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Podiatry assistants / assistant podiatrists course?

Discussion in 'United Kingdom' started by Dido, Feb 8, 2008.

  1. DTT

    DTT Well-Known Member

    Hi Bob

    Agreed and pressure of work makes these long debates difficult .

    Also in the pub or face to face


    Inaccurate comments like that could be rounded on immediately and exposed for what they are couldn't they :rolleyes:

    I'm off for a nice day with my Grandchilden now and back to a very busy coalface next week

    cheers
    Derek
     
  2. R.E.G

    R.E.G Active Member

    Del,

    I like others I am now going to withdraw from this debate, as no one has IMO offered any constructive ideas for the way forward.

    However I need to leave you with this one challenge, please explain what was inaccurate about my comments you quoted.

    'what amazes me' well it does.

    'decades' the first example of registration was in the 60's and the introduction of SRCh. So 4 *10 years = decades?

    'The previously unregistered' , would you prefer the grandparented? But of course that would be inaccurate as not all previously unregistered chose to be grandparented.

    Winging, FAIR COP it should be spelt whinging - complaining persistently and peevishly. Did you and others not persistently and peevishly complain about not being recognised for your educational efforts?

    Finally by remaining a member of the SMAE system, despite arguing for access to another option and gaining it, you chose not to so by default you support the production of the 'unregisterable'.

    Good on you mate.

    Bob
     
  3. Dido

    Dido Active Member

    Dear All,
    It seems like this debate/discussion has runs it's course.
    There have been 1,645 views of this thread and 82 posts. I certainly think justice has been done to the original document, and the supplier of same should be gratified.
    Maybe some of the points raised as side issues could be continued on other threads?
    My thanks to all who engaged.
    Dido
     
    Last edited: Feb 18, 2008
  4. With respect, the issue here is not the training and establishment of Foot Health Practitioners by private training organisations, but the introduction of a new grade of clinician by the recognised colleges (with the endorsement of such courses by the Society - to satisfy the demands by the NHS in line with government policy) and the impact such a move may have on the public and private podiatry practice in the UK.

    As previously mentioned, the Society may appear incompetent in dealing with the issue of Assistant Practitioners - a difficult issue for sure - but wider criticism could be levelled at the organisation for its failure to promote and develop another area of government policy - the commissioning of NHS services through its members in private practice - to ease the crisis in public delivery. Although CPLNHS has been policy for almost two years now, advice from the Society to assist members in private practice and guide them through the commissioning process, has been almost non-existent. On a number of occasions, the Society has offered the explanation that its primary focus must be to protect existing NHS jobs and that promoting commissioning through private practice may endanger that principle. However it appears to have been wrong-footed as Podiatry Assistants - with an extended scope of practice - will certainly endanger the level of graduate NHS appointments - as well as having a detrimental effect for practice in the private sector.

    Of course we should be extolling the benefits of a skilled graduate workforce - it is incumbent on all of us to ensure an advancement of our knowledge of foot disease and its treatment - and what better way to achieve this than through a comprehensive educational program. Fragmenting and de-skilling the workforce may satisfy the economics of a state health provider, but they do little for our own professional interests and viability - and even less for our patients.

    It is a pity that we cannot leave behind our narrow self interests across the professional spectrum and work together for the greater good of podiatry in the UK, for it may be time for the profession to reconsider its relationship with the NHS and develop more independently in terms of education and clinical practice. That being the case, there would have been an opportunity for greater partnership between the various podiatry organisations to come together and present a unified plan for future professional development - but instead we have the wonderful prospect of further division and fragmentation. A bleak future for all.

    MR
     
  5. DTT

    DTT Well-Known Member

    Hi Mark

    You are echoing my sentiments as I posted ealier but put them far more eloquently than I.


    The problem is Mark that when some are "trying to defend the indefensible" the private trainers are brought in to cloud the issue and restore the underlying prejudices that are so sadly present within the profession.


    That is a fact that cannot be glossed over IMO.


    Some of us are trying to promote that and have been for years (yourself and Bob included) but the divisions are still so ingrained and the flag waving and "hell & damnation awaits unless you blindly follow a path laid down by a particular body" is shown in several posts on this thread and elsewhere.

    On that point

    Bob

    For the record I hold no allegiance to ANY professional body. I get my insurance from the SMAE where I did my basic training ( which I paid for) and all the courses that were available from them(which I paid for) and subsequent CPD I get elsewhere ( which I also pay for) so I OWE NO-ONE nor do I give any allegiance to anyone except me, myself, and I .

    I have the same concerns as many on private trainers, but this Podiatry Assistant grade is a whole new ball game and one I feel has the potential to take away any existing safeguards we have with the protection of title as well as the point Mark has highlighted .



    That Mark IS the ONLY way forward and like it, or not, if this thread is anything to go by ( and IMHO it is not going to happen)...:pigs:


    Sad innit :bang:

    Cheers

    Derek;)
     
  6. There is a seperate argument here - what is the best way to develop podiatry education and training in the UK. The prospect of greater independence and freedom in graduate training would, in all probability, lead to a drastic reduction in the number of schools and FE establishments offering podiatry courses. Currently there are sixteen or seventeen training institutions - private and NHS supported - that offer courses in clinical practice - at one level or another. Compared to the US and Australia it would appear that there is over-provision in the UK and without NHS support, clearly this level of provision would be unsustainable.

    The question whether a rationalisation of podiatry education provision is necessarily a bad thing? In the short term it may be painful for some, however, might not a smaller number of colleges - say three or four - which brings together the greater resources and wider expertise - not lead to a stable and sustained future?

    It may be understandable that NHS management and podiatry educators favour the development of assistant grade practitioners as it helps maintain their own status quo - but is it the best move for the rest of the profession? It is lamentable that we have failed to agree a strategic plan for podiatry practice establishment in our dual healthcare system - a plan which encompasses practitioners who are employed or self-employed - in the delivery of state care - for without that vision in leadership we will forever be subjected to intrusive interference by external agencies. It doesn't help when said leadership has split loyalties!

    MR
     
    Last edited: Feb 18, 2008
  7. W J Liggins

    W J Liggins Well-Known Member

    Hello Mark

    I intended to bow out of this thread, having nothing further constructive to say. However, I'd like to reaffirm an earlier posting with which you and I agree. namely, there is no shortage of pods, only a refusal by HMG to use the existing pps; I know that you have been making this point for some time. Secondly, whilst you correctly berate the Society for not supporting their members in pp with reference to commissioning, in fairness, the same must be said for my own organisation, the Institute. I am not sure of the actions of the BChPA in this regard.

    All the best

    Bill
     
  8. Bill

    I don't know the position with the Institute but accept what you say. Failures in leadership extend across the professional spectrum. Regarding HMG, might it not be the case that in the absence of any viable constructive proposals from the profession, the government has simply delegated responsibility for solving foot health inequalities in provision to NHS management - who will always look for the cheapest option and one which maintains their own status quo?

    I'm tempted to say the profession desrves better than this, however after reading some of the posts both here and elsewhere, maybe we have the leadership we deserve. A sad indictment of the UK profession at many levels.

    Mark
     
  9. R.E.G

    R.E.G Active Member

    Mark,

    Your eloquence has never been in doubt.

    However I still fail to see you offer a 'solution'.

    Bill I respect your comments that the Society is not alone in the failures.

    Having just spent the day in deliberation over proposed changes to one aspect of the Society (not quite at Council level, but) it was enlightening to be exposed to how 'constrained' the Council/Society/executive are by the 'rules' under which they operate.

    What to me and the working party seemed like an excellent idea with undoubted improvements, ended up challenging the whole basis of Society governance.

    Not good, but reality.

    IMO it does no good to criticise this from without.

    This thread was posted by Dido to open up the issue to the wider Podiatric community, perhaps a sign of a 'new wave' of some membership thinking, but it has still not produced more than one solution.

    That solution was mine, and has been greeted with disapproval. No problem, I'm just waiting for a workable alternative.

    Mark I offer the same challenge to you that was offered respectfully to Bill,

    lets see your 'bullet point' solution to this problem.

    Bob
     
  10. Robin Crawley

    Robin Crawley Active Member

    Slightly off topic but I was wondering about this bit:

    "Along with this we are regulated, as podiatrists, with
    regulation as set by the HPC. We await further changes in Standards of
    Proficiency for Podiatrists, and without LA and POMS there is a chance we will not
    be allowed onto the register. (Janet spoke to this as if it was a foregone
    conclusion then later on in the afternoon back tracked and said that we don’t
    know if it is going to be a standard for all or just new graduates to the
    register). "

    Currently International Registrants must have LA and POMS to register as do new graduates.
    What ARE the chances of this retropectively applying to ALL in future? Personally I think it would be a good thing although many many of my grandparented colleages would not agree.

    Cheers,

    Robin.
     
  11. Sorry Bob, I must have missed your solution, although I'm sure it has merit. I assume you are not referring to the City & Guilds proposal, but perhaps you can point me in the right direction. My own view is that as long as there are barriers between the state and private sectors, and where the NHS seeks to artificially impose restrictions on access, unmet need will always be a factor in podiatry provision. There are some 3,500 pods directly employed in the UK NHS out of a total of over 11,000 podiatrists who are HPC registered. Making use of our private practitioners through commissioned service would certainly go a long way to addressing the unmet need - although it is accepted that the costs will be greater than introducing a new band of clinician at a cheaper rate. The profession - and the Society in particular - should be lobbying hard to promote the skill base we currently have and not seek to dilute the skills that have been hard fought for over the last three decades.

    Mark
     
  12. andymiles

    andymiles Active Member

    mark

    i have read your postings and heard you speak regarding moving to a model of provision based in the private sector. as previous posters have stated you are eloquant and well informed but i must respectfully disagree with you.

    i myself and i suspect many of my collegues do not want to be in private practice, if i did i would have done so by now. i grew up with my parents in business and don't want the stress and hassle. working in the NHS is no picnic but at least i know my paypacket will be there at the end of the month.

    i have heard you speak of a move towards the dental model for provision, i don't think there are many people who qualify for NHS dental provision who would say that the service is not in a complete mess. if this goverment and the previous tory administration are happy to see patients suffer through lack of dental provision i cannot see the powers that be losing much sleep over footcare.

    it may be goverment policy to increase private sector provision but that does not mean it is the right policy. if the society is not cheerleading for this then this is good IMO. was i away when sleepwalkiing into privatization suddenly became acceptable.

    would be interested to know what the policy is in the peoples repubic of scotland :)


    it is absolutely right and proper that the society is concerned with podiatrists already employed by the NHS. i cannot see the union representing nursing saying to it's members "sorry guys, your jobs are gonna disappear but as we also represent nurses in the private sector i'm afraid we're not getting involved".

    i wish everybody who has taken the path of private practice forfilment and prosperity, i really do. i am even more than happy if it leads to more cash in your back pocket than me as being in business takes real guts, more than i have.

    to paraphrase the late great john peel on celebrating 40 years at the BBC " is it a commendable dedication to public service broadcasting or is it a lamentable lack of ambition"

    however i choose to work for the NHS, it's a dirty job etc but i think i can be forgiven if i am not overly enthusiastic about my livelyhood being poached.


    now, a brief foray back on topic

    i am failing to see how the introduction of a grade 4 assistant is going to impact on the private sector. patients treated by an assistant will either be already in the NHS system or patients that should by intitled to care free at the point of contact but have been discharged due to reprofiling etc (and if i'm honest i don't see the doors being flung open). same patients being treated away from the private sector only cheaper.



    incoherent ramble ends
     
  13. Andy

    You make some valid points but also some erroneous ones too, which I would like to correct. You state your preference for salaried employment and I accept that. On the other side of the coin, there are many in private practice who would be equally reluctant to engage in partnership with the NHS on a commissioned or devolved basis. Those with long memories will argue that contractual service with the NHS is fraught with problems in terms of level of remuneration and with contractual guarantees. Payment for services has always been the crux of the problem both in previous podiatry partnerships and with dentistry - to which you allude.

    The dental model - provision of community services through a network of independent practice has many advantages over the salaried, directly employed model - notably its flexibility in meeting fluctuations in demand - but also in patient choice, incentivisation for good practice, and clinical freedom and innovation. The problems with dentistry have little to do with the structure of the model, but everything to do with the operational restrictions imposed by government. Dentists - as with General Practitioners - are still engaged in independent practice - but the latter group have negotiated a far more attractive and realistic payment structure for NHS care, which is why the former now provide their care mostly through alternative funding routes such as Denplan and direct patient payments. In podiatry, there is merit in structuring our services under both models - directly employed and devolved provision. Specialist care, such as acute "at risk" provision would be better provided in a hospital setting where clinicians are directly employed, however general podiatry care could be better managed through devolved practice - providing there is a clear and equitable system for patient remuneration.

    You say that it is right and proper that the Society is primarily focussed in protection of NHS jobs and to a point I agree, however, if indeed the government is determined to introduce commissioning of community care, should the Society not seek to embrace these changes for the benefit of all its members? Agreed there would have to be safeguards for existing NHS employees - TUPE rights for example - but these are negotiable and could be worked to your advantage. Maintaining the status quo, especially when the service is overwhelmed by demand, simply gives the profession more problems - such as the introduction of cheaper personnel which damages the prospects of graduate podiatrists both in the NHS and private practice.

    In regard to the latter - if assistant grade clinicians were restricted to practising solely in the NHS, that would be another matter - there may be fewer graduate appoinments, but the foot health market would not be wholly disadvantaged by an influx of lesser-skilled personnel, but there are presently no regulatory safeguards to limit where these clinicians might work. The emergence of the Foot Health Practitioner is an unfortunate ramification of deficient legislation. Should our own colleges and Society complicate matters further?

    No easy choices but I suggest to you that there is a bigger goal which will require many individual sacrifices if we are to attain a viable, progressive podiatry profession which services both public and private care.

    All the best

    Mark
     
  14. R.E.G

    R.E.G Active Member

    Mark,

    Honest I had written a reply, just not typed it. You have saved me the trouble.

    Basically I agree with everything you say.

    The Dental model is a good example of what can be achieved under a 'Functionally closed ' profession.

    Whether it is in their dealings with the NHS or in private practice, they control the direction the profession goes in and are able to resist the whims of Government. Functional closure would require the sacrifice of some for the greater good of others but would also open new opportunities for assistant grades to work under supervision.

    Bob
     
  15. andymiles

    andymiles Active Member

    i am all for a functionally closed podiatry profession, sooner the better, bring it on. however as mark stated the problem with dentistry is the goverment remuneration.

    the goverment arn't giving the dentists enough cash (although that could be debatable) therefor they are saying "righto, no NHS work from me then" leading to patients being out in the cold - very cheap solution for the goverment.

    my parents dentist recently decided he was no longer going to provide NHS treatment so he informed them that if they still wanted treatment from him they would have to cross his palm with ÂŁ60 each monthly. thats ÂŁ120 per month in his back pocket before he even plugs in his drill. rip off bordering on criminal.

    we as podiatrist certainly ar'nt going to get rich under the dental system and i certainly am of the opinion patients will be no better off.

    lose - lose
     
  16. Robin Crawley

    Robin Crawley Active Member

    Hi Andy!

    I don't agree. I think functional closure would be win win for the profession.
    It is illegal for me to call myself a "Mouth Health Professional" or similar and do fillings on the cheap. I wrote to the BDA and asked them if I could... They said an emphatic NO and quoted chapter and verse as to why not.

    Therefore if we had functional closure everyone would HAVE to charge realistic fees. Patients wouldn't be able to see somone on the cheap i.e. an FHP who used a pressure cooker for sterilisation and bitch that we the Podiatrists were way too expensive becaue we had standards to keep. This is because anyone doing feet would be regulated. Personally I don't see a problem with FHPs or Podiatry Assistants if they were regulated.

    If legislation was changed to enact closure all those doing feet would be grandparented if they wanted it and could prove some sort of competence. Did not garandparenting of Dentists occur in the 1980's?

    I used to think that Private Dentists were rip off merchants too until I got a patient who is a Dentist. If I had his expenses I'd want a large pay day too. Anyway and I know this is contentious but Can we earn too much? I think not as long as we do it ethically. So why impose a pay ceiling on ourselves?

    Also regarding NHS Dentistry: I think that NHS Dentists get an NHS Pension (I could be wrong, but I don't think so). We in PP don't. So NHS Dentists may not be as hard done by as they say.

    Cheers,

    Robin.

    PS. Please don't slap me.
     
  17. R.E.G

    R.E.G Active Member

    Robin,

    I have now read your posts on a number of forums (or is it fora?).

    I believe you have undertaken a top up degree, and either you always knew it or the experience has shown you a critical way of thinking?

    I totally agree with your comments, this is not a NHS vs PP vs grandparented argument but a demand for an autonomous profession.

    Bob Golding
     
  18. Johnpod

    Johnpod Active Member

    "If legislation was changed to enact closure all those doing feet would be grandparented if they wanted it and could prove some sort of competence. Did not garandparenting of Dentists occur in the 1980's?"

    ... and did not grandparenting of previously unregistered chiropodists occur in 2001?
    There has been a steadfast refusal to accept them as colleagues - despite them being asked to prove 'some sort of competence'.

    This profession has had its chance, quite recently, in legislative terms. We can forget closure. It is not in every practitioners interest unless it encloses every practitioner in present practice.
     
  19. andymiles

    andymiles Active Member

    robin

    i think we have crossed wires. i am 100% for functional closure of the profession
     
  20. Just out of interest, are you concerned with or involved in the training of practitioners - either podiatrists or FHPs?
     
  21. Johnpod

    Johnpod Active Member

    Much more concerned with and involved in providing a service for the public.

    When every man, woman and child in this country has immediate access to the service they need at the level they need it we can call ourselves civilised.

    National? Health Service, with least access to those who have paid most?
     
  22. Dido

    Dido Active Member

    Johnpod,
    I am not sure I understand your answer. What is this "service to the public" that you are concerned about? Mark's original question was concerning your involvement with the training of persons in the foothealth industry.
    I am also curious about this model of utopia that you envisage for the NHS and how you think it can be acheived?
    Dido
     
  23. Johnpod

    Johnpod Active Member

    My post seems to me to be quite explicit.

    Many in this profession are more greatly concerned with closure of the profession than with providing a patient-centred (patient friendly?) service to the whole population. Why should it not be available to everybody that wants/needs it - and why should we not strive to create a world where every person has access to every aspect of health care? This is the 21st century and we claim to be an advanced country.

    The NHS employs approximately one quarter of the registered profession. It struggles daily and achieves less with every reorganisation.

    The introduction of a course producing a new podiatry assistant grade is an attempt by the Strategic Health Authority to support a service of sorts in the teeth of adverse demography and increasing prevalence of diabetes and obesity. The calls for closure of this profession at this time betray considerable self-interest and little interest in the service we set up to provide.
     
  24. George Brandy

    George Brandy Active Member

    Johnpod

    There has to be a touch of irony in your last post.

    Those suggesting functional closure do so, not for personal gain, but for public protection. Closure would allow the Strategic Health Authority to potentially fund the training of many Assistant Practitioners with scalpel skills but only for employment within the NHS/PCT or private sector, therefore creating more treatment potential particularly within the NHS. Functioning independently would be against the law.

    Unfortunately functional closure affects all those not registered with the HPC. Could this be classed as self interest too?

    GB
     
  25. Johnpod

    Johnpod Active Member

    Show me the bodies, George. The public want a service, not protection against some imagined threat that nobody has yet managed to prove exists.

    The real irony is that less than one half of the occupation believes it should have dominion over the other half. The SCP has lost almost all the control it ever had and is no better than the rest. It cannot support its NHS members for fear of upsetting its pp members. Many of its members are suffering from residual delusional megalamania.

    And before you jump to any more conclusions, yes, I am registered with the HPC.
     
  26. George Brandy

    George Brandy Active Member

    Johnpod

    What conclusions have been jumped to?

    You confuse me. George Brandy is not registered with the HPC. Nor is George Brandy a member of SCP.

    The Strategic Health Authority plan to train Assistant Practitioners with scalpel skills but no diagnostic capabilities. With no functional closure this means an Assistant Practitioner could potentially enter the private market with the skills to treat but no understanding of what they are treating. To me this spells potential dangers to the public.

    It is my understanding that private trainers provide diagnostic skills as well as treatment skills producing an end product which is "fit for purpose" and it is the vagaries of the HPC who will not register these practitioners. This of course is not the fault of the unregistered practitioner nor the trainers.

    Let us also remember why this invaluable thread was closed down and avoid the temptation to throw accusations at one another.

    GB
     
    Last edited: Feb 24, 2008
  27. Dido

    Dido Active Member

    Johnpod,
    I do not understand why you view the ideas of a closed profession providing patient-centred healthcare as an oxymoron?
    Why should the two concepts be antithetic?
    Dido
     
  28. Johnpod

    Johnpod Active Member

    Dido, any closed shop represents a conspiracy against the public - cite one instance where things do not work that way. The issue of closure of the profession also depends upon around whom it shall close and what shall be the criterion.

    George, I owe you an apology for misunderstanding some part of your post which I now see to be rather enlightened.

    I am defensive because I do not wish to see this useful thread degenerate into a 'them and us'. I have no more answers than anybody else but am happy to make a contribution to an exploration of ideas. I intend no personal animosity whatever.
     
  29. George Brandy

    George Brandy Active Member

    Johnpod

    Apology accepted.


    London based friends tell me that private dentists are now supplying treatment at less cost than their NHS colleagues and yet still making a profit. I haven't figured this one out yet but can only guess professional closure has allowed an expansive market to develop which is appreciated by the public.

    GB
     
  30. Dido

    Dido Active Member

    Johnpod,
    Your argument, in which you describe a closed profession as "a conspiracy against the public" has rather sinister overtones. However, stripped to its basics - on one level - it is an example of a historic argument between the principles of Free Trade and Protection, two of the strongest clarion calls in hundreds of years of economic debate.
    I, personally, consider it morally wrong for the Stragic Health authority to train Assistant Practitioners to have very basic treatment skills and no underpinning knowledge, knowing full well that they could "leak out" into the private sector. As Mr Brandy says this would create a tangible threat to the public.
    When there is a ready pool of HPC registered IPPs willing, and able to do the work, this initiative is short-sighted in the least and will certainly lead to de-stablisation of the labour market, especially in the NE of the UK.
    It would be better for the SHA to look for systems of remuneration for the existing regulated practitioners instead of creating yet another new layer in the foothealth market. Historically, when Chiropody was under the control of Local Authorities I recall this system worked rather well.
    Dido
     
  31. andymiles

    andymiles Active Member

    :eek::eek::eek:

    now you come to mention it, i did have a touch of that once

    :D
     
  32. davidh

    davidh Podiatry Arena Veteran

    (DH with Mod Hat on).

    Andy,

    It's a serious business!

    :D:D:D
     
  33. gina chiles

    gina chiles Member

    Hi - as a person who has been on both sides of the posts - I can see the argument. I think for the conscientious fhp who goes beyond what the course offers- you have a place - but I for one didn't feel as though I got the full knowledge on that course and am subsequently in my third year on the degree course (with two children etc etc) - it is worth the extra mile to get the full qualification - if you want it - you can do it.
     
    Last edited: Mar 17, 2008
  34. cornmerchant

    cornmerchant Well-Known Member

    Gina

    Congrats on making the effort to get your degree, I am sure you will never regret the hard work and the extra time it takes , and it will prove to be a fulfilling and rewarding career. I totally agree, if you really want it ,you an do it.

    Best wishes for the future

    Cornmerchant
     
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