Should a Rook take a Queen?

Marmite is something that attracts some but not others and yet we all want golden treacle to cover our efforts; a metaphor for the sweet side of a career,  Changing our spots might be difficult if we are a leopard, but modern society allows us to change direction no matter how old we are. CFP interviewed Catherine Lacey, an FHP of many years after she enrolled on a first-year cohort changing from Rook to Queen in that metaphorical sense. A partnership between that crenellated bastion of distance learning, the SMAE institute and Queen Margaret University. This article follows on from Mind the Gappublished 11th December 2021.

A new perspective

The acceptance of the foot health practitioners (FHP) is a knotty topic for some and for others makes sense. No one can argue that there is a shortage of podiatrists in the UK and that recruitment remains elusive. However, for the mature person, FHP training is often regarded as both an economic way of helping patients without having to embark on a 3- or 4-year degree course and HCPC registration. Today, however, much is changing as the primary group that train FHPs have now embarked on the first course which can provide FHPs with a genuine, distance-learning route towards eligibility to apply to join the HCPC as Podiatrists. This is via a BSc (Hons) Podiatry degree programme that is delivered collaboratively with their Higher Education Partner – Queen Margaret University, Edinburgh. For the casual or professional reader it is important to understand who and what FHP can deliver.

FHP and registered nurse, Catherine Lacey speaks openly about her profession and points out that she is the first cohort of students going through the aforementioned Podiatry degree course with The SMAE Institute.

“It’s someone who has a Diploma and qualifies as a foot health practitioner. I did my studying through the SMAE Institute in Maidenhead. I think there are other schools that do it, but essentially it is a combination of home-based learning divided into separate modules covering both disease states and practical footcare elements, and then you finalise that with two weeks of clinical practice where you’re in clinic for ten working days with patients, supervised by podiatrists learning how to care for feet. There is obviously a limited scope of practice in what we can do, and obviously we have to recognise where our scope starts and ends, and when we’re outside that scope of practice we refer people onwards to podiatrists.”

What made you take up foot care?

Catherine came straight from school into nursing. She had always wanted to be a nurse and has now worked in the NHS and abroad for over 40 years. She went for her routine dental care one day and the receptionist noticed that she was limping. As there was a chiropodist at the practice the receptionist persuaded Catherine to book in to see him. The chiropodist had qualified through SMAE and had been a professional footballer. After retirement he had trained as a chiropodist and managed some painful corns on Catherine’s foot. Fifteen minutes later she was dancing down the corridor.

“It was actually really life changing in the sense that he cured my pain in 20 minutes. As a nurse, I’m dealing an awful lot with chronic disease management, and you can’t cure my patients. I can just make them feel better for as long as I possibly can but this chiropodist provided a cure. He got rid of my pain and it had a fundamental effect on me. I just thought, ‘I want to do that for my patients. I want to be able to give them the same level of satisfaction that this chiropodist has done to me.’ So I went to see him on a regular basis and asked him loads and loads of questions.”  In the end he was fed up with Catherine asking loads of questions and told her to do the SMAE course.

As I listened it was clear she was articulate and knew her subject and conveyed competence in managing patients. Having worked in hospitals and GP practices she knows her way around patients.  As far as others who train through SMAE to become FHPs she says

“Some people have no medical knowledge whatsoever, and work very hard to get up the learning curve. Other people I’ve encountered, their parents or other family members have been chiropodists. One person that’s also doing the degree course with me is a registered osteopath. So it can be varied, some people are medically trained, and others aren’t.”

A new course and graduation in podiatry

In order to practice as a podiatrist one must have a degree recognised by the HCPC. The course that Catherine is undertaking is the culmination of a collaborative enterprise between the SMAE Institute and Queen Margaret University in Edinburgh. Queen Margaret University are the awarding body and The SMAE Institute is the training provider.Instruction is carried out by trained podiatrists, many of who are well known within clinical education circles. The course itself has been under discussion for a few years as SMAE had already launched a diploma in higher education (Podiatry Assistant) course that mapped across to the first 2 years of the Podiatry degree that is delivered at Queen Margaret University on their BSc (Hons) Podiatry degree programme. That two-year course led to a Diploma in Higher Education as a Podiatry Assistant – the only qualification of its kind to carry formal academic credit, and that would allow those who successfully completed this diploma to work within the NHS as podiatry assistants. Being intrigued she went along to a seminar on this type of qualification and opportunity and realised that without the option to convert that into a full Podiatry qualification that it had limited appeal.

“I was already working in the NHS, I was earning more doing private FHP work than I would be doing NHS podiatry assistant work, so I decided at that time not to proceed with that further learning. When they started to introduce the possibility of a conversion course, that if they were able to get it HCPC approved, that we could convert that  – you would do the two years of the Diploma course in higher education which tracked mirror for mirror, term for term what a podiatry degree was doing. And then if approval was met, then we could proceed with Years 3 and 4 of a four-year degree course with the Queen Margaret University in Edinburgh and come out with a degree in podiatry. And that was the fire that lit my belly.”

Some people were full time FHPs but for Catherine, 50% of her time was in nursing and 50% of her time working as an FHP. The educational process used by SMAE  is covered mainly by distance learning. The system is modular and there are exams, with clinics arranged into blocks as with podiatry students. She will reach the end of Year 3 in July 2022 with a further year thereafter.

“We do go into blocks of clinic. The advantage for us is that we’re already acting as FHPs so we’re already patient facing, and many people have lots of years of being an FHP under their belt so they’ve got the confidence in the work they do and the patient interaction. So we’re not going in green, but we are having to work in our spare time over and above our normal everyday work. So the fact that it’s a four-year course is probably an advantage.”

She was unaware of a voluntary registration body for FHPs which seems surprising, but in her case, she is registered under the RCN and a Member of the Association of Foot Health Practitioners through the same Institute. As far as patients are concerned payment by health insurance providers don’t always cover treatment by FHPs because HCPC criteria apply.

A limit of 30 places per cohort has been allocated for this BSc (Hons) Podiatry degree which is broadly commensurate with most other Podiatry schools in the UK. This is a robust number as it helps to ensure that the programme is sustainable with a strong infrastructure in place.

Claims of misleading patients

Podiatric surgeons have for years been accused by the orthopaedic groups of misleading patients that they are medically qualified and this also applies to FHP being accused by podiatrists of the same ‘crime’.

“My training was very clear on that, in that we were taught and observed giving basic footcare. I include in that obviously cutting, trimming toenails, removing callus, removing corns, removing hard skin, treating Athlete’s Foot. treatments for fungal nail. But whenever you reach that murky feeling, that sixth sense of ‘Hmm, I’m not quite sure what to do, or I haven’t seen that before, or I’m a bit out of my comfort zone,’ at that point we refer. I think a really important point is that we have to recognise our limitations and the things that we can feel confident doing and the things that we don’t feel confident doing. At that time, whenever I’ve had that niggle of, ‘I’m outside my comfort zone, or I’m not quite sure,’ I will immediately say to the patient, ‘I need to refer you on.’ Now we have a team of six GPs here. Anything to do with feet, the GPs will not see. They refer to me – and I find that ironic because sometimes I still will have to refer back saying, ‘This is outside my comfort zone,’ yet it’s clearly outside the GPs comfort zone because they’ll see me and if I don’t know what it is I refer them on to NHS podiatry.”

There is no question of misunderstanding Catherine’s passion and enthusiasm as both nurse and a FHP. She believes foot health is a great profession because of the chance to meet fantastic people to treat. She believes that many problems are curable providing a great sense of satisfaction. That you can manage your own business, manage your time, and raise your children, with the convenience of having time out of work as required.

“It can be hard work, it can be deeply satisfying, it can be lucrative, and it’s a good job. Really is a good job.  I would definitely encourage people to do the FHP course. Maybe that’s the most direct route because from my perspective I knew that I could never stop working and become a university student full time. I needed something that would enable me to earn money, work, and study at the same time.”

Catherine does not speak for all FHPs and acknowledges that in every profession there are good and bad practitioners. Having a deep understanding of health she feels that a FHP who switches to doing the podiatry degree course makes sense.

“We’ve been FHPs for years, and now we want to make that the next step. So we’re already used to dealing with patients, we’re used to administering patient care, and we know what we’re letting ourselves in for. I think in that respect, SMAE and Queen Margaret University have given FHPs an amazing opportunity, and I’m really grateful for that opportunity because I thought I’d reached my ceiling. And knowing that I can progress to become a qualified podiatrist, I’m extremely grateful for that chance.”

She emphasises strongly that people should know their own ceilings. The SMAE institute based in Maidenhead has been inundated with enquiries. As far as her future is concerned, at the age of 60 she doesn’t see herself retiring anytime soon and has a natural thirst for learning. She thinks she will be attracted to those walkers who traipse up and down the fells as she lives in Cumbria. When she does, CFP will be delighted to read some of the success stories as she becomes a fully-fledged podiatrist.

CFP is interested in all aspects of foot health and welcomes comments from podiatrists, podiatry assistants and FHPs.

With thanks to Andrew Hill* for peer reviewing this article for CFP.

* Andrew Hill MSc Podiatry; PGCert L&T; FFPM RCPS(Glasg); FHEA; FSSCh; HCPC Registered. Programme Lead and Senior Lecturer – BSc (Hons) Podiatry. More information.

Advice for the school leaver

Students considering a career in a foot health profession have wider opportunities today than ever but in general, podiatrists would recommend embarking on the degree course as early as possible.

Many mature students enter podiatry later in life often having qualified in other roles or using access courses, together with the conversion from FHP to podiatry. There are wider opportunities available in becoming a podiatrist and training in podiatric surgery requires many years of investment and can be difficult for mature graduates with family commitments. 

Resources for a career in podiatry cover current universities, NHS employment grades and access to podiatrists. Most podiatrists are only too happy to provide advice or offer short placement visits to their practices. To find out more about a career in podiatry you can download this article  Career in Podiatry as an overview. Currently, CFP is publishing podiatry stories from experienced podiatrists on this site. Why not start by reading Emily’s story A Career as a Diabetic Foot Specialist.

You can now read how podiatry became an established profession and dropped the term chiropody

Podiatrist on A Mission available from Amazon books: ebook, paperback and hardback

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Thanks for reading “A marmite profession or golden treacle?” by David R Tollafield following an interview with FHP Catherine Lacey

Published by Busypencilcase Communications. Est. 2015 for ConsultingFootPain

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