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Why is podiatry sliding toward the Independent sector?

Why is podiatry sliding toward the Independent sector?

Podiatry is a profession that cares for foot health. With a profession of 10,000 dedicated men and women according to The College of Podiatry sources we can only deliver limited care within the NHS and so that leaves the independent sector to provide the rest. Forty-one percent of podiatrists work in the independent sector, 23% share between NHS and their own practice leaving 35% for the NHS (Farndon 2016).

What is a podiatrist and why should you use this group of specialists? Read on to pick up the true meaning of podiatry.

With GPs ever more under pressure, podiatrists offer a number of dedicated services, not just dealing with those age old complaints often ascribed jokes about corns, ingrown toe nails and bunions. Of course these complaints are no joke. However, despite being a profession dedicated to the foot evidence from 2010-13 from the Clinical Practice Research Datalink, of over 1/2 million episodes of foot pain attending GPs only 21% went to podiatrists with 30% going to orthopaedics. The health service is failing to recruit podiatrists and the independent sector is creeping under the strain.

I have taught podiatrists at undergraduate and postgraduate level and know the efforts the profession has travelled over the last 40-years to offer a quality service directed at improving mobility. We go to the GP because the service is the ‘go to guy’. Listening to the radio or TV news or the newspaper we are now out of synch with many world leading healthcare services. The idea of ‘free’ is distorted as we don’t pay enough for British healthcare at face value.

When it comes to Foothealth there are many who can offer advice but as a podiatrist myself I cannot square that circle for want of an awful cliché and say well you don’t go to your GP for your teeth. Why would you go to your GP for your feet? The answer is simply that the doctor is the first line of call, especially if you do not know what the problem is. When I joined the NHS in 1978 the main direction of podiatry (called chiropody then) considered those over 60 ‘the elderly’. Now that term grates as I find I am now a pensioner!

Children attended mainly for warts and a fledgling service offered inlays we call orthoses. This was previously the domain of the orthotist, supported by generous consultant sourced budgets 30 years after the NHS was formed. The rheumatoid and diabetic patients were targeted as having greater need and as far as working with other groups, such as physiotherapists and other specialty consultants, this was rare.

So much has changed since those times and budget trimming as with much of the health service has eroded care delivery. As a tax paying user of the health service I now have higher expectations of my speed of delivery of health care but this is where the NHS has failed for less intrusive conditions. Foot health being one. A referral for a NHS podiatry consultation for orthoses has descended into ridiculous delays, so, as a specialist desiring one of my colleagues to help a patient, a long period opens up where little help is being offered to redirect their problem. This delay is critical and limits the benefit of many treatment programmes. While I believe in the NHS, until there is common agreement from all the political drivers toward non-life threatening conditions, the independent sector will become ever more important.

The independent sector is where many healthcare providers (podiatrists, physiotherapists, doctors and surgeon) are moving to avoid the stressors of the NHS’s unreasonable demands. The healthcare professional is asked to become more of an administrator in the NHS than a clinician and this offends those that care so much about patients. More time, access to more treatment, unconstrained processes that cripple delivery attract those of us more. Toward the end of my days in the NHS I attended useless meetings that caused me to cancel clinics. As a foot surgeon any significant meeting could affect my surgery lists, or the dreaded winter effects filled up surgical beds affecting operation cancellations. Arguing the case with my Chief Executive bore little fruit and another list was cancelled. My podiatry colleagues were no better off and any criticism of management was rejected forcing colleagues into those shadows of despair.

More than ever I see the NHS unable to deliver best podiatric care, not because of poor podiatrists but because of a systematic failure to recognise the importance of less sensitive areas of medicine. Put bluntly this means areas that carry less political gravitas.

Today podiatrists can screen for blood pressure, assess weight distribution, check for diabetic risk and other health diseases, undertake neurological and vascular assessment of the limb, and contribute to smoking cessation support. Podiatrists study medicine as well as their own field and can offer first line advice related to Foothealth and allied medical disease. The profession is split into musculoskeletal podiatric specialists dealing with muscles, tendons and joints, higher risk conditions affecting skin and other tissue damage including rare skin conditions such as congenital epidermolysis bullosa. Some podiatrists have a special interest in dermatology while others work closely with orthopaedics and podiatric surgeons to advise on the appropriate time for foot surgery.

Times have changes. A new focus for the NHS – definitely. For podiatry, well we have been adapting for years to meet patient’s needs, the only problem is patients do not know who we are and what we do. Hopefully another foot Health Month might improve that misunderstanding or not? Anyway to the go to person for feet MUST BE A PODIATRIST.

David R Tollafield is a former podiatric surgeon, member of the College of Podiatry (London) and registered podiatrist, and now author and journalist for podiatry. He writes regularly in ‘Footlocker’ his personal monthly blog. His website is consultingfootpain.co.uk and you can write to him at busypencilcase_rcb@yahoo.com. He also publishes Reflective Podiatric Practice for colleagues signed up to his newsfeed.

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