Referral From FHPs

[dewdrop]

Now we are getting down to the nitty-gritty as you so adaptly summarised, Robert.

The impression that FHPs have reluctance to refer on to a pod, in my personal experience, is due to the facts that

1.That they have been led to believe by the private trainers that they are equal to pods. So why would they want to refer on and admit to a pod that they are not as equal as they thought?

2. If they refer on to a GP, then the pods in the area won't know the limits of their training and they can keep up the pretence of equality.

3. If they refer on to a GP then the whole matter will be kept confidential and no-one will know that they exist. This is particularly relevent if they are operating from a mobile 'phone, don't give receipts and perhaps don't pay tax.

This is my personal experience in my area, as often I don't know that an FHP exists until they stop trading and my 'phone starts to ring.
If they want to be taken seriously as footcare practitioners then they need to raise their game considerably and they could start by referring on to those more competant.

Of course if they did that, then they would have to write a letter which would reveal their address, which might not suit if the Inland Revenue has no knowledge of them.

Is there any wonder that this group has such a bad press as most do nothing to enhance their image?

So why on earth do you think, Robert, that an individual approach is needed ? Why to you think that a pod should seek out and cultivate a relationship with an FHP? Surely the onus is on the FHP to develop the contacts?

I have spent much time in my own practice putting into place referral pathways and contacts so I can refer on when I need to. So why can't FHPs do the same if they are the responsible practitioners they claim to be?

David,

Patients have access to less expensive treatment as needed.

If FHPs are equal to pods, as you say, then why should their treatment be cheaper? Surely the cost of "best practice" is the same for both pod and FHP ?

[davidh]

Jul 31, 2009 16:55:21 GMT dewdrop said:

David,

Patients have access to less expensive treatment as needed.

If FHPs are equal to pods, as you say, then why should their treatment be cheaper? Surely the cost of "best practice" is the same for both pod and FHP ?

Where did I say that

[seekerofwisdom]

David,
re post 8#

It's a good system which benefits everyone.

That remains to be seen.

Pods delegate and prioritise their workload.

I am surprised that the pods were not able to prioritise the workload before the FHP came along?

The FHP gains practical experience of conditions which she would not otherwise be treating regularly.

What would those be? I thought you said that FHPs were able to do mostly the same treatments as pods anyway?

Patients have access to less expensive treatment as needed.

Why would it be cheaper?

As FHPs are supposed to be independent practitioners in their own right why would they want to rely on the cast-offs from a pod practice?

That's why they don't refer to pods as there is nothing in it for them.

Cynical SOW

[davidh]

Jul 31, 2009 19:06:07 GMT seekerofwisdom said:

David,
re post 8#

It's a good system which benefits everyone.

That remains to be seen.

Actually it works very well.

I am surprised that the pods were not able to prioritise the workload before the FHP came along?

What would those be? I thought you said that FHPs were able to do mostly the same treatments as pods anyway?

Patients have access to less expensive treatment as needed.

Why would it be cheaper?

As FHPs are supposed to be independent practitioners in their own right why would they want to rely on the cast-offs from a pod practice?


That's why they don't refer to pods as there is nothing in it for them.

Cynical SOW

Dewdrop - how does
"Patients have access to less expensive treatment as needed."become
"If FHPs are equal to pods, as you say,"

I think I answered Robs question, and the question on the scope of FHPs reasonably succinctly.

I'll bow out now.

[10feet]

Jul 31, 2009 7:52:57 GMT davidh said:

Well, as a "consummate wordsmith" it would seem I'm damned if I do/damned if I don't clarify/outline/suggest/defend or otherwise define the FHP scope of practice.

However I'll have another go ;D.

FHP scope of Practice.
Same as Pods but they don't give LA or carry out nail surgery.

Some have better training than others, but this is essentially what they do.
On the subject of degrees, a BSc(Hons) whether in Podiatry or Needlework fulfils certain common criteria which you cannot ignore. The core subject, I'll grant you, is totally different.

One Pod Practice I'm familiar with, which work very closely with a FHP, is a good model of cross-referral.
All three Pods are three-year degree trained, and as far as I know are members of the SCP. The FHP is SMAE-trained/insured and refers at-risk feet and anything the Practice and her feel is outside her scope of practice.

It's a good system which benefits everyone.
Pods delegate and prioritise their workload.
The FHP gains practical experience of conditions which she would not otherwise be treating regularly.
Patients have access to less expensive treatment as needed.

David,

I have your get out clause.

The situation you describe here is an Assistant Practitioner, no doubt with scalpel skills, in a supervised environment. This is not an independent FHP therefore of course the lead Podiatrist will be able to offer an assistant at lesser cost. This indeed is an unusal set up for the privately trained and perhaps not the best example to use.

There seems enormous confusion throughout this thread as to what is a Foot Health Practitioner. Even you have shared this confusion with us. I am confused.

The impression I am left with is that FHPs (the "traditional" FHP Robert initally referred to in his post and not the untraditional degree trained deregistered FHP) are trained to deal with what they see, not to diagnose what they see and what can be done to cure what they see. Hence the cyclical treatment of do a bit, pay a bit and come back for a bit more.... If there is no ability to diagnose, why the need to refer to a Podiatrist?

Bill,

I think that it all rather begs the question. What is an FHP? An FHP is someone who has no training at all, to someone who could legally, properly and appropriately describe themselves as a chiropodist or podiatrist but has taken the opportunity to avoid paying for the questionable privilege of HPC registration. Thus, legislation, designed to clarify a matter has suceeded in obscuring it.

Never let politicians and civil servants into your life unless totally unavoidable. I believe that subsequent legislation (which is bound to occur) will make matters even worse.

All the best

Bill

Interesting point you make about subsequent legislation. I realise that this is opinion but would you care to expand on it and share with us?

Pete

[dewdrop]

David,
As you have left the room there is not much point continuing the discussion is there ?

PTP,
As you astutely point out the model for cross-referral that David cites is indeed unusual and seems to run contrary to the philosophy of the FHP trainer/training.
One of the selling points of the FHP course is that it gives the trained FHP the flexibility of setting their own work schedule around whatever (family) committments they have. They are told that they will be equipped to practise safely as autonomous practitioners, so I fail to see why they would want to align themselves to a pod practise as an assistant?

This statement from Bill Liggins intrigued me

I believe that subsequent legislation (which is bound to occur) will make matters even worse.

To what does this refer? As far as I am aware the HPC have no plans to regulate FHPs in the foreseeable future. Perhaps you could enlighten me as well?

[davidh]

Aug 1, 2009 5:26:52 GMT dewdrop said:

David,
As you have left the room there is not much point continuing the discussion is there ?

Please feel free to make your correction.
I'm still reading the thread - just not joining in .

[dewdrop]

Oh hello David,
I see you're back again lurking. ;D

Can I draw your attention to a post of yours from the other Pod A (Pod Arena) #27 15th September 2008?
Knowing where your interests lie might explain your robust defence of the unregulated.

Mentoring can take many different forms.
In this case I have been approached to mentor students, should they need it, on the new FHP Course. Nothing to do with teaching, everything to do with helping them with mundane day-to-day queries ("who should I ask about this?" - "where do I go for that?").

It is true that you did not actually say here that you thought FHPs were equal to pods. However, if you are mentoring them then surely you are supporting this idea as promulgated by the private trainers ?

[robertisaacs]

Hey all

Dewdrop.

I think you're right. It should be the responsibility of any clinician to refer on where they need to, just as I need to refer to surgeons, rheumatologists etc. But the sad truth is that's not happening with fhps.

We could just say "well it's their fault" and shrug our shoulders but I've always thought it better to light a candle than to curse the darkness.

So. Reasons fhps don't refer. Dewdrop gave 3. (how do you know if they pay tax btw?

Here's a few more possibilities

They don't realize what treatment options exist (we don't know what we don't know)

They are afraid they'll get a stream of verbal abuse by a pod who will just rub their noses in their own superiority

They don't see any benefit to them

They think it will damage their reputation.

Are these good reasons?

Regards
Robert

[dewdrop]

Hello Robert,

We could just say "well it's their fault" and shrug our shoulders but I've always thought it better to light a candle than to curse the darkness.

1. Yes it is their fault.
2. It is easy to be altruistic from the security of an NHS position. Out in the world of IPP it is a little different.

(how do you know if they pay tax btw?

I don't.
But if any trader operates from a mobile phone, does not give receipts, does not appear in Yellow Pages, has a location that no-one knows about and is known only as "Sandy" (and I apologise profusely in advance to all the Sandys that are reading this, it was the first name that came into my head ) wouldn't you smell a Rattus Rattus ?

That is why I asked David for info on the training of FHPs as he seems to be linked with that.

I was wondering what they are actually taught about clinical boundaries and when to refer on, but so far no info has been forthcoming. If we could find that out maybe we could see where the problem lies.

So we are no further on.

Hmmmmmm.

[billliggins]

Hello Pete

Concerning my comment on subsequent legislation.

It's not my opinion, it's based on a statement made to me by Marc Seale that I understand is in the public arena. Sooner or later there will be some sort of certification or other recognition of FHPs (in our area of practice) and others eg. Sports Massage Therapists. Neither he nor I made any reference to when this might be but as a personal opinion I doubt very much whether it would be before the next election. I think that the training of home helps by NHS podiatry departments (to which I have referred in another post) and the declared intent of the NHS to embrace Assistant Practitioners clearly shows which way the wind is blowing.

Dewdrop. I agree with you that it is not the responsibility of a chiropodist/podiatrist to seek out FHPs to educate them when to refer. However, a chiropodist/podiatrist may find it advantageous to do so.

Bill Liggins

[robertisaacs]

I would say that the "security" of an nhs position would make one objective rather than altruistic. However it's moot because I've been part time nhs and part time pp for some while now.

Either way I don't see it as altruism so much as enlightened self interest.

Let's say your neighbors kids are chucking litter into your garden. They should not be doing that. It's wrong. It's their fault. You should not have to waste your time on it.

So what do you do? Get pissed that they're doing something they should not? Or do you pop next door, have a chat, explain why you'd rather they didn't etc

To give a more applied example, there are a number of osteopaths around where I work who issue orthotics. I saw quite a few who had had significant problems due to poor prescriptions. I've got to know a few of them. We've done some mutural education. I now know more about what they do and vice versa. Result is, I now get some referrals from them and they get some from me. Both our patient groups benefit as do we. Everyone wins and the patients most of all.

Altruism? Perhaps. But it worked!


Regards
Robert

[10feet]

Robert

You are working with colleagues you know to be vigerously regulated by the General Osteopathic Council, perhaps even more so than ourselves as Podiatrists.

This is not altruism. I would see this as self interest in a protected and protective environment. Sorry to be harsh but after all it is business.

Would you offer the same training to FHPs without the same regulatory prospects? Doubtful. Not good business?

Pete

[10feet]

Hello Pete

Concerning my comment on subsequent legislation.

It's not my opinion, it's based on a statement made to me by Marc Seale that I understand is in the public arena. Sooner or later there will be some sort of certification or other recognition of FHPs (in our area of practice) and others eg. Sports Massage Therapists. Neither he nor I made any reference to when this might be but as a personal opinion I doubt very much whether it would be before the next election. I think that the training of home helps by NHS podiatry departments (to which I have referred in another post) and the declared intent of the NHS to embrace Assistant Practitioners clearly shows which way the wind is blowing.

Dewdrop. I agree with you that it is not the responsibility of a chiropodist/podiatrist to seek out FHPs to educate them when to refer. However, a chiropodist/podiatrist may find it advantageous to do so.

Bill Liggins

My apologies and I thought you were hinting at new information.

We are aware that the HPC have no intentions of regulating aspirant groups until 2011/12. This has already been declared.

Even if they begin licencing assistant grades it is not going to resolve the situation we have. So if FHPs became legally recognised along with all 3rd sector providers there would still be the same old problem of the same old dodgers with a new name appearing.

We are going around in circles on this one.

I think we have to be aware that the latest DoH Document about footcare service provison for commissioners is the Government's weak and desperate attempts at levelling the playing field for those of us that work on the foot. Its sad.

I wonder if the Care Quality Commission will ever prove its worth?

Pete

[dewdrop]

I wonder if the Care Quality Commission will ever prove its worth?

Care Homes Regulations 2001
National Minimum Standards

Standards 7 - 11
Health & Personal Care
Standards 8.11

8.11 The registered person enables service users to have access to specialist medical,
nursing, dental, pharmaceutical, chiropody and therapeutic services and care from
hospitals and community health services according to need.

Many nursing homes now use FHPs as a cheaper option to pods. I wonder what "specialist" group they fall under?


Standard 33.7 - Quality Assurance - is also interesting



33.7 The views of family and friends and of stakeholders in the community (eg GPs,
chiropodist, voluntary organisation staff ) are sought on how the home is achieving
goals for service users.

I have never been consulted by any care home, either as a relative of a resident or a chiropodist. Neither do I know of any colleague who has been.

So I guess we could say, Pete, IMO ,that the answer to your question is "no", the standards are certainly not being enforced.