I qualified in 1985 from Durham School Chiropody, as it was called back then and went straight into the NHS. I literally walked into my 1st job with East Berkshire Chiropody Service. Qualifying as a ‘chiropodist’ felt like a job for life, and most newly qualified students went straight into the NHS as the ‘automatic’ expected career route. Good grounding.
It was so different in those days. We were still doing school inspections to check children for any presenting foot problems to treat or refer on. Pregnant women were treated. Once people reached retirement age they qualified for NHS chiropody. There used to be real excitement in clinic if a patient presented over 90 years. War veterans in and POWs regularly made up the clinical lists. Chronic foot deformities and pathologies were a regular occurrence. It was highly interesting and varied job, but Chiropody was considered a bit of a ‘Cinderella’ service.
Today we are no longer referred to as chiropodists, but as Podiatrists. This is a very welcome change to raise the bar. We don’t offer maternity or school inspection services anymore. Treating 90 year olds is a regular day event and I no longer get to hear great war stories. As for getting patients with chronic foot deformities like an untreated Club Foot, Rickets these are now rare clinical presentations, along with debilitating forefoot deformities like bunions with the big toe angled at 45 degrees. I used to witness this all the time. I think at one point I thought all ladies over 70 had bunions!
The NHS has been busy in correcting such severe and chronic foot pathologies. Along with good foot health education and better living standards such awful presentations are becoming a thing of the past. Diabetic foot amputations rates are falling. This is all positive feedback, but of course there are the negatives. Longer waiting times, reduced resources and cutbacks, increased stress levels resulting in disillusioned NHS podiatrists.
Today I believe NHS podiatrists have it much harder than when I first qualified. There are the daily pressures of clinical governance and protocols to adhere to. More paperwork. In theory great practice, but can eat up practical time, adding an additional layer of stress. There is also the fear of the ‘complaint’. It can be the 0.001% patient who bites you in the preverbal and undermines all your confidence. Happens in both the NHS and private sector. We now live in a ‘No Win, No Fee’ punitive culture. This in effect does make us more risk adverse, with everything needing clinical evidence to be effective, but in reality can reduce the number of treatment options and hamper innovation.
Medical Insurance companies will only recognise treatments which are endorsed by NICE. Our clinic offers laser treatments for fungal nail infections. A highly effective, clinically proven treatment option, but insurance medical companies won’t endorse it because NICE hasn’t.
In many ways there is a tougher environment out there for podiatrists. We are constantly trying to prove we can do more than just cut toenails. The feedback I get from NHS podiatrists is they just don’t have the time or resources to widen their scope of practice whilst treating patients let alone take out to promote the profession. No time for thinking out of box and innovation means in effect patients could lose out in the short term and long run?
In my area, patient waiting lists are on the rise for initial diabetic foot consultations. Patients with problematic and painful ingrown toenails are having to wait a long time for surgery. This raises the question on whether the NHS should work in closer collaboration, partnership with the private sector? Private podiatry clinics like my own do not have waiting lists and can always offload NHS waiting lists to get people treated quicker. A case highlighting the need for NHS reform.
Now please don’t get me wrong I believe the NHS is an amazing institution and my NHS podiatry colleagues are working their little cotton socks off. The high volume of people accessing the NHS creates a swimming against the tide situation. Ploughing in more money is only a very quick fix. I get hugely annoyed the NHS is politicised, although there needs to be reform. This needs to happen on both sides of the coin. People should be made to be more responsible for their own care as a civic duty. Preventative medicine should be given more priority. Don’t rely on the NHS to pick up the tab all the time when you cannot be bothered to help yourself.
The NHS and private sector should be working in closer partnership, as should all NHS departments in Primary and Secondary Care. Lets try and connect the dots more to get results quicker. The NHS has for example all these referral pathways which in essence can be delaying tactics. Meant to save money, but can actually cost more. Wouldn’t it be great to see an NHS Podiatrist and Orthotist for prescription footwear on the same day or to get a diagnostic ultrasound or X-ray there and then. Sounds like Utopia, but in defence of the NHS, this is also hard to achieve in the private sector. I know by listening to my patients we all have ideas on how on we can improve the NHS.
Ultimately, we should all be grateful that we do have the NHS offering such amazing free treatment, especially coming through for us when we and our loved ones really need it. As a footnote though could we please bring back school inspections? Start young to help ensure good footings for the future.
