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Podiatry Assistants

Discussion in 'General Issues and Discussion Forum' started by W J Liggins, Oct 16, 2004.

  1. W J Liggins

    W J Liggins Well-Known Member


    Members do not see these Ads. Sign Up.
    Welcome to this section of Podiatry Arena. The precise activities of Podiatry Assistants vary from country to country. In the U.K. it seems that the Department of Health is examining the possibility of a radically enhanced role for these staff. Unlike the USA, where the profession maintains control of support staff, the precise duties of assistants is in the hands of others. What is the situation in Australia, New Zealand, South Africa and elsewhere? How can these staff be utilised to benefit the profession? How can the profession exert control?
    Any information, suggestions or comments will be very welcome.

    I look forward to your postings!

    Bill Liggins
     
  2. davidh

    davidh Podiatry Arena Veteran

    Hi Bill,
    It seems pretty obvious to me that in order to safeguard the podiatrist, our role needs to be clearly defined before defining the role of podiatry assistant.

    That said, I believe the pod assistant (foot health professional/ footcare assistant etc) to be a very useful adjunct to podiatry (both the individual practitioner and the podiatric team). For example, we are both very aware that in the UK there exists a huge number of pensioners who need, but cannot access through the NHS, simple nailcare. The value in using a pod assistant to do this type of work lies in the fact that the patient is seen, on a regular basis, by someone with the background and training to enable them to recognise developing conditions which need referral back to the podiatrist.

    I would like to see a regulated extension of podiatry assistant roles, and in any case, I believe this to be inevitable - but not until the role of the podiatrist is recognised, regulated, and protected.
    Regards,
    David
     
  3. pgcarter

    pgcarter Well-Known Member

    Lots of debate about this in Aus, same needs in the aged population, same cost pressures, professional insecurity about loss of jobs and income etc. I think it's needed but it will be a trauma in the short term.
    Regards Phill Carter
     
  4. Matthew Oates

    Matthew Oates Member

    Foot Care Assistants in Oz

    This is in fact right on our doorstep. East Gippsland TAFE (Technical & Further Education) has established a Foot and Hand Carers course to be up and running in 2005 to try and address some of the rural and regional podiatrist shortages occurring at the present time in Victoria (and dare I say it across the country). I have provided links to their websites:

    http://www.egtafe.vic.edu.au/docs/courses/footHandCare.htm

    http://www.footandhandcarers.com


    Matt
     
  5. Tuckersm

    Tuckersm Well-Known Member

    The foot and hand carers course are not podiatry assistants. They will be independant practicioners (according to their web site).

    However the South Aust association has been running a course for pod assistants for some years and in Victora the association, union DHS and others have been working with the Communith Services and Health Industry Taining Board to develop a podiatry module to be an add on to the Allied Health Assistants course. It is expected that these assistants will assist the podiatrist in performing their duties (Intsrument Prep., Clinic Prep, Patient prep, etc.) This course has had I believe state accreditation at the Cert 3 level and will undergo national accrediation in the future. Mayfield is the proposed eduction facilitator
    :cool:
     
    Last edited by a moderator: Mar 3, 2005
  6. Tuckersm

    Tuckersm Well-Known Member

    At Risk

    Further on Podiatry assistants and other things, The Podiatry Registration Board of Victoria recently found a podiatrist guilty of unprofessional conduct of a serious nature, in that along with some issues re; incorrect billing of government agencies, he had put the public at risk by allowing his footcare assistants to use sharp debriding instruments on patients and that they were providing orthotic therapy with little supervision. This descion could limit the scope of practice of any potential footcare assistant working in a podiatry practice, but will of course have little direct impact on the independant foot and hand carer
     
  7. Tuckersm

    Tuckersm Well-Known Member

    Podiatry Assistants and Basic Nail Care

    After discussion with a number of podiatrists, I have had a further look at the A.Pod.C policies in regard to Foot Hygeine and Podiatry Assistance http://www.apodc.com.au/apodc/Australian Podiatry Council.htm#1
    It states that
    Yet the Podaitry Assistant Policy states
    Does this indicate that while the profession accepts that other health care providers will provide basic foot care, those working under the closer supervision of a podiatrist should not provide basic nail care?

    As the population continue to age, there will be an increased need for basic nail care as well as more complex foot care. Even with a large increase in podiatrists (which given events in WA and NSW may not occur) there will not be enough podiatrsist to provide care for people with foot problems let alone people who need basic nail care so alternatives need to be found. should we as a profession be driving this or should we let it occur with limited input from podiatry?

    Any Comments?
     
  8. W J Liggins

    W J Liggins Well-Known Member

    It seems that the profession in Australia are edging towards the USA experience.
    Personally, I have no concerns about the precise duties of an assistant provided that the assistant is working fully under the auspices of the qualified professional - in this case podiatrist.
    The problem in the U.K. is that the profession have missed the boat and are controlled by the Health Professions Council - a Quango, who are quite capable of registering any group they choose. A group called 'Foot Health Professionals' are lobbying for registration at this time.
    Is the profession in control of it's own future in this regard, in Oz, NZ & South Africa?

    Bill Liggins
     
  9. Head

    Head Welcome New Poster

    Podaitric Assistants

    Dear Moderator and others,
    Below is a discussion paper I have developed in support of the formalised training and registration of Podiatry Hygienists in Australia. A bit long winded but it need sto be detailed to respond to many concerns raised about this issue. I wouild be interested in the response to this.
    John Head
    The Impact of Podiatry Assistants Providing foot Care on Podiatry Profession in Australia.

    This discussion paper is written in response to current issues and concerns raised on the impact of the introduction of APodA trained Foot carers.

    There are currently 2 policies by APodC related to the issue of foot care provided by non-podiatric staff. The first is for “Podiatric Assistants” which clearly states that they are accountable and supervised by podiatrists and their duties specifically preclude the “hands on” use of instruments in the treatment of patients.

    The second policy is related to “Foot Hygiene” and is defined as the routine care of normal skin and nails by public sector health care workers as part of, but not the exclusive, role in their range of duties.

    The Australian Podiatry profession is now faced with a range of issues that necessitate us to review these policies if we are to stay as the prime profession in the role of foot health care.

    There is an increased demand for foot care and the podiatry profession doesn't and won't have enough people in the workforce to deal with it. The current Australian podiatry workforce numbers just over 2000, is predominantly female (64%) and private sector based (75%) (AIHW). There is a shortage of podiatrists with only 47% of job vacancies filled (DEWR). Of the 709 podiatry practices in Victoria only 38% offer domicillary and 22.5% offer nursing home care.

    Recent changes to podiatry schools in Western Australia and New South Wales have reduced the intake of podiatric students and will result in further strain on the existing podiatry workforce in the foreseeable future. The resultant increasing demand on tertiary podiatry positions naturally leads to higher TER scores and higher quality of academic graduates with higher expectations of the type of medicine they will practice. Burnout rates in podiatry, due to disillusionment within the profession, is a current issue and needs to be addressed (Tinley 2002).

    The increase in demand for podiatry and foot care in general is well documented due to the aging population and increasing rates of diabetes (6-12% 400,000 Victorians). The estimated need for complex and basic foot care is expanding beyond the capabilities of the podiatry profession alone to cope with. The Australian workforce is currently increasing by 170,000 per year however it will be only growing by 12,500 per year by 2020 (DHA 2001). Podiatry will therefore be competing for skilled workers in a reducing market and policymakers for tertiary education are going to be focusing on issues such as workforce retention rates and flexibility related to the return on training investment. We must therefore improve the scope of practice and satisfaction within the workplace for the podiatry profession.

    Whilst sectors of the profession perceive that non-essential foot care is not a podiatric responsibility, it is seen as an important responsibility by government and within hospital, home health and extended care settings. It has been suggested that providing basic foot care is similar to providing other remedial therapies such as massage and oral hygiene. This is simply not the case as not all muscles need massaging, but all toenails need cutting; using specialized, sterilized equipment with precise skilled dexterity by an operator, on a part of the anatomy that is difficult, if not impossible to reach for most of the target clients.

    Regarding providing oral hygiene as being similar to providing basic foot care does however draw some relevant comparisons. Dentistry is similar in a number of ways to podiatry. It is a specialized allied health profession dealing in a specific area of anatomy. and it is dominated by private practitioners (approx 90% ADA). In recent history dentistry has had to respond to increasing public demands on the profession. The Dental Association, in cooperation with the Dental Practice Board, decided to make some pre-emptive changes within the profession, before they were forced to by government. They established training, regulations and work policies for Dental Therapists and Dental Hygienists. Contrary to predictions of many within their profession, who foretold of division and down grading of dentistry, it did not “reinforce stereotypes” of dentistry as teeth cleaners and dentistry did not lose public positions. But it has allowed for an increase scope of practice at the “top” end of their profession (ADA 2005). This whole process was done with strict guidelines of practice for Hygienists and Therapists who must work for, and under the direction of, qualified dentists (Dent.Pract.Reg. Board 2002)

    97% of people on public podiatry waiting lists have a foot pathology. With the inclusion of a qualified foot carer in a public clinic the podiatrist could concentrate on that pathology while the career completed foot hygiene and directed treatments. Public sector waiting lists will always be long and providing basic foot care to the public does not create dependency. What ever happens, nails will always grow and someone has to look after them!

    If we as a profession spend our clinic hours discharging clients to outside of our service then we loose market share to professionals prepared to provide that service. This opens the door for policymakers to negotiate with professions outside of podiatry and can lead to marginalisation of our profession. This may be already happening with current East Gippsland TAFE Foot and Hand Carers course commencing this year and some enrolled students already promising “podiatry” services at a discount rate to clients. Other public podiatry services have established foot carer models to cope with service requirements and are working outside of APodC guidelines.

    It would seem counter intuitive that current APodC policy means podiatrists are able to employ and train staff to provide clinical assistance but won't allow them to provide basic foot care under podiatric direction in a clinic with specific facilities and instruments for foot care. Whereas any allied health professional or health care institution outside of the podiatry profession can employ a less qualified health worker to provide that service!?

    It seems we are at a cross-roads with this issue as we have come across increasing demands with increasing qualifications and a need to retain all aspects of foot care. New and future graduates don't want to do this work. If we persist with current policy we either risk loosing the basic end of foot care to other professions and loosing highly qualified professionals to disillusionment. If we are to retain the basic foot care end of our profession and remain the pre-eminent profession in foot health then I suggest we change the current policy to allow for Podiatric Assistants to provide basic foot hygiene under the employment and direction of a qualified Podiatrist.

    In good faith,
    John Head
    Feb 05
     
  10. Tuckersm

    Tuckersm Well-Known Member

    John,

    I know that the dental model is often raised as a possible model for podiatry. One major problem though is that while dentistry registration acts, in most if not all of Australia, contain scope of practice definitions and restrict not just the title of dentist put also the practice of dentistry, whereas the podaitry acts around the country do not contain scope of practice defenitions or restrict podiatric procedures to podiatrists, and only the title is protected.

    There are already a number of places around the country where non-podiatry foot carers have been employed as substitute podiatrists due to a percieved difficulty in recruitment (NSW Hunter region and Royal Hobart Hospital)(maybe it has moore to do with the rate of pay in NSW than lack of podiatrists). Unfortunately these substitute services are then never evaluated properly, except in a way that "the patient love it" rather than on economic/cost benefit grounds.

    Ultimately I am not sure what is the right way to go. I do have concerns that governments may get "confused" in the discussions and think that podiatric foot care and non-podiatric foot care are the same thing and are therefore interchangable.

    Though a recent decsion by a formal hearing of the Podiatrists Registration Board of Victoria may clarify things at least in that state.
     
  11. Head

    Head Welcome New Poster

    Dear Steve,
    Thanks for your information. It's good to have someone in an informed position contributing to this debate. I'm surprised that the Vic Podiatry Registration Board has no power to implement recommendations on scope of practice for public safety made by the Podiatry profession. If this is the case then we need a review of the podiatry registration act. Can you tell me is the act comming up for a review?
    Also I agree with your information on the introduction of foot carers already within the profession in an adhoc way. This must stop and the profession must have some control over it before it progesses to beyond our domain. Implemeting a structured Podiatric Hygienist model is one way to do it and it would get rid of the government "confusion" about who to deal with on foot care.
    I would be interested to know what the final decision is about the recent registration board formal hearing on this matter.
    Regards,
    John Head
     
  12. Tuckersm

    Tuckersm Well-Known Member

    John

    all Victorian Health Professional Acts are currently under review http://www.dhs.vic.gov.au/pdpd/workforce/pracreg/sys_review.htm

    This review has been underway for over 12 months with responses from the public, the Boards and professions. These have been collated and presented to the Health Minister for consideration. New acts may be introduced into parliament in the Autum session, but don't hold your breath. The review has focused more on the big picture stuff of board function and administration, but did include discussion on podiatry prescribing as well as regulating the non registered (massage therapists etc.)
     
  13. John

    Your article will have resonance in most developed countries. I would therefore suggest you delete 'Australian' and change 'these' to 'our' in the first paragraph to give the writing a more international flavour!

    You make the argument for introducing a new grade of practitioner on the basis that demand is overwhelming the available capacity. Have you looked at ways of increasing capacity other than increasing the size of the workforce? Perhaps what is needed first is for podiatrists to change the way they traditionally work and the way they are remunerated - both in the public and private sectors. Have you considered the impact that patient scheduling has on available capacity, for example, or the factors present in fee-per-item charging where it may not be in the clinicians best financial interests to take a curative approach to clinical management? In the public health system in the UK the traditional podiatry caseload is between 600 and 1,000 patients per clinician, yet it is quite easy to increase the caseload three-fold without increasing the workload - simply by employing a more appropriate scheduling system. This also negates the need for waiting lists and I note your comments in that respect. Do you face the same hurdles in changing practice procedures in Oz as we do elsewhere?

    I agree that podiatry is losing market share and I also agree that the policymakers and legislators will use our professional snobbery to their best advantage - not ours. You also write that 95% of patients on podiatry lists have foot pathology - which I agree with, otherwise why are they on podiatry lists in the first instance. But how many people in society have podiatry problems that require the expertise of a graduate practitioner to deal with? And is that demand sustainable?

    It appears that in most countries the profession is going through a period of self realignment when it comes to its scope of practice. There is a vast difference to what the public want from us and what [a portion of] the profession wants to do for them. Nail care in elderly patients is an integral part of what podiatrists provide, just as treatment of corns callous, verrucae & etc are too. We may perceive these aspects of our work as slightly less glamorous as paediatrics, biomechanics or surgery, but they form a large majority in terms of actual demand from the general public. Should we discard them to other agencies over which we have no control? Only if you wish to decimate podiatry!

    In the UK we have delegated these tasks from the State provider (the NHS)to charitable groups such as Age Concern or Help the Aged or to social care agencies like local authorities. Part of the profession advocates training a generic practitioner who would undertake traditional 'chiropody' leaving podiatrists to undertake 'specialist' work only. Whether this is sustainable I have no idea for there has been no quantatative market analysis to indicate whether the existing or projected workforce can be sustained with such a realignment. It is a dangerous move supported by a spurious argument. The profession would do well to examine its direction.

    Mark Russell
     
  14. Head

    Head Welcome New Poster

    Mark,
    Thanks for the response. I must admit I have little first hand knowledge of the UK experience with podiatry and assistants. I have been under the impression that the profession has had a rather difficult relationship between Podiatrists and chiropodists for a number of decades due to lack of organisation and cooperation of the defined rolls of the two professions some time ago. But this has recently changed with mutual recognition and registration. Please correct me if I'm wrong.

    What I'm proposing is, in part, trying to prevent the same split happening here via the establishment of a second profession in Australia which has a stated agenda of providing 60% of current podiatric service after a one year Certificate 4 Diploma. There is already a profession in Australia dealing with foot problems and it's called podiatry. The problem is we are effectively over qualified to cut toenails and someone has seen the opening in the market and has jumped in "boots and all". If we stand by and say we don't want them to start but we're not willing to do the work, then the professional arrogance you've mentioned leaves the door open to split the Australian profession.

    Regarding reduction of public waiting lists through altered scheduling. I'm aware many of the public sector have implemented altered scheduling with good results, as far as waiting lists go. The problem is many of the altered scheduling has been implemented by discharging patients for "routine care" to family, friends or other health care workers. So they are either lost to the podiatry system or return when there is a problem. So the podiatrist is used to cure rather than prevent. Some public sytems have implemanted the use of assistants, with some using instruments on patients, which has significantly increased patient number through put. But it's directly against our Association policy and therefore there is no regulation or control of the training or employment duties of these assistants.

    Regarding the sustainability of community demand for basic foot care in Australia. The percentage of people over the age of 65 is currently about 12% and heading toward 25% by 2020. They grey vote is now a government priority so they're looking for pre-emptive health care solutions and bodies to deal with on these issues. By our profession now grabbing this issue and offering a geniune structured alternative, it broadens the market for podiatry and gives government health policy makers a proven, established and registered body to deal with when contemplating public health care issues.

    I would be interested to hear the US experience on this. I have been told that there is a fairly well structured podiatry assistants profession and affiliation with the American Association. Maybe we could learn from each others experiences.
    Sincerely,
    John Head
     
  15. If only that definition existed. In the UK there were two routes to practice - the first a degree course through an recognised college of further education which gave graduates registration with the State regulator; a condition for employment in the public sector - and the second, training through a private institution, normally distance learning with some clinical input, which gave their students basic skills to allow them to practice in the unregulated private sector. Both groups of practitioners called themselves chiropodists and podiatrists. In the private sector there were also practitioners who had no formal education from any institution and likewise they too called themselves what they wished.

    This was clearly an unsatisfactory situation and the government created legislation to address these issues. Unfortunately it did not define chiropody and podiatry as seperate professions nor did the legislation protect the practice of each - only the title. A three-year period of transitional arrangements has resulted in parity of qualification between practitioners from both sectors; practitioners with little or no formal training now have the same legal status and title as practitioners graduating from a 4-year full-time programme. There is no differentiation.

    In addition, because the practice of podiatry has not been protected, the private establishments are now training a 'new' practitioner called a Foot Health Professional and there are proposals that they too be allowed parity after a short period too. The situation is a complete mess and does no-one any favours whatever side of the fence you sit, except of course the public service accountants who, as you rightly point out, view these developments with glee. There are proposals now for the State provider to introduce a new grade of staff to undertake what we understand to be general chiropody. These staff will be 'scalpel-weilding non-graduate advanced practitioners (bit of a mouthful when you're asked what you do) and will gradually replace the graduate podiatrist in public practice.

    Good on you. If the UK experience is anything to go by you'll be surprised where the opposition will come from.

    Same here and it's called rationing and it's been implemented by Advanced Redesign of Service Experts. That's not quite what I meant by scheduling but I'll write again and explain myself in better terms.

    See above. In the UK the professional body are pushing for such a move without prior consultation.

    I'm thinking about emigrating. The UK professional body is still navel gazing.

    Best wishes

    Mark Russell
     
  16. Tuckersm

    Tuckersm Well-Known Member

  17. paul-w

    paul-w Member

    Hi All

    I am a dual British/Australian citizen living in the UK but considering moving back to Australia. For family reasons it would be Adelaide I went to.

    My background is in IT and I'm educated to MSc level. However, I am considering changing careers (I'm disillusioned with the boom/bust nature of the IT industry) and was looking into training as a Podiatrist which I know involves undertaking a BSc.

    I then discovered this site and Matt's posting about www.footandhandcarers.com.

    Undertaking a TAFE qualification seemed to me to be an excellent way of gaining entry to the area of foot and hand care without the commitment and expense of a three year degree course. Perhaps in due course I could undertake the BSc part-time while earning money as a foot and hand carer.

    The problem is that I would be moving to South Australia rather than Victoria.

    I see from the post here by Tuckersm that the SA Association of Podiatrists has been running a Podiatry Assistant course for some time, but I have to say that being an independent practitioner appeals to me more and this is what the TAFE course in Victoria seems to offer.

    I'd very much appreciate feedback from anyone on the following questions:

    1. Do you know of any similar course that is planned for South Australia?

    2. I see that the East Gippsland course isn't nationally recognised yet. Who would approve foot and hand carers in SA? Is it the SA government for example or the association of podiatrists?

    3. Would I stand a reasonable chance of being accepted onto the course in Victoria, considering I have no prior experience?

    4. Financially, would it make sense to undertake a three year BSc when a one year TAFE course would permit me to carry out some of the tasks carried out by a podiatrist? The foot and hand carers' web site places considerable emphasis on the reasonable living that can be earned - http://www.footandhandcarers.com/employment_earn.htm. They seem to indicate that a Podiatrist might charge $40 for a half hour session and that a foot and hand carer could charge a similar sum but would visit the patient. Do these figures sound credible?
     
  18. Tuckersm

    Tuckersm Well-Known Member

    Paul,

    The foot and hand care course is not yet fully accredited in Victoria, and is currently undergoing a review on its need and course content by the Victorian Gov. You would be unlikely to gain any credit towards a pod degree, and would be unable to work as a foot and hand carer while studying, as once you begin study, you become a podiatry student, and can only work under the suoervision of a registered podiatrist.

    There are as yet NO qualified foot and hand carers so we don't know what the employment prospects would be. There would be no health fund or governemnt rebates for this service unless there was a policy change, limiting your ability to charge $40 as this would be somewhat more than the post rebate podiatry fee. You would be unable to call yourself a podiatrsis or by any name that could indicate that you are qualified to practice podiatry.

    It couls be in the future, if the podiatry associations change their policies and with some gov negotiating that such people will be required to work under the direction of a podiatrist, as is the UK Podiatry Assistants model
     
  19. paul-w

    paul-w Member

    Many thanks for the quick response. I currently work in the IT industry where there's no professional body and so can fully understand the position of Podiatrists wanting to safeguard their profession.

    I just went back and read more of the contents of the www.footandhandcarers.com site and note that the clear intention is to train Foot and Hand Carers who would market themselves as such and, perhaps, establish business relationships with Podiatrists if the Podiatrist was willing to do this. Can you see a situation arising where the Association of Podiatrists would forbid such business relationships?

    What prompted the Vic govt's review?

    If someone did the course and moved to SA, is there anything stopping them setting themselves up as a Foot and Hand Carer?

    Do I take it that in the USA the position of Podiatrists has been eroded by these Foot and Hand Carers?
     
    Last edited: Mar 7, 2005
  20. Tuckersm

    Tuckersm Well-Known Member

    Paul,

    Podiatry is not controlled by the professional associations but by government legislation. ie. The Podiatry Acts of the various states (each Australian State has its own Podiatry act, except SA where it is still the Chiropody Act) which limits the ability of of unqualified people to practice podiatry. Currently to become a registered podiatrist you need to complete a 4 year Bachelor of Podiatry (3 years in SA) from one of the approved courses around the country. you would have to check the SA act to see if a foot and hand carer could work there

    The Gov Review has been brought upon by some concern about the course content and its affect on public safety. Podiatrists are registered and regulated because the governemnt considers what we do potentially dangerous to the public, especially if undertaken by someone unqualified.

    There is future potential for arrangements between F&H carers and pods once insurance and vicarious liability is worked out, and the Registartion Boards and Professional Associations establish guidelines to ensure public safety.

    Pedicurist currently provide a large number of non-poduiatric foot care services as part of the beauty industry, and I am unaware of any formal realtionships with podiatrists, yet informal realtionships do exist.

    Foot and hand carers may become very prevalent in the future as the population ages and podiary numbers do not grow at the same rate, or may not progress as the podiatry looks at alternatives in managing basic foot care services such as podiatry assistants and self management options
     
  21. paul-w

    paul-w Member

    Thanks for that. Just checked the Act at http://www.parliament.sa.gov.au/Catalog/legislation/Acts/c/1950.56.htm and, as you say, I'd need to hold "the diploma or certificate in chiropody of the South Australian Institute of Technology" or an equivalent qualification gained elsewhere in order to be registered.

    Also, a "person who is not registered as a chiropodist under this Act shall not use or display the title or description "chiropodist", "podiatrist", "foot specialist", or "foot therapist" or any other title or description that might induce a member of the public reasonably to believe that that person is qualified or authorised to practise chiropody." So I guess that covers F & H Carers.
     
  22. paul-w

    paul-w Member

    Since the F & H Care course is based in VIC I thought I'd check their Podiatry Act for the sake of completeness.

    It specifies that anyone seeking to register as a Podiatrist must have "completed a course of study approved by the Board" or hold an equivalent qualification to the ones that the Board approves.

    Also, just like the equivalent SA Act, "a person who is not a registered podiatrist must not ... carry out any act which is required to be carried out by a registered podiatrist by or under an Act".

    So when the first people to complete the F & H Care course start to practise, is there the possibility that the Registration Board of the relevant State will take legal proceedings against that person? If so, presumably a court will have to decide whether the F & H Care qualified person is in breach of the Act and therefore a test case isn't too far away. If the F & H care person wins then the floodgates will be opened.

    Presumably it won't come to this and the States will either legislate to create a registration system for F & H carers or make absolutely sure that F & H carers can't practise.

    Is this how others here see it?
     
  23. Tuckersm

    Tuckersm Well-Known Member

    It is unlikely that F&H carers will ever be registered, but their scope of practice may well be limited through the podiatry acts to the same interventions as performed by Pedicurists. (the cert III in F&H care is basically modules from the beauty industry pedicure course and some modules from personal care attendants, the cert IV includes more podiatry related modules and raises safety concerns (how can you learn in 12-18 months what should take 3-4 years?))

    A recent Vic Reg Boards investigation of unprofessional conduct against a podiatrist using F&H carers in his practice had the outcome of limiting the work of such people to that described in the Aust. Pod Manual for both Pod assistants and Foot Hygiene. It interprreted the policies in that as part of an overall job of assisting a podiatrist an assistant can provide foot hygiene service. ie a combination of the 2 policies, but these are currently all up for review.
    http://www.apodc.com.au/apodc/Australian Podiatry Council.htm#1
     
  24. ehresources

    ehresources Member

    another option

    Hello,
    This is an old thread but I'd thought I'd post a reply anyway...
    I am in Canada and am a Registered Nurse who specializes in foot care. Here, RNs and RPNs (Registered Practical Nurses - aka nursing assistants, LPN) are able to provide foot care. There is additional training required beyond what we were taught in nursing school. There is a movement here to standardize our role. There are some guidelines out there, some have been retired (for not being up-to-date) and all are under review. We function within the role of a nurse and often work side-by-side with DPMs/Chiropodists or independently. My question is this...why create a new class or level of care providers when you already have a valuable resource right in fromt of you? Many nurses are looking for a change and foot care is very appealing. We are less expensive than podiatrists and already have to support and structure for providing home visits. We have training in anatomy and physiology as well as the necessary base for wound and diabetes care, care management etc. I am working with a group of nurses now to push for standardiization of our educational requirements, our role and best practice guidelines. Input from our podiatry colleagues is essential and I would love to hear from anyone out there about our initiatives.
    J
     
  25. dipper

    dipper Active Member

    Foot care assistants

    As a new member to this group, I would just like to state that, there is apparently only one accredited foot Health Practitioners course in the U.K.

    among subjects covered are Anatomy, phsiology, bacteriology,diagnostic skills
    high risk patienst materia medica, dermatological conditions referral, physical therapeutics and there applications, emergency first aid,
    Practical common foot disorders nail dystrophies hypertonic skin conditions and control diagnosis and treatment planning, electric file technique, patient care and retention, lesion reduction using safe scalpel technique principles
    how to use ultrasonic cleaners & autoclaves business skills,instrument care and clinical practise, padding and dressing techniques, diabetes mellitus, circulation and lymphatic disorders, treatment of verruca, flat foot, heel fissures and many other problems. designed to be completed with and without medical nkowledge, practical taken in clinic, should complete in 10 months 1 module per month.

    Any amendments or differences anyone might know about I would be happy to know about.
     
  26. paul-w

    paul-w Member

    You refer, I expect, to the SMAE Institute's Foot Health course. I went to their open day recently because I'm condidering doing their course. It isn't accredited by the HPC. However, there are HPC registered podiatrists who did this course rather than a degree course. The HPC allowed practising podiatrists with the SMAE Institute's diploma to register, but the deadline for registration passed earlier this month. You now need a degree to register with the HPC as a podiatrist/chiropodist.

    Of course, the HPC only protects the podiatrist/chiropodist title. SMAE Institute is still running its course and intends offering a distance learning degree in the not too distant future. SMAE's courses would count as credits towards the degree. SMAE argue that demand for podiatry services will exceed supply because there aren't an awful lot of 18 year olds who want to do a degree in podiatry; it's not exactly glamorous :) .

    SMAE say the UK universities churn out only about 200 podiatry graduates a year and therefore believe there is room for foot health practitioners who have taken their non-degree course. They point to the recent inclusion of a Foot Health classification in Yellow Pages as evidence of this. I get 100 results when I search the UK using Yell.com.

    However, the fact that SMAE is seeing fit to offer a degree means that they are hedging their bets.
     
  27. C Bain

    C Bain Active Member

    Accredited by Whom?

    Hi Dipper,

    At this moment there are no accredited Foot Health Practitioners courses in the UK!

    But soon some may well be accredited if the approach to the HPC. is found by the HPC. to be favourable?

    Regards,

    Colin.

    PS. You two very enlightening posts here, Dipper and Paul, thank you!!!
     
    Last edited: Jul 21, 2005
  28. dipper

    dipper Active Member

    foot care course

    Hi Paul,
    umm, not sure? see reply from me to Colin
     
  29. dipper

    dipper Active Member

    Colin,
    This course is an open college course with modules completed from lesson books sent to you and days of attendence at the college. The College of Foot Practitioners, tranining fromHPC registered Podiatrists. After qualifications your insurance and continual occupational devolopment are assured by joining the Alliance of private sector practitioners having done so you will become your name Dip CFHP, MPSPract.
    As soon as you complete forms you 1st book is sent to you. (At a price of course)
     
  30. C Bain

    C Bain Active Member

    FHP's, Conversion!

    Hi Dipper and Paul,

    Yes the West Midland and Smae are both continuing to train FHP.'s and eventually both are expected to have some form of Registration at the HPC. possibly before the turn of the year. Both highly respectable training courses I am sure! But what are you intending to do with them?

    In the case of Paul, he appears to be working towards a degree with Smae. translating a FHP. Course into a Podiatrist/Chiropodist when Smae Schools Degree will, (Perhaps?), be accredited by HPC. by the time he gets there!!!! FHP. courses translating into a podiatry degree is news and novel to me, but I don't see why not!

    In your case Dipper you are going forward and training and remaining as a FHP., a lot of others have done just that for various reasons this year! But you are going to finish a degree yourself aren't you??? Is it , was it, a Health Degree, Foundation??? If so have you considered converting your degree into a Podiatry degree by approaching one of the present Accredited B.Sc. Podiatry Schools???

    Regards,

    Colin.

    PS. Dipper or Paul? I wonder whether you can tell me if the West Midland are also contemplating the setting up of a degree course and HPC. accreditation for the same?
     
  31. dipper

    dipper Active Member

    Podiatry or Footcare.

    Hi Colin,
    I am starting a degree in september at Uni, and I am going to be a podiatrist in 3years when I finish (hopefully).
    I have an enquiring mind and like to see what sort of training footcare students have, it is also a safeguard in case my illness does not allow me to complete the degree, as most of the fore mentioned footcare course is done from home.
    However I really want to be a full Podiatrist, I would like also to train in surgery.

    I have a question (what more he says).

    I have seen quite alot of Orthotic Insoles, In my day you had to take prints and measurements then mould supports to the exact foot shape, yet these other Orthotics are sold in shoe size.
    As every bodys feet are different, how do they then work properly.
    Or am I a dinosoar, with all the new machines they have today.
    Suzanne
     
  32. C Bain

    C Bain Active Member

    Hi Dipper,

    Custom made are always the best, but possibly more expensive like everything else in life! It is possible to tailor orthotic material to a persons shoes but most purists tend to want to personally fit their own! Podiatrists who specialize in this might just add some of their experience to this reply hopefully?

    Regards,

    Colin.
     
  33. Dawn Bacon

    Dawn Bacon Active Member

    Hi Suzanne
    There is great debate amongst the biomechanists about the comparative effects of bespoke or "off the peg" orthoses (have a look at google shcolar/pubmed etc for some of the research/references in this area). In my own experience? --sometimes a ready made orthosis can do a good job, sometimes a modified orthosis is the answer and sometimes only a casted bespoke device will do the job. All based on the assessment of the presenting problem, the biomechanical pathology, the requirements and expectations of the client.
    Good luck in your studies,
    Poll.
     
  34. dipper

    dipper Active Member

    Hi Poll,
    Thank you I will take a look, my 1st impression excuse the pun, is exactly if no assesment is made, how would one know if they are going to be suitable.
    Many thanks,Suzanne
     
  35. dipper

    dipper Active Member

    Hi Colin, thanks for information.
     
  36. Wizard

    Wizard Welcome New Poster

    Dipper,
    I completed the College of Foot Health Practitioners course in January this year. I am at present, the only FHP working in Herefordshire, and ONLY undertake treatments that I have been trained to do by the College. I actually set up my practice in April, and after a few months of hard work getting myself known, I am starting to see the fruits of my labour. I provide a domicillary service to patients in a large rural county who often find it difficult getting into the towns. Besides this, I have started offering a service to local businesses - visiting and treating their staff during work time.

    I am not trying to 'poach' patients from established Chiropodists, but just to offer a routine service to people who do not need the full blown services of more highly trained professionals.

    The course was useful and informative and has given me enough knowledge to be a safe and responsible practitioner. However, I do feel that I need and want to know more, and will be looking for ways in which to further my learning.

    If I can be of any further help with regard to the course, please do not hesitate to say.
    Ian
     
  37. W J Liggins

    W J Liggins Well-Known Member

    Hello Posters

    Whilst in no way wishing to stop messages and debate, could we just keep on the theme of Podiatry Assistants please?

    If you wish to deviate too far from the subject in hand, could you start a new thread?

    Many thanks

    W J Liggins
     
  38. C Bain

    C Bain Active Member

    Podiatry Assistants = FHP's!

    Hi Bill and all!

    A very good point Bill, PODIATRY ASSISTANTS I mean! It is possible I also fell into the same assumption as Wizard here. When I read his post I never even questioned the assumption that 'Podiatry Assistant does not = FHP.?

    Could this be a sign of the times or could it be the position that some of us have argued ourselves into regarding Assistants? You have obviously kept both the above separate in your own mind and until decisions are made in the HPC. probably just as well to continue the same!!!

    Podiatry Assistant usually has the normal connotation that the ASSISTANT has someone to ASSIST? At the moment who is the Assistant assisting? NHS. Assistants, an obvious master identified. FHP's. who is the master, is there one? Do they the FHP really want one for as you have just pointed out they do not fit this Thread with Wizard's last post interesting as it may be!

    Regards,

    Colin.

    PS. Another worrying point to make here! When I listen to Wizard I find myself substituting CHIROPODIST when reading FHP.? I wish the HPC. would get back off their hol's. and do or say something about this? I know how difficult it must be continuing their confidentiality but it's beginning to sound like the next sequel to Chiropodist raising their level to Podiatrist whilst leaving some behind now FHP's. raising themselves to Chiropodists whilst leaving some behind.

    PPS. I except Wizard that was not what your intention or what you were about! But it all sounds just to familiar you know!

    PPPS. Thinking the unthinkable has your sense of direction, Wizard, possibly brought up the thorny subject of there should be an FHP. Sub-section to the UK Forum. Why can I feel the heat rising at the suggestion?
     
  39. quissu

    quissu Welcome New Poster

    Any information, suggestions or comments will be very welcome.

    you see in Portugal Podiatry is in begining and surgery or prescription (d'ont now if you say like that) is a mirage to us for now. We don't talk about podiatry assistant, but it's important to maintain control of support staff, or someday day may be abble to do things that belong only to Podiatrists today, rules are very important ;)
     
  40. C Bain

    C Bain Active Member

    Quissu for you!

    Hi quissu,

    If you want a chat might be in the offering in the Break room Forum late tomorrow!

    Regards,

    Colin.
     
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