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Podiatry Assistants in the NHS

Discussion in 'United Kingdom' started by Amy Walton, May 23, 2005.

  1. Amy Walton

    Amy Walton Welcome New Poster


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    I am a Podiatrist working for the NHS in Surrey, UK. I have been asked to participate in a group looking at the role of a Podiatry Assistants in the NHS.

    Currently our PA has spends approximately 18 hours a week on clinical duties and 17 hours on adminstration duties in the Podiatry office.

    We are looking at ways to expand the role of the PA. For example, currently the PA does not debride using scalpels.

    We would like to utilise the skills of the PA to enable flexibility in currently crowded routine clinics, enabling Podiatrists to concentrate on diabetes screening, biomech, wondwound care, etc, and thus reducing waiting times.

    I am looking for ideas and suggestions, please on how we may go about doing this. Have any of the Podiatry arena members been through a similar experience?
     
  2. Stephen Moore

    Stephen Moore Member

    Podiatry Assistants and the NHS

    Amy

    Can I suggest that you contact the Society of Chiropodists and Podiatrists, they have set up a Task Force to look at the whole issue of Podiatry Assistants and potential Assistant Practitioners.

    Useful contacts would be Alison Wishart, Dean of the Faculty of Management and Head of Podiatry in Hounslow; Mike Townson, Board member of the Faculty of Management and Head of Podiatry in Portsmouth and Janet Macinnes, Head of School at Brighton and member of the Task force.


    Regards

    Stephen
     
  3. Craig Payne

    Craig Payne Moderator

    Articles:
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    This is an issue that profession is wrestling with in Australia - ie just what should a PA do and what should be considered their scope of practice...

    The approach I think you should consider, is the answer to the question as to why should they be employed? --- my answer is to allow the Podiatrists time to be used more productivly (is see more of the right kind of patients) --- their tasks and scope should reflect that.

    That does not mean they should necessarily be treating low risk patients (should the service even be seeing them anyway?). It does not mean they should do scapel debridement (dosen't mean they shouldn't either)

    In our discussions here, I have been using this eg - takes a podiatric diabetes clinic and apatient with an ulcer.... the PA can get the patient in and ready; they can use a proforma to obtain some basic info (eg current blood glucose readings; etc); they can remove the previous wound dressing (and leave it for the podiatrist to inspect) ... so when the Podiatrist arrive the patient is ready. When the podiatrist is finished, the PA can apply the wound dressing; apply emollient; check the shoes; discharge patient; etc --- all this happens while the Podiatrist is treating the next patient that the PA got ready. .... there is no reason why the Podiatrist can not see up to 3 times as many patients in this scenerio .... thats a good 'bang for the buck'

    In Australia, a new national policy is under consideration by the national body and should be approved in a matter of weeks concerning PA's. The innovative and creative who make use of the policy change will thrive .... the above is just one of many many eg's in which use can be made of PA's
     
  4. davidh

    davidh Podiatry Arena Veteran

    Nice one Craig.
    One of the problems we faced with the NHS in the past was a restriction on numbers treated per session (came from professional body recommendation I believe?).
    Does this restriction on numbers per session still apply?

    Regards,
    david
     
  5. Craig Payne

    Craig Payne Moderator

    Articles:
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    With the kind of support I am talking about I can see no reason for a patient not being booked in every 15 mins. Its very short sighted if the professional body is restricting it .... I also realise that a "culture" shift may be needed for that to occur.

    Another eg of creative and innovative use that I use in discussions is .... lets take a sports medicine clinic and a new patient runner with an overuse injury ... PA gets patient in; uses a proforma to elicit a running/competition/training history and other basic bits in the history; the bag load of running shoes are laid out on bench -- ie patient is ready; Podiatrist come in --- makes diagnosis; discusses treatment; if orthoses are indicated, Podiatrist goes off and treats another patient while the PA does video/computer gait analysis with and without a couple of different orthoses designs; Podiatrist comes back - reviews video etc with patient --> make decision re orthoses type then goes away to treat another patient while PA "manufatcures" prefab or prepares for casting; Podiatrist returns for cast or check of modified prefab ---- how efficient is all that???? The PA could have even done the video gait analysis at the start before the Podiatrist even sees the patient (its not rocket science to deteremine if one is indicated or not) ....

    As I said above:
     
    Last edited by a moderator: Jun 12, 2005
  6. Craig

    I fully agree with what you say. Assistants are extremely valuable additions to the profession and have much to contribute. The important word here is ‘assist’. I see the role of the PA as much the same as the dental nurse who prepares the patient, completes notes, assists the dentist in making amalgams, books appointments & etc. Team working like this is extremely efficient and increases capacity considerably. All to the good.

    The problem is that the government and institutions may see the role of the PA, not as an adjunct to podiatry personnel, but as an alternative. This is further complicated in the UK where we have a new regulator who appears to be intent on making policy on the hoof when it comes to regulating “new” professions. Although the titles of chiropodist and podiatrist are protected under law and the educational programs fully validated, there are a number of ‘independent’ schools who have circumvented the legislation by hosting courses to train Foot Health Professionals – essentially the same courses they used to market as chiropody and podiatry. The practitioners who ‘qualified’ under these courses have now been grand-parented into the main body of the profession under the guise of ‘closure’.

    One issue therefore lies with the people completing courses as FHPs as the Health Professions Council will be obliged to regulate them once their numbers reach a certain threshold. To do so the FHPs will have to construct their own Standards of Proficiency (SOP). However, if the HPC decides that the SOP of FHPs does not differ substantially from the SOP of chiropodists and podiatrists, it is probable that they too will be grand-parented into the profession, further diluting the skill and knowledge base.

    The other issue is the proposed development of the new NHS workforce where it is envisaged that PAs may have an extended role in treating pathological nails and skin lesions. If podiatry existed only in the confines of the NHS this may not be so great an issue, but it doesn’t. Approximately half the profession in the UK gain their livelihood from the private sector and an influx of autonomous assistants and FHPs will dilute the market share considerably.

    One solution would be to frame legislation which protects the practice of podiatry – what is termed 'functional closure'. For this to happen we need government to consider a dedicated Podiatry Act – something that is long overdue. To facilitate that we must have credible research to back our contention that podiatry is a sufficiently important profession in its own right to warrant such a legislative program – hence the importance of the study Cameron outlined.

    Happy days!

    Mark
     
  7. diane

    diane Welcome New Poster

    amy

    hi, this is not a direct answer to you letter, however you may think i have a bit of a cheek in replying to you, i noticed that you are a Podiatry assistant and i would be most grateful if you could point me in the right direction of where to search for anywhere in the u.k. that offers some sort of training for same career as yours(but hands on training would be ideal). i find that the only path open to me where i can get some sort of info is mainly through university etc,other than this i find this to be a closed book, i would be most grateful for any info that you could pass on........ please forgive my forwardness, but getting desperate for reliable information.

    yours

    diane
     
  8. DAVOhorn

    DAVOhorn Well-Known Member

    re FCA's

    Dear All,

    I agree with Mark that FCA / PA should work in the same capacity as a Dental Surgeons Assistant.

    This would make my clinic more efficient as i would concentrate on the provision of Podiatric care and the assistant would do the rest.

    I am concerned that MISUSE of assistant grades as autonomous clinicians may happen.

    the HPC was put into place to protecet the public from non registered people treating patients.

    So the NHS as a piece of misplaced financial expedience may allow the use of NON HPC reg persons to treat pts.

    My PCT does not have an FCA as we have discharged most of the caseload that an assistant grade would have treated.

    We treat primarily high risk pts.

    Those that are not high risk receive a course of tt and are then discharged from the service after that course of tt.

    It seems problems occur when pod depts do not wish to discharge pts after appropriate packages of care and so wish to have anciliary grade to facilitate the provision of non podiatric services within the dept.

    My PCT hope to be setting up a training program to train carers family etc to provide simple social care safely. This we hope to be putting into place soon.

    Certainly all new referrals to the dept are triaged via the referral form and those that are not at risk and who have not identified a podiatric need are offered a HEALTH EDUCATION SESSION. This includes advice on the correct cutting of nails. Where to buy nail nippers and diamondeb files etc etc.

    This is having a very positive impact on the management of the level of new pt referrals..

    We hope to introduce a similar package aimed at Level 1 and Level 2 Diabetics as per NICE. This a colleague and i are working on now.

    We are also working on a training day for Health care staff so that we can educate these staff on care of the foot so that when they give advice there is commonality with the advice that we give.

    There are massive changes ahead for the NHS Pod depts if we wish to take the opportunities.

    NICE 2
    Falls Prevention
    Admissions Prevention
    Orthopaedic Triage
    Management of Long Term Chronic Disease in young adults
    Management of Long Term Chronic Disease in Children
    Management of long term chronic disease in the elderly.

    The above represents a small example of where the Pod dept in my PCT is going.

    The above is all to do with providing relevant health and social care to prevent people having to be admitted to Acute Hospitals for a wide variety of problems.

    This if managed well will save the PCT's millions as the money will be spent in Primary Care and Not in Secondary care or A&E admissions.

    An example would be people with chronic lung disease .

    Physio would provide packages of care to enable simple daily exercise to try and maintain lung function.

    OT would provide adaptions in the home etc to enable someone to maximise their abilities to maintain themselves in the home.

    Pod would provide pertinenet care eg wound care, orthotics, simple insoles, Suitable footwear (yes we are looking at this). Treatment of pathology of feet eg cal hd complications due to PVD and Neuropathy. Provision of advice for family and carers to maintain the feet via application of emolients , hygiene and simple nail care.

    So i see an interesting future working with my Nursing,Physio and OT colleagues.

    I hope for true Multi Disciplinary Working. Hoipefully this time round with initiatives like this and Invest To Save this will now happen.

    or am i still misguided and ever hopeful.

    regards David
     
  9. R.E.G

    R.E.G Active Member

    David,

    Not looking to be controversial, but where does the 80 year old blind independently living female with no relatives or close friends needing nail cutting fit into this NHS model?

    OK she is on disability living allowances, so should be able to pay my fees, but is well p***d about it.

    As the discharge policy comes into play, we 'poor' private practitioners have to 'face' the charging situation.

    It ain't that good, I think the transition could have been handled a bit better.

    What do you think?

    Bob
     
  10. Craig Payne

    Craig Payne Moderator

    Articles:
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    You are assuming that this should be a "health" service and should be provided by the NHS...we have had discussions on this in other threads ... when health care dollars are limited, they should be allocated to services that provide the greatest health gain - where is the health gain from allocating public money to a non-pathological toe nail cutting service?
     
  11. carolethecatlover

    carolethecatlover Active Member

    Hey Diane, me too. I am a Dental Surgery Assistant who just CANNOT get into dental hygiene, (you have to have a relationship with, or be related to a dentist, yes, honestly) So I am trying pod. would be happy to the pod assistant if it paid better than being a DSA. Carole
     
  12. jackie moorhouse

    jackie moorhouse Welcome New Poster

    I have been a podiatry assistant in the uk for 21 years. I used to be just an assistant like you describe but as the years went on I took courses in appliance manufacture. I have always had my own caseload of patients needing nail cutting for pathological nails. I use a drill.I mainly work on my own doing patients who have been assessed by the podiatrist. I assist at nail surgery. I work in residential homes daycentres for the elderly and learning disabilities.Now at 58 they want me to retire, No way! watch this space!
     
  13. jackie moorhouse

    jackie moorhouse Welcome New Poster

    jackie

    :) :) I have been a podiatry assistant in the uk for 21 years. I used to be just an assistant like you describe but as the years went on I took courses in appliance manufacture. I have always had my own caseload of patients needing nail cutting for pathological nails. I use a drill.I mainly work on my own doing patients who have been assessed by the podiatrist. I assist at nail surgery. I work in residential homes daycentres for the elderly and learning disabilities.Now at 58 they want me to retire, No way! watch this space!
     
  14. davidh

    davidh Podiatry Arena Veteran

    Hi Jackie,

    I hope you continue in your present work for a good few years yet!

    However, would it be fair to say that if you were forced to retire you may decide to set up on your own?

    Regards,
    david
     
  15. dillydonut

    dillydonut Welcome New Poster

    I have just passed my podiatry assistant exam after one year on the job training(NHS), I had to revise from a handbook from the society for PA's spent 500hrs in clinic, I am currently a band 2

    the exam consisted of sittting a hours paper, treatment of two patients and have a short answer question sessoin with the examiner and hand him the proof on continual assessment from the back of the handbook signed by my internal assessor after completion of various tasks.

    I am just starting to have regular clinics with nailcare only patients who maybe low risk Diabetics or have a need for nailcutting e.g. sight problems disability, Rheumatoid etc, I still assist in nail surgery and spent a lot of time doing admin.

    It is interesting to hear the scope of other PA's, some are band 4 and work on their own and do home visits, but I have to have a more senior member of staff in the same building or I have to cancel my clinic and I am not allowed to do home visits. I do not do assassements, debride, nail surgery, ulcers, apart from dressing them if they are seen by a Pod first, which I completely agree with.

    In order to protect the work role of Pods podiatrist should have clear boundries in all sectors on thier limitations and scope of practice other wise it is the case of why employ a podiatrist when you could emply two PA's to do the job?

    I find it difficult to find any information about scopes of practice as this tends to vary between trusts, countries etc

    Dill
     
  16. cornmerchant

    cornmerchant Well-Known Member

    Will there be any point in training as a podiatrist in the future?

    Seems to me that the assistants are going to do most of the work at cut price, with shortened training times,and less regulation, so where are the jobs for pods going to end up?
    Call me stupid, but in PP ,an assistant is the last thing I need.

    The world has gone mad.

    Cornmerchant
     
  17. jo_pod

    jo_pod Welcome New Poster

    Hello You All,
    I was just reading through re: PA - and as a Podiatry student was wondering if there's any possibility that level 3 students could work -at least- as podiatry assistants?
    I appreciate that some of you think that we-podiatrist 'don't need' PAs, however me and some of my pals are really looking forward to get to the 'podiatry world' before we graduate - therefore we would love to join Pod Teams who do need assistants and maybe future podiatrists. A part time positions would be best for us. Sorry to disturb - just not sure where can we turn with such query.
    Will have a look at Podiatry now as well but haven't seen yet any jobs for assistants. Any Ideas where to look???
    Thanks very much for any comments in advance..
     
  18. carolethecatlover

    carolethecatlover Active Member

    JoPod,
    Here in the land of Oz, If I pass all my 2nd year exams, next 3 weeks, please wish me luck, I get to be a 'podiatry assistant' Allied health cert IV it's called here. It is difficult to figure out what I am allowed and not allowed to do.....not use a sharp instrument.....but cut nails, and prescribe and make orthotics.....yes. Don't whinge about the job being taken away, here in Oz, lots of work. Carole
     
  19. JB1973

    JB1973 Active Member

    hiya dillydonut
    congrats on passing your exams. we had a podiatry assistant go throught he same last year ( with me as mentor) and it was a relief to get it over with!.
    as far as being a band 2 how was that decided. our assistants are band 3 and as well as routine nail care we are now looking into the possibilty of utilising the assistants to carry out low risk diabetic screening, home visits etc. i understand the apprehension of podiatrists who see the assistant encroaching on their role, however i also remember a few years ago when we first started using assistants and some pods refused to work with them. now i dont think anyone would argue that they are as valuable a member of the team as anyone. cormerchant has a point though and unfortunatley finance will dictate that more assistants are employed as we wont be able to afford band 5, 6 or whatever soon. hopefully it wont be to the detriment of the profession.
    cheers
    JB
     
  20. ladyfaye

    ladyfaye Active Member

    Hi Jo

    In response to your question as to whether you can assist podiatrists as a PA whilst you are still a student.....I see that you're studying in South Africa so I assume that you are registered under the HPC as a student Podiatrist.Im not sure what the regulatory boards rules and regulations are in such instances but it would be worth finding out before you actually decide to venture down that route. My feeling and I stand to be corrected would be that I think it would be difficult in SA to secure a "paying" assistant post whilst you are still a student.If the practise you were helping at indicated that they were assisting in your training,logic would have it that the practice would have to be validated by the regulatory board.I urge you to please investigate fully before embarking down this road!

    Furthermore,if you were to look for vacancies...Podiatry Now and the SOCAP website are good to utilise,however looking on the NHS job website and applying directly to PCTs may help. Also,food for thought...on an earlier thread it says that the PAs have to complete 500 supervised clinical hours.....Can you demonstrate having completed the required number of hours in the event you tried to register with SOCAP or the NHS? I fully support the positive roles PAs play in daily practice having had the opportunity of working with 5 PAs over the last 6 years and I believe that we can learn from and support each other .

    Good luck in your quest for answers

    Regards

    Faye
     
  21. mamatootsies

    mamatootsies Member

    Hi jo_pod! :D
    I too am a pod student, 2nd year. Following our first year NHS placements a couple of us got offered work as FCA's for the summer. It may be worth approaching your placement supervisors and asking them directly- you could always remind them they have already arranged CRB checks and insurance for you? I was a FCA/PA in a previous life... can't wait to do the 'whole job'! :butcher: Good luck with the job hunt!:D
     
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