Social nailcare by volunteers

Haircuts!

Thirty quid for a haircut Graeme? You vain creature you! As a fashionista I've never paid maore that £8.00 for a dry trim and even then I baulk handing over the notes. Must be the Adam Smith in me.

 

I'm wholeheartely with Graeme on this one.

I think Mark's recipie for social nail care is also a recipie for rsi for the person who is doing the nail cutting.

If my patients want cut and come again Chiropody (or chooperdy as Akbal would call it) then that's fine by me. I do charge and get £30 for a nail cut. No problem. This is from old people and young people alike.

Charging £28 - £50 is not theft. Tell me Mark, would you prefer to have your nails cut by me or Graeme who have sterile instuments, insurance, training, hpc registration, take full medical histories etc, OR would you prefer to see a volunteer who used the same set of nippers on 20+ people all day? (Please don't take offense at that), but I do feel strongly about this as indeed you do, it's just that we have opposite opinions No hard feelings ok

Private footcare is a business, the same as Dentistry is a business. I will see the hygeinist next week (on the nhs) and this will cost me £21 for a 20 minute appointment. For £30 my older patients get a home visit!

The people I have found who moan about price increases are often in my experience people who smoke, drink can go on foreign holidays etc. No I'm not against these things at all. But are their priorites healthcare or other things?

Yes there are poor people out there and sadly that will always be the case, I don't know what the solution is for them. Perhaps there could be free footcare if they are on benefits perhaps? Like you can get if they need to see the Optician or the Dentist? Nevertheless the Optician/Dentist is not that much out of pocket ie doing a £5 treatment where HE only recieves £5 for the treatment is he??

Perhaps mine and Graeme's views are different because we don't ever do NHS footcare...

Cheers,

Robin.

 

Hi Mark

I really hoped you would post your "vision" of the future that would inform people on this site ( who have not already seen it on others) of what I personally feel was the way forward.

Your tack on this subject is well read and you really are preaching to the converted . WE KNOW THE NHS DOES NOT WORK !!

As an IPP I see that on a daily basis . I could cite hundreds of patients that have come to my surgery because they could not get , could not wait or were unhappy with the treatment they received (or didn't) from the NHS .

It is not the fault of the Pods themselves its the system that stinks and you as an employee are bound to a framework of rules and yes "bovine excrement" which are now frankly working against patient care and I am afraid with the advent of the HPC that is already spilling into my world .

Again a point I made in an earlier post , podiatrists seem to feel that financial advice is within their remit . Unless you are an IPP it is not ! your own opinion is irrelevent and if you dont believe me , try justifying your £6 fee for a dom "nail cut" I would really love to see your breakdown of income /expenditure on that one !!!!!! I can tell you it is a non starter in business IF you are providing a proper service .

The incompetent and the "rip off" merchants will , and do ,soon go under or worse become what we all want to get rid of ,the cash only "fiver a time guvnor" type that will always bring this profession down .

So why does everyone get so upset with each other ?? The simple facts are :- you work for the NHS presumably becase you choose to and the very best of luck to you .That is a genuine comment, I have no wish to follow your path and I admire your endevours to further the profession and your own aspirations in that way.

I am an IPP because I chose that way. To bring care "as you do" and to fill a void that the NHS does not provide for many to an acceptable standard .As I stated in an earlier post I have done so very successfully for over 16 years .

I hold every qualification that my teaching institution can offer and I have been in "hands on patient care " for over 38 years including time with the NHS albeit not in this profession and continue to strive to provide the very best in technology and patient education that I can find .

That does not make you right or a better practitioner than me or vice verce.

What I find frustrating with this whole situation is the persistant generalisations leveled by both sides (the yah boo podobabble)

I personally don't get involved . There are good and bad on both sides as we all know and can shout and scream as much as we want about our own point of view but again the fact is we are all going to have to work together like it or not because despite all the petitions, representations and everything else the HPC has decreed that is how it is going to be.

Perhaps divide and conquor may be the buzz word for us in the corridors of power.

This is the first site I have ever posted on although I "read only" several .

I hope that I am provoking a common sense and perhaps a pipe and slippers calming approach to the discussion because at the end of the day common sense MUST prevail.

Oh and one last thing , give me the number of your washing machine repairer please . All the tradesmen in my area charge a minimum £70 to ring your doorbell let alone mend the thing !!!!

Best wishes
Derek

 

This is always a hot topic .

Why are volunteers providing personal care and hygiene ? are volunteers also cutting hair and finger nails as well ?

The use of public health dollars needs to be considered in more detail ,as does older people not being able to care for themselves ? Is it because they physically cannot or do they have a perception that they do not need to worry about self care as they saw their parents being seen by the chiopodists and they do not expect that they should look after themselves and that is the responsibility of the NHS.

There are a number of barriers from my experience about people not looking after themselves surely it is our responsibility to empower people to address these barriers so they can look after ourselves . I find a long handled file , with a thick handle and a bit of education on benefits of independence in the context of self management framework being a very useful and effective use of public health resources.

 

Podiatry practice reform

Derek, Graeme, Robin & others

You misinterpret the point I was trying to make. I'm all for podiatrists earning good money; it saddens me greatly to see practitioners on low incomes especially in public care. A married couple (practising podiatrists band 5 NHS) with two kids qualify for tax credits in the UK and that doesn't agur well for future recruitment. it also doesn't help that under Agenda for Change podiatrists are facing a pay freeze for the next 11 years. How's that for "looking after the interests of members" ?

Personally I rate podiatry more important than dentistry and therefore I would like to see remuneration on that basis too. But I also think there's a different way of attaining that platform without screwing the public backwards. Sure there are people who would be happy to pay £30.00 for a simple nail cut but there are many, many more who need that service yet cannot afford even a fiver. You have to think of different ways of capturing the entire market and still get paid at a level that is commensurate with your status. If we're talking about ball-park figures I'd like to see general podiatric practitioners having the capability to earn a minimum of £70K p/a - if they provide a good, effective service.

Derek, I'm writing a proposal for the profession just now and I'll present it here when I'm ready. BTW I am not employed by the NHS; I am an independent contractor and have been for many years. With my salacious lifestyle I couldn't afford to live any other way!

Best wishes

Mark Russell

 

Oh my gawd......not only havn't I got a BSc (hons) in podiatry, but how I'm a thief!

OK only kidding!

Independent contractor, is that the same as a quango type scenario thingy, or does that mean you get paid the same rate whether or not you decide to treat someone?

On the subject of aftershave....Mark yours is a bit too strong, Derek, yours now seems to be working fine.

Regards

David (tounge very firmly in cheek) Donovan

 

Contractors

"Independent contractor, is that the same as a quango type scenario thingy, or does that mean you get paid the same rate whether or not you decide to treat someone?"

No it means I get to poke managers in the eyes when they start with their verbal diarrhoea or initatives.

 

Hi Mark (and the rest of the world)

If I may be so bold , I think it is you that is looking through at very blinkered view of the overall podiatry services in this country .

It would appear (misinterpretations aside) that your analagy of the NHS podiatry pay & conditions is agreed and by any reasonable thinking person as totally wrong for all the reasons you have given. Incidentally I fought like you for 24 years to improve the status , conditions and pay of an NHS group of workers so I do know the fire in the belly and the passions involved.

The IPP's in this country do have a place in the treatment and care of ALL groups that the NHS cannot or will not service which is now a patient choice option.
What you seem to completely overlook is what we do is a BUSINESS !! OUR LIVING !! and like any other ,the books must balance at the end of the year to remain solvent.

The ideal of free health care in this day and age is no more realistic than your suggested charges for treatment!

It would appear the UK is working towards the American system of medical insurance dominance of treatments vs costing to provide care for the masses and along the way there will be casualties .

There always are and usually the most vulnerable sections of society that can't hit back I don't support it but unfortunatly , that is how it is .

The reality is , I (as an IPP) am not here to subsidise the NHS and the harsh reality of business in the real world is "sink or swim" if you or your colleagues cannot cope in the NHS ,LEAVE and become an IPP . Come and join us if you think we have it easy ?? (I did when I had a regular wage coming in to pay my mortgage and support my family) and I can tell you now , easy it aint !! Look how many fall by the wayside and quit .

If you want to further your vision then instead of trying to destroy the IPP situations and practice , accept we are here to stay ( and make no mistake we are or at least I am for a few years yet) and let us support you because in reality , I cannot function without your ( NHS) assistance and likewise you cannot function without mine ( IPP).

The fundemental problem with your liking Dentistry with Podiatry is simple . ANATOMY !! Since time immemorial people have been " doing their own feet" why ?? BECAUSE THEY CAN !! I have not heard of too many people (sane ones anyway) that extract teeth or repair teeth themselves .

I term myself a podiatric general practitioner how am I ever going to reach anything like the pay scales to which you refer unless I get paid from someone !!

Therefore (and this is one of my favorite quotes to patients) " anyone can do my job and everyone knows better than me , UNTIL IT GOES WRONG " !!

I usually only see patients in the first instance when they cannot stand the pain anymore or some well meaning idiot has messed up .

Which brings me on to another I feel fundemental difference between the us.

I believe the type of patient we see as IPP's is different to that seen in the NHS . I can only speak on a personal basis but I suspect I speak for many .

I see mainly acute conditions in my surgery that cannot be seen immediatly in the NHS situation . Every patient I see demands 1 , pain relief and 2 , resolution of the condition (and in many cases 3, the magic wand /pill ) They demand it because they are paying for it .

I see very few chronic mainly elderly (cut & come again patients).

On the domicilliary side I do and that again because of withdrawl / unreliability of NHS services.

That I feel maybe where there are misunderstandings which breed bad feelings .

I cannot imagine ever treating an endless stream of basic nail care patients .If I did , I believe I would be pretty keen to offload some of them elsewhere to "give my brain a chance" !!

But in business I have to treat anyone who requests my services ( my choice) and if no one else will do it , then I will but at a cost.

The birth pains that are happening now in the profession will probably get worse before they get better. The longer we hang on to this mutual self destructing lack of understanding will determin the inevitable time of resolution.

We all tend to live in our own world and perhaps that colours our point of view to the exclusion of the realities in the world outside and as you state you are an " independant practitioner" contracting to the NHS .

But you are still bound by the rules protocols and yes those bloody irritating know- nothing managers that waft in and out with their half baked unrealistic waffle that is or has destroyed the NHS across the board .

Let clinicians back to run the NHS and care standard will return !! (see I still remember how to do it and I DO believe it .So poke their eyes and anything else you want !! ) :

I look forward to your latest vision being posted here and if you don't mind perhaps will comment in due course.

My best wishes

Derek (with a dash of aftershave)

 

Comment

Derek and others,

I'm afraid you completely misundestand my viewpoint on practice structure and representation and responsibilities. If I may humbly suggest, can you give me a few days to present to you what my position actually is, for it's not that far removed from the argument that you put forward; indeed I'm sure and certain that we stand on the same platform. But it's late and I'm absolutely knackered and I'd like a few hours to rejuvinate my energies before I respond further. Will you allow me this at least? I know I've been critical to others for not responding promptly but age is getting the better of me recently and I've had a heck of a few days, but I promise to clarify matters which I'm sure will be to your satisfaction.

Can I also add my congratulations to Craig for seting up such a vibrant forum and now that I've mastered all the nuancies, I'm certain that this medium will prove tremedously useful for the future well-being of our profession.

Will be back soon - honest!

Mark Russell

 

Hi Mark

Please don't knock yourself out on my behalf !!

Reply as and when and if you can. We all have pressures on our time and as in the IPP world , time mangement /prioritising is an integral part of practice life so I do understand, so don't be too suprised if I delay a response in the future

I see your latest venture with the petition to the Scottish Assembley is under way and I guess the reason for the pressure on your time.

You wont be suprised that I don't support it and not because I don't practice in Scotland !!

In my opinion It's yet another attempt to force division into the profession ( Grandparented bashing again ) :-(( ( sorry run out of smilies)

I thought you cared about the elderly Mark )

Perhaps all that energy will one day be used as a constructive rather than destructive force . Time will tell .

I look forward to your return to the forum and along with you consider this site to be one of the best around and an asset to the advancement of the profession in its many forms .

WELL DONE CRAIG !!

Best wishes

Derek

 

Regulation

Derek

You don't have to resident in Scotland to support the petition and of course you have every right not to do so. But I disagree that a dedicated registrar as opposed to the HPC would be in any way divisive; how could it be?

Mark Russell

 

Mark

I will put this reply down to the fact you need a lie down !!

If you cannot answer a direct comment then please don't reply at all .

The point as you very well know was made aginst the Grandparenting part of your petition yah boooooo hang em high all tossers ect .

You carry on with whatever you have to do to discredit misrepresent or genralise IPP's and when you are beaten AGAIN , perhaps you may be tempted to join us in the real world and channel your energies to genuine constuctive comments to aid availability and care to the public !

Instead of wasting tax payers money on administration to address spurious petitions and the like which as we all know have the underlying boring same old lines , try leaving out the parts where you are trying to destroy businesses and livelyhoods and practitioners who have for many years provided safe effective practice and improved QUALITY OF LIFE to thousands and thousands of satisfied happy patients !!!

You may then find if of course your intentions are really as you state re "the registrar instead of the HPC" you would be supported by all sides .

I could go on but I am in the wrong thread to persue the discussion properly and frankly have not the time or the interest to engage in hypocritical dogma and predjudice .

Think on this :- when your all blown out of argument on this matter

I (the IPP ) WILL STILL BE HERE , COZ I AINT GOING AWAY !!!!

Regards

Derek

 

Regulation

I'm afraid you've lost me Derek. No where in the petition do I criticise private practitioners; I'm merely suggesting that the rules are equitable for everyone. If you interpret the petition the way you do (yaa boo hang em high, ad naseum) that is your perrogative; but kindly refrain from suggesting that your view is what I intended. The only person that has mentioned the term 'divisive' has been you. I see the move as being worthwhile and constructive.

I don't know your background but I guess that from what you write that you're a grandparented chiropodist; that's all well and good. I'm happy to debate the issue with you but I feel that some test of competency should have been applied before you were included on the register. Your colleagues from the graduate sector had three or four years of testing before they were accepted. And I also would like to see some ongoing recertification for the entire profession every five or six years. Other professions and trades have to do it. So should we.

Now I'm not sure if you think I've aswered you clearly or directly but I've tried to do the best I can - without reverting to insult or abuse. If you disagree with my reason you could always post to that effect on the Parliament site. It would be interesting to see the response.

Best wishes

Mark Russell

 

Mark

I am sorry if I apeared to personalise and bring this down to a level that caused offence.

That is not and never will be my intention and if I have inadvertantly done so please accept my humbled apologies .

You are entitled to your opinion and I respect that but I am also entitled to mine.

In any debated issue feelings flow but personal insult should never be allowed to take over this site as it has so many others.

As you said you do not know my background but I have posted some of it in this thread so I will not repeat it.

An IPP can be train from either side and sits a " test of competence "every time a patient is seen by them .

I do not believe that because a practitioner has done a period of academic study however many tests they have automaticaly makes them safe to practice and by the same token those that train to a minimum standard elsewhere can also have the same leveled against them .

My point is Grandparented pod's / (IPP's who do not choose employment in the NHS) are here to stay like it or not .

To keep on and on in different lobbys harping on the same thing I do not believe helps anyone at this stage in the game. I also believe it is damaging the "image" of the profession .

Channel your efforts into bringing those that have been Grandparented and those that havent done any serious cpd in donkeys years up to speed and MOVE FORWARD .

As you said in your last post (ish)
It's late I'm knackered

Best wishes

Derek

 

Derek,
I can't help thinking you have the wrong end of the stick here.

If I may speak for Mark, nowhere does he criticize IPP's or private practitioners or grandparented practitioners.

Nowhere does he suggest that he wants to make you see NHS patients.

He and I (and many others) would like to see unity in the profession. To achieve this we see a single professional regulatory body as being the best vehicle for the job. This would be used to regulate all podiatrists/chiropodists in the UK - no us and them.

FHP's and those trained to that level would also be governed by that body, and if we were able to utilise some NHS funds we could ensure that those podiatrists in PP would not have to borrow funds to start practicing, but could tap into NHS funding since they would be providing (partly) a service for the NHS.

The petition may allow us to move forward with this.
Regards,
David

 

Regulation

Derek

We have been around this stump many times over the past couple of years and we’re not going to achieve consensus. I see little merit in rehashing what has already been said. I can understand your position perfectly well; why would you want to sit any test when you don’t have to? I’m sure there are many people who would love to secure a qualification without passing any examination along the way. But that’s not the way things are done, normally. Suggesting that your ‘test of competence’ is passed each time you sit in front of a patient without an adverse reaction is, in my opinion, nonsense. Legislation which purports to protect the public must be proactive rather than reactive; why expose patients to unnecessary risk?

I’ve just noted, this morning, a comment from Professor McLean on the discussion part of the petition – the first maxim of healthcare. Do no harm! I can’t argue against that. It is incumbent to ensure that we do as much as we can to prevent adverse risk; that is the whole purpose of effective regulation.

Please read the submission from Brendan again – I’ve provided a link earlier – and consider carefully what he has to say. He has experience from both ‘sides’, as you put it, and he notes there is a world of difference in the education and training. And that only applies to those practitioners who have done any training in the first place; many other have done none whatsoever for even a minimal level is not mandatory.

As far as your employment intent is concerned that is of little relevance in the overall argument. By securing HPC registration you ARE eligible to work in the NHS and it would seem many ‘managers’ would be willing to employ you as an assistant grade scalpel-wielding practitioner – at a lesser rate than our graduates of course.

You invite me to ‘move on’ and think ‘positively’ and I would suggest to you that I have. I’m not asking the profession to resolve the issues over regulation. For many convoluted reasons it’s clearly unable to do so. This time I’m asking Parliament.

All the best

Mark Russell

 

This sounds interesting and would benefit all pods (and FHP's) whatever their background. Presumably it involves the formation of a General Podiatric Council. I await your proposal with baited breath!

Regards,
Graeme.

 

£70K/annum

Hi all,

With 4 weeks holiday (Only fair) 1 weeks bank halidays leaves 47 weeks for work. 35 Hrs per week (NHS rate) for £70K gives £42.55/Hr for wages. 20 min apps is a contribution of £14.18 per pt. Oh I pay rent, depreciation, transport, equipment , materials , sick pay insurance, NI, pension contribution, and more. How much a nail cut?

Kind regards

Luke Hawkins

 

David

Perhaps I have got the wrong end of the stick but when wording is to quote Mark ( I can't seem to drag the direct quote from a different thread ?? )

"I have today petitioned the Scottish Parliment why Scotlands people should be exposed to unecessary risk from GRAND PARENTED PRACTITIONERS who's only scrutiny or examination has been self declaration"

Now , call me old fashioned , but if that is not a repetition of the proposals that have been argued and lost during the formation of the HPC then perhaps I am as daft as my wife thinks !!!!

If this petition is sucessful based on that argument then , human nature being what it is ,will it not follow that the whole shooting match will be dragged up with the HPC to try and change the goalposts again .


And Them and US starts all over again !!

I also want to see unity and a podiatry council run by and for the benifit of us ALL not for just an elite section .

I have genuine concerns that if many current NHS proceedures are to be implemented with the lumbering beurocracy we are now seeing proposed for the profession as a whole they will force the fee's charged by IPP's beyond the reach of the very people Mark is trying to protect .

I don't want that and I'm sure no one does !

Best wishes

Derek

 

Hi Mark

I can only say it as I see it .

The generalisations made cannot be right.

I said about my background in an ealier post :-

I hold every qualification that my teaching institution can offer and I have been in "hands on patient care " for over 38 years including time with the NHS albeit not in this profession and continue to strive to provide the very best in technology and patient education that I can find .

Now one thing I am very proud of is that in all that time I have NEVER had one patient complain about my competance or treatments in either occupation

So how am I a danger to the public Scottish or otherwise ??

I follow the first maxim of healthcare and I "have done no harm "!

Before I hear the scoff 's and comments about standards of education I am Not suggesting for one second that the academic qualifications I have match degree levels of todays graduate but I have sat all the testing required to attain the qualifications I hold .

I believe Mark that is where our joint platform lies.

We have to tier the workload and scope of practice as to qualification .

Podiatric surgeons (DPM's) , Podiatric General practitioners , FHP's and or ???

I was at a seminar last week on gait analysis run in essence by Chiropractors. There were physio's and oesteopaths present and I was the only Pod there .

They have just dicovered that if you treat back pain from the feet up it works better than from the back down !! sound familier ??

I believe we should be working that way in the profession improve your base line , set minimum standards , set the foundations and everyone benifits .

It won't happen overnight and will have many growing pains along the way but if we continue to alienate sections it will never happen at all.

Cheers

Derek

 

Hi Luke

And not forgetting for those practicing in central London :-

The £5 congestion charge , £110 clamping release fee's , £180 towaway fine and the £1 for 10 minutes on a parking meter . If your there 11 you automatically win the previous 2 !!!

Be Lucky

Derek

 

Regulation

 

Hi Mark,

I think this discussion can easily degenerate into the old SRCh v non-SRCh debate if it hasn't already. I don't think you are making any new friends with comments like the above. I personally have not known of any practitioner with no training or qualifications. Granted, they may have been around years' ago but then so were dinosaurs.

I would suggest if you have issues with clinical standards of grandparented pods then discuss it with the HPC; they are the independent arbiters of such matters. Of course, malicious complaints will be dealt with accordingly.

Regards,
Graeme.

 

Mark

Firstly I do not fear non acceptance from my peers , that has been a fact of life for me since I started in practice . Oh the tales I could tell )) (sorry no smilies again)

I know I can provide a full range of treatments to an acceptably high standard and have done for 16 years ON MY OWN !!

I have a rule , I make all the decisions , I abide by the decisions I make and I am responsible for those decisions in other words the buck starts and stops with me .

We are ALL very well aware of the shortcomings of practitoners ACROSS THE BOARD, after all how would you feel if you were made to refer a patient to a "academically superior but a well known functionally usless podiatrist ??

What I find irritating is why (as with your petition) is it only ever the Grandparented that are cited as the bad guys ??

That was the point of my outburst in the (mr angry) post I made .

The wording has to be changed because I believe you alienate independant practitioners that in your words "practice to a high standard" And in fairness , after your comments ,why should I and many others like me , be lumped in by generalisation

My concern is that gives another excuse for many to promote the "under the table division" and to continue the "in-fighting"

I also believe we are not a million miles apart in our thinking but approaching it in opposite directions

Hopefully by discussion on excellent sites like this, the thought process to see a different point of view will be stimulated.

Best wishes

Derek

 

Regulation

Graeme

With respect, it'll only degenerate into insults and bickering if you let it. I have no intent of re-opening old wounds. The past is the past and the future is there to be written. But if we are to build a strong unified profession we need to get the proper foundations in place first. That includes regulation and if we are to be successful I suggest we approach this without first adopting preconceived or historical positions.

If you read my last post you will note that I also have concerns about the standards in the registered sector; hence my preference for a revalidation process. In the end I agree that the greatest arbiter of standards is the patient; that is why I believe their right to choose their practitioner must come first in future delivery. But we need effective regulation to give the public confidence in what we do. That is why there must be some benchmark.

The last time grand-parenting was introduced there was an examination – theoretical and practical. I doubt you would have much difficulty with it yourself and in many ways it would seek to reassure and confirm in your own mind at least, that you are just as good a practitioner than your graduate colleagues who came from a different route. It is the conscientious, safe, hard-working practitioner – degree, diploma or otherwise – and their patients, that this petition is designed to protect. I include you in that as well.

Yours sincerely

Mark Russell

 

Graeme

I have no intention or interest in degenerating the discussion down that road believe me.

As far as I am concerned I have a (very expensive) piece of paper called an HPC registation certificate hanging up in my surgery no doubt the same as you have , Mark has, David has and every other registered podiatrist has.

That in itself puts an end to that argument thankfully !!

Best wishes

Derek

p s Whats wrong with dinosaurs ???? Roooaaaaaarrrrr )

 

Regulation

Derek

This has to be my last post this weekend; I have to get on with other things, mostly domestic, I’m afraid. I will try and return next week so - please don’t take my absence in any other way.

You write that you “provide a full range of treatments to an acceptably high standard and have done for 16 years ON MY OWN”. How do you know? One of the problems of this profession is that traditionally we provide our care in an isolated environment. For the first ten years after I graduated I never had another practitioner in surgery with me. I used to think that I was the ‘bee’s knees’ when it came to patient care. Then one day, when I was working in the USA I happened to sit in on a session with a seasoned podiatrist from Illinois, and boy, were my eyes opened. The way he conversed with patients was remarkable. He listened and advised and never talked at the patient only to them. There's a world of difference between the two. All his advice was delivered in a measured but simple way and although it differed from patient to patient, it fitted exactly their own particular background or nous. He was a master communicator and I learned so much in the few hours that we shared.

Working the way I do, I’ve had the opportunity of sharing many other precious and valuable moments ever since. I suspect I’ve worked in and travelled to more podiatry clinics and practices than any other practitioner in this country today. I didn’t intend for this to happen; it just did as a result of circumstance. But the net result is that I’ve worked alongside many fine and talented people – from all sectors. I suggest that the majority feel the same way as we both do. They share the same passions, hopes and ideals. And most of all they share the same aspirations for the profession too.

I would submit they share the same views on regulation too. We, in the registered sector, don’t regard the independent practitioner as the ‘bad guys’. Far from it. But there is concern about those people who don’t have the same approach or training as some like you obviously do. There are some who have no training whatsoever and unfortunately they are sitting in the same boat alongside you - so how do we differentiate?.

You’re not being asked to undertake a three/four year course of study. But I think it only right and proper that you undertake some simple test of competency as it will, during this conciliatory process, give reassurance of some benchmark of standards. I know of a nineteen-year-old beautician who’s has been successful in her application to the HPC because, by dint of her doing pedicures and toenail painting at her mother’s salon for the last four years, she’s been able to ‘prove’ that she’s gained the majority of her income from ‘podiatric practice’ during that time. That cannot be right. I wonder if you agree?

As far as coming from different/opposite directions is concerned; don’t count on it. I’m old enough now, never to counter a stationary position on most subjects. I’m always open to persuasion. I’ve enjoyed the exchanges this weekend and I trust we will have many more. In the meantime I hope you can reflect on what I had to say. Have a good week.

Mark Russell

 

Hi Mark

I will reply properly to your post on your return.

I too have enjoyed the exchanges.

One last point .

The reason I know I work to an acceptable standard is very simple

Thousands of patient that have tried elsewhere before coming to me :-

TELL ME (and others) SO !!!!!

that my friend is the benchmark that matters !!

We will be off to our cottage in sunny Cornwall (or perhaps not so sunny) for the week next week for a long overdue break .

I look forward to a continuance with you and others on my return

Be Lucky

Derek

 

Age Concern procedures

Being a mere podiatry student I don't really feel qualified to join in the debate re who should be cutting the elderly's toenails, but as a volunteer for Age Concern's toenail cutting service, I did want to set the record straight on a few things. A charge of £3 is made for the service and all volunteers are trained by a State Registered (or HPC registered now I suppose) chiropodist. They ask all 'clients' (never referred to as patients) certain questions which are:
Do you have diabetes?
Are you taking steroids
Are you taking anti-coagulants?
Do you have any problems with your circulation?
Are you seeing your doctor for anything currently
Are you in good health today?
When I cut toenails at an Age Concern centre, all instruments were only used once and then sterilised in a 'pressure cooker' type (Little Sister) autoclave. The only instruments allowed nail cutters are nippers and nail file. Nail cutters (even podiatry students!) are not allowed to do anything other than cut nails - no clearing sulci, no debriding callus or corn.
For domiciliary visits, clients purchase a pair of nippers and a nail file from Age Concern for £10 and these remain with the client. Each cutting in the patient's home is charged at 2.50 each time. They are not sterilised but are only used by Age Concern volunteers for that person.
The criteria for qualification for Age Concern's nail cutting scheme are explained to the patient when they first present ie the nail cutting is carried out by volunteers who are not chiropodists and is only for those who for reasons of physical impairment eg poor sight, or inability to reach toes, cannot do it themselves,but are otherwise in good health. The client reads a document to this effect which they then sign if happy with it.
This is the procedure used by Age Concern in East Sussex, I cannot vouch for other parts of the country.
I hope this clarifies some points.

 

Hi Marcia,
Welcome to the debate, and thanks for your imput .

I would encourage you to join in further. After all, you may be performing a valuable service now - how might you feel after qualification, when your clients suddenly become prospective patients?
Cheers,
David

 

Not in a position to comment, but I will!

Thanks for the welcome, I'm glad to be able to join in. Re cannibalising my own business, if I were to go into private practice, I am not sure that my conscience would allow me to charge elderly people a standard rate (such as the £28 or so, that I believe has already been mentioned and which, for example Scholl shops would and do charge Age Concern's 'clients'), if all they required was toenail cutting. Also, I would (now here speaks the idealist!) prefer to spend my time on more taxing cases than those only requiring toenail cutting, who don't actually require the services of a graduate. Perhaps more threatening to the sort of private practice I would envisage for myself, are the podiatrists who work for Age Concern as they would appear to 'undercut' the 'standard' rate (the one in Eastbourne charges £12 for a consultation). Finally, although there may be a shortage of podiatrists, there are far more of them than volunteer nail cutters, so I think there's probably enough business for everyone.
Best wishes,
Marcia

 

Hi.
I and a few others who've contributed to this thread would agree with you there !
Performing a "screening" , which I assume is what this person is doing, is a valuable precursor to routine nailcare. However, a podiatry screening should command a realistic fee - the lower fee comes when the patient is having thir toenails clipped!
Cheers,
David

 

Hi All

Back from my break sort of refreshed ( gave me an opportunity to get my 2005 diary done in between calls diverted to my mobile).

Mark ,back to your post : you say of your Podiatrist in Illanois

"He listened and advised and never talked at the patient only to them".

I have to tell you , outside the NHS we all do that !! that's another reason we survive in business , the patients actually like us ) We have to sell ourselves as well as our services and the first rule is "you never ever talk AT the patient or over their head .

You go on to state :-

"We, in the registered sector, don’t regard the independent practitioner as the ‘bad guys’. "

Mark you really must try and keep up , I am in the registered sector !! the same as you and every other HPC registered Podiatrist .

So from one registered podiatrist who took 8 years of study to obtain the qualifications I have to another .

Your 3/4 years with all the holidays ,sick days , hangover days at university and your very sheltered professional employment in the NHS perhaps it is you that should be sitting the "little test" in understanding the workings of the real world ??

To be on a NATIONAL radio network quoting your inapropriate opinion of fee's could have caused IPP's across the country all having their own unique set of circumstances charging what is in reality a fair and just fee much vexation having to justify what they are charging to patients who had heard the broadcast.

The "foot fiddler" you refer to as painting nails etc and getiing HPC registration I expect will be limited to that by her scope of practice .

Of course it is a nonsense but if and when a standardised CPD comes into force to set minimum standards she will be excluded by requirments of standards.

Pehaps then the eminent podiatrists assembled at the Scotish parliment will not be insulted by clueless politicians giving nothing more than lip service and relating how nice their pedicure was !! ever feel like your wasting your time ??

Best wishes

Derek

 

Hi Derek,
Just to put a couple of points straight...............
Mark ran a successful private practice for a number of years,
and
He works as a locum/consultant in the NHS. This means; no paid holidays, sick days etc etc, just hard work and the opportunity to stand up to the managers and others within the NHS hierarchy who maange to (generally) make such a hash of things.
He really is looking from both sides of the fence.
On with the thread !
Cheers,
David

 

Hi Marcia

I would like to pick up on a couple of points if I may .

Firstly please don't "put yourself down" describing yourself as a "mere" podiatry student !!

You are the future of the profession and that can only be applauded.

In you first post you state :-

They ask all 'clients' (never referred to as patients) certain questions which are:
Do you have diabetes?
Are you taking steroids
Are you taking anti-coagulants?
Do you have any problems with your circulation?
Are you seeing your doctor for anything currently
Are you in good health today?

How many who answer "yes" to any of the above are ACTUALLY refused treatment ??

Would there be an element of "well your here now and we will be carefull" attached ?

In your second post you state :-

"if I were to go into private practice, I am not sure that my conscience would allow me to charge elderly people a standard rate (such as the £28 or so, that I believe has already been mentioned".

If you ever do come into private practice you will find patients WILL expect you to cut their nails irrespective of your educational background and , the £28 that has been quoted is not as you seem to suggest and extortionate fee .

If you take a reasoned look at whats involved (which will vary from area to area) taking into account the time / equipment / practice costs involved ,tax ,insurance ect .

Conscience does not come into it. The facts of life are , that IS actually a fair fee .

No one is trying to "rip off the elderly" .

The NHS cannot provide the service so increasingly we do, but as a PROPER service.

If you take the £2.50 you quote from an age concern volunteer domicilliary visit perhaps you can explain how that can ever be construed as providing a "safe effective practice to the public" ??

I'm afraid your figures like Marks and Davids don't add up.

It cannot be done PROPERLY unless an adequate fee is charged .

Not being hard on you honest ) Just giving you another perspective.

Best wishes

Derek

 

Hi David

Firstly my quote you used was in relation to actual study time at university , not in his employment (keep up please )

I don't know Marks background as obviously you do so perhaps you could enlighten me ,

Was his private practice integrated with his NHS work or was it like many of us a "stand alone " private practice with no regular income and lending of services etc ???

I commend Mark in his efforts of manger bashing at every opportuniy. I did it myself for 24 years in the NHS and I still remember the frustrations and anger it generated in me by their sheer incompetence and innefectual waftings which did nothing except to make patient care harder to provide for us at "the sharp end".

I left all that behind a long time ago and have no wish to return to it hence my comments about the lumbering HPC .

One point I would make though is ,

If Mark feels that Graduates are the educationally superior beings and therefore must be right ( which is what I take from some comments in his posts)

Why does he argue so with these mangers , are not they mostly graduates nowadays ???

Cheers

Derek

 

Welcome back Derek......................it's been quiet for a while

Regards

David D

 

Hi Derek,
As far as I know, Mrak did the old 3-year diploma course, same as me. I can't remember too many "sick days" or "hangover days" on that particular course.
I don't know what post-grad work he has done since.

Private practice was a stand-alone, but he may have seen some NHS patients within the practice set-up.

I don't see where Mark has ever said he regarded graduates as educationally superior beings. I would fall on this side though - unless you have been through the degree process, and know a litle about research (how to conduct it, when people are trying to pull the wool over your eyes etc) your viewpoint naturally becomes biased towards your own belief system.
Regards,
David

 

Factual Content of Submissions

Derek

One of the things a graduate education and a subsequent career in a varied professional environment has taught me, is never to make assumptions until I have all the facts to hand. To do so would be negligent and would not serve me or my patients well.

I asked last week if you would kindly refrain from misquoting or misrepresenting what I have said or written, but I see that this request has fallen on deaf ears. You assume that I have had a “…..very sheltered professional employment in the NHS.”

You then continue; “To be on a NATIONAL radio network quoting your [sic] inapropriate opinion of fee's could have caused IPP's across the country all having their own unique set of circumstances charging what is in reality a fair and just fee much vexation having to justify what they are charging to patients who had heard the broadcast.”

You have no idea of my background, my work experience or my opinions on such. Perhaps you may care to find out before you make such wild assumptions in the future and when you do maybe you will be minded to write with less sensationalism and a little more maturity. I stopped contributing to other forums because of infantile and destructive dialogue. I hope that does not have to be the case here.

As far as radio and television broadcasts are concerned I have never given opinion with regards to what I thought was an appropriate fee level for practice. That statement is complete fabrication and I would be grateful if you could withdraw it forthwith. Nor have I ever mentioned or written the term ‘foot fiddler’ or claim to participate in ‘manager bashing’. Many of my closest friends are employed as podiatry managers and whilst we may have differences of opinion regarding professional delivery I do not set out to insult or harm them personally. Lastly I have never suggested or written anything to imply that; “Graduates are the educationally superior beings and therefore must be right.” That is a quite ludicrous statement to make although I have to say that you appear to be making the case for that particular position in some of your recent submissions to this forum.

I am perfectly happy to have dialogue with anyone about this profession – including you – but in future can we please try to conduct ourselves a little more honestly? I don’t mind anger or passion or laughter. But I dislike those who lie or seek to mislead, intensely.

Kind regards

Mark Russell

 

Mark

I am suprised it has taken me this long to get you to this fever pitch !!!

How do you feel ?? insulted ? outraged ? someone has questioned your education and professional ability by blathering nonsese about graduate education and the NHS and has suggested that YOU sit a test of competence.

More to the point this person (me) dosent know you or your background .......

Sound familier ?? Dosent feel very nice does it ???

Well Mark welcome to my world !!! because that is how I feel every time you and others with the cloned thinking from the old guard feel everytime you make public comments that on the one hand we (the grandparented) are all very nice people and on the other bring our integrity , professionalism and character into question by inuendo and suggestion .

You want me to sit a test of competence despite the little knowledge you have of me that's ok ?? but not if the rolls are reversed ,you become mortally wounded !!

You accuse me of misrepresenting you well now aint that the pot calling the kettle black!!!!

This particular quote in relation to your petition whch we heard before with the HPC(yes a direct quote without any personal comment from me) is one that really sticks in my throat:-

"whose only scrutiny or examination, has been self declaration"

That statement is not only made untrue by ommission it is blatent misrepresentation and sensationalism on your part .

"Self declaration" ? what about the 3 or more referee's that supported every application ??

With that statement you not only bring my integrity into question (by suggestion) but also the professional integrity of the people who supported my application .

That was in my case 2 hospital consultants who have known me for over 30 years and a GP that has known me for around 10 years . All of which put their own professional integrity on the line when they made and signed the statements in my support .

They Mark are very good friends of mine one consitutes one of the 6 true friends we all find in a lifetime .

Incidentally Mark , I cannot find any "good word" you have written about hospital managers , but now they are your best friends

So forgive me Mark if I dont feel sorry for you this time.

You have taken the bait I laid for you and have had your pride dented in the cut and thrust of debate . You will get over it we have to on a daily basis


Your final paragraph :-


"I am perfectly happy to have dialogue with anyone about this profession – including you – but in future can we please try to conduct ourselves a little more honestly? I don’t mind anger or passion or laughter. But I dislike those who lie or seek to mislead, intensely".

Strong words Mark which border on personal attack . I have stepped back from you once I will not step back again .

I do not take myself or you for that matter seriously enough to descend to those depths .

So in conclusion , I hope I have broadened your eduction inasmuch as next time you make public statements such as the foregoing you will know of the feelings you are inflicting in hundreds of hard working podiatrists many of whome strive daily to improve their knowledge despite the efforts of some (perhaps themselves with hidden agenda's) to exclude them every step of the way .

But no doubt that will also fall on deaf ears as it has in the past .

Derek