovefeet Banned

    Ok Tom. Thanks for your reply. However, the concern I have is point 4 of the leaflet that will be for the general public. It sounds like Podiatry is a separate entity from cutting toenails, which is not correct. In my opinion it needs to be done by a Podiatrist or Podiatry assistant, for the simple reason that carers/ FHPs cannot be relied upon to be the eyes of the Podiatrist or Podiatry Assistant. Even staff nurses in nursing homes can't be relied upon.....

    The only time I will ever feel comfortable with my patients having their toenails cut by anyone other than myself or a Podiatry assistant, is that the patient has no medical or social problems that will have a negative impact on their foot health, in the event they get haemed during the toenail cutting procedure. That is what was instilled in us when I studied my degree, and therefore will stick with that attitude.........

    words from one of my favourite clinical lecturers "Err on the side of caution..."
     
  6. Lovefeet

    Lovefeet Banned

    Thanks for your input DTT. You are bang on with what you say.

    I think they trying to market toenail cutting as social instead of medical and then state its not Podiatry...just so that they (NHS) are not obliged to have to offer a toenail cutting service themselves.

    The problem with this happening is that when it comes to training Podiatrists, the students will no longer have the patients to practice their toenail cutting skills on To be honest with you, I think the writing is on the wall here in the UK, with regard to training Podiatrists, it just won't be viable for the NHS to train Podiatrists via univeristy (students grants for Podiatry students) and then not be able to provide them with NHS Podiatry jobs and then to add insult to injury threaten private practitioners livelihoods, but misleading the public by implying that toenail cutting is not Podiatry.:boohoo::boohoo:

    Todays general knowledge question is:=
    How many HCPC registered Podiatrists does it take to figure out that cutting involuted and or thickened toenails is Podiatry - not general footcare? :morning:
     
  7. DTT

    DTT Well-Known Member

    I understand from the general flow of newly qualified pods that ring me for jobs , shadowing, or placement which have increased dramatically in recent months, tell me that the last year at uni now consists of preparation for starting in private practice as there is no jobs for them in the NHS.

    It seems ironic that these people are taken in on the promise of training for a new career having the rug pulled on them in the last year and now, what appears to be a concerted attack on the routine livelihood of private practitioners, will make a start up business all but impossible for them to succeed.

    If this goes through in Scotland and is rolled out in the UK perhaps there will be a section on the application for universities " come and do a degree in podiatry with no realistic chance of getting a career at the end of it either in the NHS or Private Practice. run yourself into student loan debt with no earning potential on completion"?

    I bet someone in the hierarchy will wonder why no-one is applying !!:wacko:


    To answer your question....Just one.....ME:rolleyes:

    Cheers
    D;)
     
  8. W J Liggins

    W J Liggins Well-Known Member

    Tom Galloway is, as is often the case, quite correct IMO.

    In an ideal world, functional closure would have become a reality both north and south of the border. The fact is that it has not. That being the case, it is surely better to accept the inevitable and try to exert a modicum of control by Pods employing assistants (FHPs or whatever) and offering the various governmental bodies what they want (cheap nail cutting). Then the profession would be in a position to bring pressure from a situation of relative strength rather than continue to tilt against windmills.

    Bill Liggins
     
  9. davidh

    davidh Podiatry Arena Veteran

    Hi Bill,

    Sadly I fear your post is too much like common sense for the majority of the UK profession.

    Cheers,
    David
     
  10. Would agree in sentiment that in an ideal world, podiatrists would employ assistants to undertake basic footcare etc but that would only work if you have functional closure. If you don't, then in the (less than ideal) UK health field there is nothing to inhibit or prevent "assistants" from becoming independent providers of footcare under whatever banner they choose (aside from the protected titles) and with a modicum of ingenuity, the public will continue to be deceived and endangered, thus maintaining the farce of the regulatory claim of "protecting the public". Much venom has been directed at the unregulated training facilities, but at least their graduates have some training - even if it is inadequate and questionable - but there is nothing to stop Joe Public from purchasing their instruments and setting up in practice without any training whatsoever. Worse than that, there is nothing to prohibit a dangerous clinician who has been struck-off from continuing in practice under a slightly different banner. If we employ assistants then one would hope they would have to undertake a recognised course of study and training perhaps along the lines of dental hygienists and nurses. But the dental profession has functional closure and hygienists and nurses must work under the responsibility and supervision of a registered dental practitioner. If the profession adopts the same practice without the proper legislative framework, it would be like building houses on quicksand.

    Of course, the elephant in the room is the standards of proficiency within the registered profession and that perhaps goes some way to explain the insecurity and low self esteem which is so apparent in the arguments and debates which have characterised the UK profession as long as I can remember. Grandparenting didn't help - even accepting that some of the grand-parented clinicians were far more competent than their registered counterparts! If I were to hazard a guess - I would say that the majority of HCPC registered podiatrists are not competent to undertake anything more than what we understand to be basic footcare - cutting toenails and removing callous and corns and treating VPs (badly), which makes the proposition of supervision rather peculiar. One wonders what percentage of the profession that provides orthoses for patients have even heard the term "tissue stress" or what is meant by DMICS or rotational equilibrium. Probably about the same percentage of those that use LA who could accurately relate the MSD of the various medicines they administer.

    The foundation is simply not there to build the profession you describe. The foundation is enshrining and protecting that entity in law vis-a-vis specifying the podiatrist's scope of practice within the body of a regulatory framework that prohibits others from providing the same out with that regulatory framework. Unlike Tom, I do see functional closure as an attainable and worthwhile goal - and I think that with a proper understanding of the issues, the vast majority of the public would feel the same too. It is lamentable that in just over 50 years of regulation in our profession, that we have yet to achieve it, but perhaps not surprising, given our continuing and persistent identity crisis or “professional schizophrenia” as Tom eloquently puts it. Without the proper foundation, the profession will languish where it has been for the last 50 years.

    Mark
     
  11. Lovefeet

    Lovefeet Banned

    Thanks for your input. The closing date for viewpoints was on Friday, 30th November.

    The opinions are made public, so lets see if The Society of Chiropodists and Podiatrists, bothered to add their two pence worth.....
     
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