Who undertakes pallitive care in your country

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As those who read every thread may know the not so United Kingdom are going through some changes on who does the General Pallitive care/Social care as they seem to refer to it as sometimes.

I know there has been talk of Podiatric assistance working with Pods in Australia, but who does the nails cuts, deals with the corns and Callous in your country for your average healthy non high risk patient?

 

As Podiatry is new to Sweden 3.5 years and the 1st grads finished June 09. It is pretty easy to say another group do the pallitive care.

Of the new grad working most are in high risk clinics. Intersting point is The foot therapists who do most of the pallitive care are/were very concerned about this new Podiatrist taking patients from them, the politics were intersting.

I see mainly MSK pats , but one of my goals of this year is to up my pallitive patients.

be intersting to see the other European contries such as Belgium and Spain where podiatry is newish compaired to say the UK how it works now.

 

In Australia the vast majority of people provide their own foot care, for both routine nail cutting as well as basic callus reduction.
In Australia there is about 1 podiatrist for every 10,000 people, and if a podiatrsist was perofrming only only foot hygiene tasks, they may be able to adequately service 500 people a year (a 1/2 hour appt every 2 months), which would be about 5% of the population.

 

I have though that would have been the same for ever country.

The reason behind the thread is due to the ongoing debt in the UK. General palltive care is being opened up to more and more folk. What I´m trying to find on is this the future for the rest of the podiatry world where a PP bread and butter work gets taken away from them or not.

ie does a pod in Spain do pallitive care does a DPM still do Pallitive care or is there only Podiatric assisstant doing this work. If so and thats where the other countries are heading then why is not DPM type programs being rolled out in every countries education process etc

 

With the decrease in insurance billing rates available to US DPMs, many moving into non-surgical care. Some US trained colleagues of mine have reported a decrease in payment for a bunion surgery from $2000 in the 80's to about $400 now. Palliative care is becoming more profitable/less costly/lower liability compared to surgery as the insurance payments go down. Then of course, if someone is not high risk and willing to pay, who's going to turn that down when there are bills to pay?

Here in Canada, we perform a lot of the palliative care (D.Ch's, we are "Chiropodists" but practice to the scope of international Podiatry with minor surgeries in our scope plus orthotics etc). It is our bread and butter.

However, there are very few of us compared to clients, and so many go to a pedicurist and get that awful cheese cutter thing done on their corns/calluses. Some have come to a D.Ch. after getting badly slashed.

We also have a HUGE number of RPN/RN foot care specialists who have taken anything ranging from a 2 day to a 3 week course in foot care. As a profession, our concern is that they are unable to properly assess risk since they are not trained to the level of Primary Care; indeed the diabetes course typically consists of teaching them how to poke around with a monofilament and telling them to be careful not to cut the patient because they're at risk of infection. Use antibiotic on any cuts. ??? They cannot predict ulceration risk reliably with their training.

Some people have wound up with foot ulcerations, and even been amputated as a result of lower level care providers doing their nails. These providers are unable to tell if a person's -feet are critically ischemic. The public doesn't fully understand the different roles; they have medical training they must be good enough, and these people are cheaper than me but sometimes you get what you pay for.

One gentleman I treated post foot care disaster as an in-patient had gotten "ingrown nails" that I suspect were really ischemic ulcers in all sulci due to rough treatment with goodness knows what implement by someone with very limited training, and a doctor proceeded to avulse them all with further disastrous implications. I suspect the original treater was either a home care worker or Personal Support worker (6 month training, below Registered Practical Nurse).

In my perfect dream world, I'd be okay with others treating, but only under my direction, only if they do a good job, and only after a thorough exam by me of course, to determine risk. And only after my bills are paid. They can have easy nail care, I'll keep those at risk feet our profession.

Sarah

 

In the UK it is mainly done by the Podiatrist but this varies greatly between different Primary Care Trusts. In some NHS PCT's they employ Podiatry Assistants to do general nail cuts under the supervison of a qualified podiatrist. In private practice I know of no Podiatrist who employs such an assistant. I think with an aging population, the role of the assistant will become more vital because there is just no chance enough podiatrists will be trained in the next few decades. I really see no particular reason for podiatrists to be treating healthy low risk patients (though I believe that such patients should see a podiatrist every so often for a review).

 

I think for this thread to develop we need definitions then we are not talking at international crossed purposes.

In relationship to the foot, I would define:

1. Personal Care as tasks that someone should be able to carry out for themselves such as cleansing, nail cutting and using a pumice or file to remove rough skin on the plantar aspect of the foot. Personal Care can be carried out by the owners of the feet irrespective of their health status providing they are fit and able to a) see their feet b) reach their feet.

2. Palliative Care as the necessary intervention by Podiatrists for foot problems falling outside of Personal Care. It is the management of these foot problems by a podiatrist which may reach a cure and ultimate discharge or put a maximum time between appointment times to enable a pain free existence.

Up until this last 12 months or so here in the UK when someone was unable to carry out Personal Care to the feet they may have been transferred to NHS care and seen either by the Podiatrist or the Podiatry Assistant. Or they may have sought help from a Private Sector Podiatrist or a beauty therapist or a family carer would take over. Social Care providers were not permitted to carry out personal care to feet other than cleansing. All this is changing as we begin to see NHS Podiatry Provision shift from Health Care into Social Care.

Again compared to other countries, in the UK state Healthcare is free at the point of service delivery, Social Care is not. Social Care is chargeable and is often means tested. The providers of footcare within Social Care whether it is Personal Care or Palliative Care are largely unregulated and the "consumers" are not assessed for their needs, generally are elderly with changing healthcare needs.

So we have a massively confusing system within the UK of private sector providers of footcare, personal or palliative with only the most discerning of consumer being able to work out who is and who isn't providing safe, effective and legal treatment at a cost.

Please feel free to change the definitions to find suitable ones which we can use in debate.

GB

 

Hi George I would add 1 line to the pallative care... which would read those willing to pay for treatment which others may consider personal care.