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Will the new NHS reforms allow GP's to send patients to private podiatrists?

Discussion in 'United Kingdom' started by richardrobley, Apr 15, 2012.

  1. richardrobley

    richardrobley Active Member


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    With the new NHS reforms approaching and everyone working within seemingly against it, does anyone know if GP's will be sending NHS patients to private podiatrists. I have done a contract for a local GP surgery before and it was poorly paid to say the least, and when they had to supply disposable instruments they scrapped it all together.
    Not a lot of information out there regarding podiatry so if anyone can enlighten me I would be very grateful, cheers.
     
  2. Disgruntled pod

    Disgruntled pod Active Member

    Sidelining slightly: A local GPs surgery in my city was/is hiring out a room to a FHP trained by the fantastic Mr. Heylings.

    She was/is charging £15 for an appointment. I had one of her patients come to see me as he was getting now where with his igtn. I took one look at it and said that it needed nail surgery and that I would not even touch it without LA.

    This lady had been taking money off this patient for completely ineffective treatment, 2 or 3 times. How many GPs will be hiring out rooms to FHPs just to make more money.

    And @£15 a patient, what with room rental, I wander how much money the FHP was making. Mind you, she was doing the local Age Concern cente for £10 a patient.

    Oh and £15, "The bitterness of poor workmanship is long remembered after the sweetness of a low price is forgotten."
     
  3. David Smith

    David Smith Well-Known Member

    Richard

    Under the Health and Social Care bill and the criteria of 'Any Qualified Provider' you will have to tender for a contract with a Clinical commissioning group, which could be any clinical group but will most likely be a GP commissioning group since they have been preparing for this for years. For more info Go here http://healthandcare.dh.gov.uk/
    and here
    http://www.supply2health.nhs.uk/AQPResourceCentre/Pages/FAQ.aspx
    and here
    http://www.businesslink.gov.uk/bdotg/action/layer?topicId=1073900012

    I've been to quite a few seminars on this subject and I've come to the conclusion that there will be much less money to fund just as many services and patients but with many private companies, the main ones being GP commissioners, taking large profits (stuffing their already bulging pockets with the cash they have the responsibilty for allocating (because that wont be abused will it :bang:) out of the total cash available and so there will be even less money to actually buy 'any qualified providers' services and that's assuming that the commissioning group decide that podiatry in your area is worth funding anyway, and so your private podiatry service will be in even more demand than ever before.
    GP's and the clinical providers companies they set up will be getting very rich, it's not illegal even tho its discouraged and they are already doing it according to news reports. I reckon its gonna get real ugly in the NHS world in the next few years.

    Regards Dave

    Dave Smith
     
  4. richardrobley

    richardrobley Active Member

    Thanks for that David. I already have many people coming to me as they have found it impossible getting an NHS appointment and from what you've said it looks like that's going to continue.
     
  5. morganholly

    morganholly Member

    Message to Disgruntled Pod from a Disgruntled FHP. Please don't tar all FHP's with the same brush. Some of us take pride in our work and have the client's best interests at heart. Your comments are uncalled for. There is good and bad work in every profession. I have been to see a client today who has seen two chiropodists in the past for his ingrowing toe nails who have both left him in a mess and in severe pain. He has rebooked an appointment we me so I rest my case.
     
  6. Catfoot

    Catfoot Well-Known Member

    Morganholly,
    We keep hearing these anecdotal stories from both the regulated and unregulated sector, so I take them with a pinch of salt.

    The fact is that FHPs have a very small window of experience in their 5- 14 days practical training and are therefore not equipped to give a comprehensive footcare service. If they were to accept that and refer on appropriately that would be fine, but in my experience they don't.
    I think all FHPs should align themselves with a pod who is trained to administer LA and qualified in orthotic provision, so they have a referral pathway in place.
    As long as FHPs are unwilling to do this or ask pods for help then they will continue to have a poor image that is entirely of their own making.

    The present trend seems to show that GP practices are keen to maximise revenue by hiring out room space to FHPs and alternative therapists. The FHP is always the loser as they need to pay rent regardless of how many patients they see. Of 3 GPs surgeries in my area who rented space to FHPs only one still has an FHP working there. Mind you at £12.00 a treatment it is not surprising.

    I have offered my help to such FHPs in my area by suggesting I can perform nail surgery for them if required, even offering to travel to the GPs surgery in the evening. So far no-one has taken me up on this offer or even responded, which i think is quite rude.
    If FHPs want to be treated as "professionals" they should act that way.


    regards

    Catfoot

    PS Just for interest who do you refer your IGTN patients to ?
     
  7. David Smith

    David Smith Well-Known Member

    Catfoot

    This is taking the point away from the OP but pots and kettle black come to mind.
    Today's podiatrist likes to push basic chiropody into the broom cupboard, and rather think they are MSK specialists, Orthotists, Paediatritians, vascular specialists, dermatologists, Surgeons, Specialists in many 'alternative Therapies' like acupuncture after a weekend course or lower limb physical therapy after an afternoon's course. Somehow, just coz its on the foot or somewhere near it makes it the Jurisdiction of the podiatrist:confused:
    Even the idea that podiatrists new from university are competent in biomechanical evaluation and orthotic prescription is contentious and certainly the knowledge of many podiatrists I meet on courses are jaw droppingly naive in terms of their knowledge of Anatomy and physiolgy in terms of MSK conditions and the biomechanical evaluation and interventions required to address those problems. They can do a PNA under local anaesthetic tho:bang:
    On top of all that they come out of university with a degree and see nail cutting as several steps below them and only want to do the 'real professional' podiatry work, i.e. the stuff mentioned above, and then complain like billyo that someone, without a degree who loves to do that work and do it well, does not have the qualifications or professionalism to do it. Dog in a manger comes to mind here.


    Dave
     
  8. Catfoot

    Catfoot Well-Known Member

    David Smith,
    Ok, let's get back to the op.

    The question is "will the new NHS reforms allow GPs to send patients to private chiropodists?" The answer is "why not?" as some are doing this already and will probably continue to do so.

    More discussion here :- http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=76376

    Your comments about degree-trained pods being clueless in various areas and being reluctant to do nail-cutting is contentious in itself. I'm sure Judith BB and other Podiatry lecturers would be interested in hearing your concerns about their students not being "up to scratch".

    regards

    Catfoot
     
  9. Johnpod

    Johnpod Active Member

    Put the cat out while I have a word with the vet. I'm sure she's got something stuck.

    Mind you, why would I pay a vet's bill if I can get it done at the cattery?

    And you are at least two years out of date CF, since JBB does not teach podiatry undergraduates any more. Pity you have to attempt to drag third parties in to try to support your 'contentious and anecdotal' case.
     
  10. Catfoot

    Catfoot Well-Known Member

    Ah Johnpod,
    back again from the estate agents ?

    "I have studied many philosophers and many cats. The wisdom of cats is infinitely superior." - Hippolyte Taine

    regards

    Catfoot
     
  11. morganholly

    morganholly Member

    Thank you for your post CatFoot. I agree with you completely about your comment that an FHP should work alongside a Podiatrist and welcome your comments that you have offered your services to your local FHPs. I would love to do that personally but from my personal experience FHPs can be seen as a threat to Podiatrists taking their business, so your comment about it being FHPs own making is a little one-sided. We should all be sensible about it and work in harmony together for the good of the patients and their feet. I haven't had to refer a client as yet for an IGTN but I would have no hesitation in referring to my local Podiatrist for anything that was out of my remit as a FHP because that is the sort of person I am. Like I said there is good and bad practices in every profession so we shouldn't be tarred. Thank you for replying.

     
  12. Catfoot

    Catfoot Well-Known Member

    Hello morganholly,
    I think i should be clear that i don't support joint working ( in the same clinic) between FHPs and Podiatrists/Chiropodists, as I cannot see an advantage to the patient and there are issues of clinical responsibility that are disadvantageous to the Podiatrist. (These have been discussed many times so I won't go over old ground here.)

    I am pleased to note you willingness to refer.

    "I would love to do that personally but from my personal experience FHPs can be seen as a threat to Podiatrists taking their business, so your comment about it being FHPs own making is a little one-sided."

    I'm not sure I follow the above. If you are making contact with a pod to create a referral pathway for your patients, for condtions outside your scope of practice, then I don't see how this can be perceived as a "threat" ?

    I am suprised you have not yet referred an IGTN to a Pod. I suppose it would depend on your definition of an IGTN. I would define an IGTN as this :-

    http://www.podiatryandchiropodycentre.com/ingrownnails.html

    or this :-

    http://en.wikipedia.org/wiki/Ingrown_nail

    did you not see this condition when you trained?

    regards

    Catfoot
     
  13. morganholly

    morganholly Member

    Of course I saw ingrowing toe nails when I did my training and I learnt how to treat them. The links you have sent me defining an igtn tell me nothing new that I don't know already about them but thanks for sharing them anyway!
     
  14. Catfoot

    Catfoot Well-Known Member

    Hello morganholly,
    Are you saying that after a couple of weeks practical training you would be able to treat the type of ingrowing toenail pictured without a local anaesthetic ?

    I'm astounded :eek:

    Catfoot
     
  15. morganholly

    morganholly Member

    You are trying to put words into my mouth and make assumptions and whatever I see I cannot win with you - I do feel you are a bully and have issues with FHPs so if this is the attitude of yourself and possible other people on the Podiatry Arena then it is not the arena for me. Goodbye!
     
  16. Catfoot

    Catfoot Well-Known Member

  17. DTT

    DTT Well-Known Member

    Well Done catfoot,

    It must make you very proud to achieve that level of intimidation and elicit that response in doing so :mad:

    I'm sure you will run back to the cesspit and savour the admiration heaped upon you there from the rest of the sado's.
    Yours in total disgust
    Derek
     
  18. You should try public relations when you leave podiatry, Catfoot. I'm sure you have a knack for it. But there is a little collective hypocrisy with this one insofar as the arguments and strategy you employ are the same as the othopods use against our podiatric surgeons - use of title (surgeon), inferior training (non medical) and the unspoken one - territorial encroachment and potential loss of income. Thankfully - at this end of the profession - there doesn't seem to be the same desire to belittle each other's clinical skills or competencies.

    Best wishes
     
  19. morganholly

    morganholly Member

    Thank you for your support Derek, it is much appreciated! :))

     
  20. morganholly

    morganholly Member

    Thank you for your support Mark - much appreciated!

     
  21. Johnpod

    Johnpod Active Member

    So there you have it, Catfoot. Your attitudes are about as welcome as f*rt in a 'phone box. Must be the sardines.

    ------------------------------------------
    Beware of cats - English proverb.
     
  22. morganholly

    morganholly Member

    Thanks for your support Johnpod - I may stick around afterall !!


     
  23. DTT

    DTT Well-Known Member

    If you do, be prepared to put your case without room to have the likes of catfoot and co to intimidate you.

    If they do harden your argument with facts not emotion and the "I'll huff of then" attitude.

    Stick to your guns and harden your resolve, make your case and argue effectively

    I did and I'm still here 25 years later :cool:
    Good Luck
    cheers
    Derek;)
     
  24. Catfoot

    Catfoot Well-Known Member

    Mark,

    I’m not convinced that argument can be applied to the FHP v Pod debate.

    Pod Surgeons are educated to degree level and are regulated under Statute, while FHPs are not so regulated and their course will not give them a qualification anywhere near degree level. Orthopaedic Surgeons may well regard Pod Surgeons’ training as inferior, which it is if you consider length of training as a criteria.

    A Pod Surgeon’s training is standard ;- 3 or 4 years F/T for Pod degree, followed by 1 year residency and then another 6 years mentoring/training. FHP training is not standard across the UK– which is one of the stumbling blocks to their regulation.
    In addition Pod Surgeons have a very well-define scope of practice and do not pretend to be Orthopods – there have been (and still are) a plethora of FHPs advertising themselves as “Chiropodists”.

    There are 46 NHS Podiatric Surgeons’ posts at present. We do not know how many FHPs are practising.

    “Territorial encroachment” is a different matter. Surgeons have always been very a bit twitchy about this. Their attitude stems from the days when “Physicians” were from moneyed backgrounds who were able to afford medical school and were considered to be men of learning. The surgeon was regarded as a rather uneducated ”sawbones” whose only claim to fame was the ability (in the days before anaesthetics) to perform amputations/operations at lightening speed. They were not allowed to use the title”doctor”. Nowadays doctors who train to become surgeons drop the title doctor and this becomes a mark of status.

    I personally, have never had a concern about FHPs poaching patients, however, this posting from the SCP forum expresses the concerns of one Podiatrist :-

    "I graduated with a good degree in 2011, and unable to get an NHS job I started in private practice, setting up in 2 chemist shops in different locations and starting a home visiting practice. Despite seeking advice and spending a small fortune on marketing, and carefully pricing my services the response has been poor. I feel there is too much competition not only from other pods but also there are a lot of so called foot health practitioners and people passing themselves of as chiropodists. One such person was advertising a full foot treatment for £12 how can any qualified pod compete with that?. I am now considering quitting the profession and maybe just becoming an un registered foot health practitioner in my spare time if you can't beat them, might as well join them, I just wish I had been given honest advice about job prospects before I entered into this profession"

    I suppose it depends on what you mean by "the profession". As you have chosen to de-register it could be argued that you are no longer a member of the "profession" of podiatry. FHPs are definitely outwith the profession.

    Morganholly, the times that I agree with DTT can be counted in blue moons but on this occasion he makes sense. If you want to participate on a podiatry forum with academics then you need to grow some vertebrae and learn to put your arguments in a logical and unemotive way. Throwing your toys out the pram when you hear something you don't like only makes you look childish and stupid and weakens your position as an FHP.

    If you want a "touchy-feeley" forum where you will hear what you want to hear, and no-one is allowed to post anything contraversial, join SMAE and then you can have access to their members' site

    regards

    Catfoot
     
    Last edited: Apr 26, 2012
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