Social nailcare by volunteers

Hi David D

Where has your post gone ???

I have the content by mail but I cannot reply to much if it is not there for the world to see

Thank you for my welcome back from my holidays (sod's law came down yesterday with a virus thingy the has knocked the stuffing out of me )

If you look at my latest post to Mark it may become clearer the reasons for my "rambling posts " about education and NHS .

A friend once told me " every doctor who qualifies should be ill in hospital for 6 weeks after"

To inflict on others what they are inflicting on you (knowingly or not) can concentrate the mind on a different prespective . That was my intention sorry if I bored you but you did say it had been quiet lately !!

Oh and congratulations on your degree you should be very proud !!

Be lucky

Derek

 

Hi all

Derek, I accidentally erased my last thread after trying to make an amendment to it , and having had a long day treating those poor unfortunates we talked about not so long ago I didn't have the energy to re-write it.

As for the degree, yes I am proud, infact very very very (you get the idea) proud, but even though the OU is one of the top ten uni's in the country, it is still frowned upon by some institutions....(when will it all end?)

Out of interest, will you and Mark be exchanging xmas cards this year?


All the best

David D

 

Hi David

I actally would not mind sending Mark an Xmas card if I actually sent any !!

BAH HUMBUG !!!!

These arena's are for debate and as long as personal attack is kept out of it all will be well .

I bear Mark no malice he just has a different opinion that I strongly disagree with .

Nothing personal honest.
Best wishes

Derek

 

Thank you Derek. You have just made the case for supporting the petition more powerfully than I could have imagined. If anything I feel more vindicated than ever. But my sense of relief is tempered by the realisation that my fears of infantile and destructive contributions to this forum were well founded. Nothing personal, like.

Regretfully yours

Mark Russell

 

Mark

I think the fact you NEED to feel "vindicated" of your actions sums up your argument.

I will let others form their own opinions

Derek

 

Mr Admin

Thank you for that .

I have re read the rules and have not found myself to be in breach of any.

Best wishes

Derek

 

Hi All

Back to the thread :-

What is a fair charge ??

As an IPP patients employ me for my TIME and obviously everything associated with my skills as a professional .

Now irrespective of local situations , if I am going to do a domicilliary visit to a patient say 2 miles away.

It will take me say 20/30mins to get there park and ring the doorbell .

If it is only simple nailcare ,another 20 min by the time you have got in set up treated the patient and cleared down .

Another 20 / 30 min back to the surgery

That is best part of one and a half hours of my time

Now we can all add and subtract time / running costs etc which will be in the main dependant on local issues

But , one and a half hours for £6/8 ??

That does not even come close to the national minimum wage !!!

Pehaps someone can enlighten me on how anyone can survive on this payscale ??

I understand if perhaps you are treating 20 patients in a residential home / nursing home or the like because of the volume of patients fee's may be adjusted but £6/8 cant be done ..

Cheers

Derek

 

Derek,
Low cost simple nailcare?
I believe it can be done .

To my way of thinking there are two ways of looking at this:

1) Do the job yourself, and you are right. It can't be done - unless you charge a realistic fee, but a realistic fee for your time + travelling etc is not a realistic fee for the patient (in my opinion - and bearing in mind that we are looking at simple nail-cuts).
2) Employ someone to do this work on your behalf. I would suggest a FHP who is trained to do this work, trained to recognise more involved work which they may then refer back to the more experienced practitioner (yourself), and of course they carry the same indemnity insurance as you or I.
Only a suggestion, but the + points are:
If you adopt a "shared fee" system (50/50 split) you can make a profit by doing little more than providing the premises.
The patients get a good deal on their nail-cuts.
The FHP gets some clinic exposure.

I suggest this from many years of private practice experience. I never used this system, but I certainly would if I was in general practice currently.
Also, I can't think of a better way to publicise my practice, nor of bringing in potental new podiatry patients.

As an aside, re-validation of one's skills every five years or so is a great idea, as long as it applies across the boards. I'd be willing to undergo re-evaluation, so would Mark Russell. I know a few former SRCh's who might not!
Cheers,
DavidH

 

Hi David H

Hmmm ,interesting .

In theory it has it's merits IF you are talking about a surgery based practice only . I can understand because of the volume of patients seen for simple nailcare an FHP could make a living on a 50-50 split but ,I don't get too many come to my surgery just for that . Yes probably because the price puts them off .

My problem is domicilliary visits . Whoever does them in my area you can take up to 30 mins to travel 1 mile at times so with the best will in the world the amout of patients you can fit into a day is limited .

The other thing is the situation of working in patients homes , the space available , poor lighting ,searing heat from the fire they always manage to sit you in front of and of course "the chat"

Now as you know many elderly housebound see very few people from one week to the next so they expect (especially if they are paying) you to spend an amount of time with them at your visit . In reality that equates to a minimum of 20 mins per visit at best . Of course you can bash in don't talk cut nails and bash out again but if the patient is paying they will not tollerate treament like that and will bad mouth you to the GP the district nurse the milkman etc and as we all know the ratio of good and bad publicity !!

So how does the FHP make a living unless your fee goes up ?? and if you are going to put up your fee you might as well do it yourself .

The costs of transport , parking etc would be born by who ??

I would be the first in line to get rid of my domicilliary practice and spend my whole time in my surgery where I can practice more efficiently apart from that , it is less hassle and a far better working environment for me. But that won't happen coz it goes with the job.

I think in principle your proposal is good but whether it would work in every situation? Hmmm , I don't know .

Perhaps others may wish to comment??


Best wishes

Derek

 

Hi David H

To answer your aside

"As an aside, re-validation of one's skills every five years or so is a great idea, as long as it applies across the boards. I'd be willing to undergo re-evaluation, so would Mark Russell. I know a few former SRCh's who might not!

Now I know this might be a bit early to get back into this one as perhaps tempers are still cooling but

I agree in principle with revalidation/ or tests of competence for that matter that I , along with you and Mark would be happy to undertake as long as it is fair and applies to everyone !!! and not just a certain section of the profession that is the whole point of my oposition to Marks proposals .

He is singles out the grandparented every time using every trick in the book to discredit and exclude them with never so much of a mention of the dodgy Srch 's we all know exist .

Now I do know Mark is nobodys fool but I believe he and many others have cloned thinking in relation to grandparented pods much of which has been published here and elsewhere .

If you read back in this thread it's my impression that on face value he thinks there are some good Gptd pods out here but makes no allowance for that in his proposals and as he does not know how to seperate the good from the bad lumps everone in together and wants them to sit a "test of competence"

No mention of course about the his own doing the same .

That is what makes me so angry, the double standard .

I also do not see how you can ever unite a profession by excluding sections of that profession .

Get everyone in and on a level playing field then set standards !! that can be the only way forward .

But what standards ??

Marks concern is that Gptd pods are now eligable to work in the NHS and are not trained to a high enough standard to do so.


We have never been given the opportunity to learn techniques or procedures that would allow us to anyway.

I , as I am sure many have , been following Marks efforts with baby Emma (for those that don't know it can be found on a seperate thread here) .

Now I personally would not have a clue with that particular child and also could not ever expect to have the direct facilities at my disposal that the NHS can provide .

My point is that if any Gptd pod was stupid enough to get themselves into that position they would be found out pretty damned quickly and hopefully have due process taken against them for practicing outside their "scope of practice "

There lies the protection for Marks fears yes "scope of practice"

The protection is already in place !!

How do we define an individuals s o p ?? that is something that we can only ever sort out by setting a base line and going from there which I think is where all our efforts as a profession should be aimed .

What is the point of setting a "test of competence" that is devised by a Gptd pod who knows nothing of NHS training or procedures and vice verce . We must devise a tiered system of :- DPM / podiatric surgeon , podiatric general practitioner / FHP etc with training to match the grouping which will then establish a realistic range of cpd etc etc.

We are told cpd is going to be linked to qualification

( I was going to start a new thread with this one but I havent the time to answer or reply to more than one at the moment so forgive me for starting it here)

Fine great stuff , but will I be able to go to my local podiatric teaching establishment for it or will I be restricted because I am Gptd ??

How much will it add to the running costs of my business and therefore to my fee ??

So perhaps I could request comment on :-

Is there such a thing as too much CPD ???

Cheers

Derek

 

Hi,

Those who frequent the SMAE site will know of my support for grandparented members - however at this time we have a golden opportunity to move the UK profession forward, and in my book this overrides any self-protectionism (whether individuals or professional organisations), or "my quals are as good as yours" arguments. In any case, I am sure many SMAE graduates are as good as some former SRCh's.

Derek, I think most of the "recognised" schools in the UK will start to welcome grandparented members come next year. You will have a choice about where you want to do your CPD.

Coming back to costs of toe-nail care, I strongly suspect you would lose some of your doms to surgery-care if you employed a FHP and charged £8 a clip. As I mentioned before, I can't think of a better way to make your practice grow!
Cheers,
David

 

Derek

You really undermine your argument with your presentation. For reference, I’ve quoted the relevant text.

“I agree in principle with revalidation/ or tests of competence for that matter that I, along with you and Mark would be happy to undertake as long as it is fair and applies to everyone !!! and not just a certain section of the profession that is the whole point of my [sic] oposition to Marks proposals .”

I’m not sure why you oppose the proposal. I have always considered revalidation essential to maintain standards for the registered profession. I am also glad you consider fairness and equity as principal tenets of integration. As the graduate practitioner had to sit a fairly comprehensive examination before being allowed onto the register, you will agree therefore, that the non-graduate practitioner should have to sit an examination of equal standard before being allowed parity in terms of legal status? That is only fair isn’t it?

“If you read back in this thread it's my impression that on face value he thinks there are some good Gptd pods out here but makes no allowance for that in his proposals and as he does not know how to [sic] seperate the good from the bad lumps [sic] everone in together and wants them to sit a "test of competence”

Exactly my position. Just how do you suppose we separate the wheat from the chaff other than setting a test of competence?

“No mention of course about the his own doing the same.”

I already did along with another 10,000 or so graduate practitioners who have gained either a diploma or degree in podiatric medicine.

“That is what makes me so angry, the double standard.”

The truth usually hurts Derek. Especially when you’re in denial.

“I also do not see how you can ever unite a profession by excluding sections of that profession. Get everyone in and on a level playing field then set standards !! that can be the only way forward.”

Huh? On that logic let’s all call ourselves cardio-thoracic surgeons and then once we ‘get in’ we’ll set some new standards to accommodate the obvious shortfalls in skills and knowledge. But never mind, the public will be safe, as the regulator will strike off anyone who proves a menace. Way to go Derek – I’m sure the public will be comforted!

“Marks concern is that Gptd pods are now [sic] eligable to work in the NHS and are not trained to a high enough standard to do so. We have never been given the opportunity to learn techniques or procedures that would allow us to anyway.”

That’s irrelevant. There is now parity of employment rights within the public sector for grand-parented practitioners. As you admit yourself, your knowledge of techniques and procedures is inadequate at present, therefore you present a significant risk. That is the basis of my concerns.

“My point is that if any Gptd pod was stupid enough to get themselves into that position they would be found out pretty damned quickly and hopefully have due process taken against them for [sic]practicing outside their scope of practice.”

At that point the damage has already been done. Reactive regulation rather than proactive regulation is a disaster. I suggest you read the following letter:
http://epetitions.scottish.parliame...tID=10902&IssueID=4&Root=10900&Level=1&Filter
Do you think this lady would be reassured?

“We must devise a tiered system of :- DPM / podiatric surgeon , podiatric general practitioner / FHP etc with training to match the grouping which will then establish a realistic range of cpd etc etc.”

On this point I loosely agree. Regulation has to be structured accordingly – podiatry assistants, trainees, general practitioners, specialists – rather than one size fits all. That would be a cornerstone of any dedicated registrar/regulator such as a General Podiatry Council.

What I disagree strongly on Derek is your approach to discussion. I made comment earlier regarding the fabricated story about a radio broadcast, yet you 'justified' this by telling us that's how you feel when people make up things about yourself. That is no way to conduct a debate. Perhaps you might want to reflect on this before you submit a reply.

Yours sincerely

Mark Russell

 

Hi David H

I sincerely hope that the cpd door will be opened fully as you suggest and increase our opportunties to advance our knowledge in the near future .

I look forward to that .

Best wishes

Derek

 

Hi Again Mark ,

Welcome back !!

I am at a loss to understand exactly the point your last post is making ??

My "presentation undermines my argument" ??

You then go on to quote the parts of a reply to Davidh that are in the main out of context with the intention of the message .

I'm sure we can all make argument by doing that but ???

However I will answer one or two points that warrant a reply .

You state :

"practitioners who have gained either a diploma or degree in podiatric medicine".

May come as a big shock to you Mark but I have one of those as well !! Took me 8 years to get mine .

So where does the "denial" bit come into it ??

I have looked at the thread to which you referred me and obviously cannot comment because I do not know the whole details of the case in question or the distance learning establishment to which the lady refers .

One comment I would make though is that I think it is an inditement on our society that when on the one hand the allegation is made of an infection being caused by "dirty instruments" but the ladies demise was by MRSA which breeds in a dirty environment . No excuse for either in my book .

Of course Mark we can all pick out practitioners that fall well short of what is an acceptable standard and point fingers for the sensationalist value I don't really believe that helps .

Doctor Shipman and the Bristol Heart surgeons were all registered practitioners . I didn't notice that protecting their patients , or perhaps you can tell me different ??

The point I was making with my quote on your efforts with baby Emma , was simply that in reality I could never invisidge that catagory of patient presenting to me in my surgery and if it did would be refered directly to their GP for onward referral and treatment.

That I beleive Mark is a responsible attitude and not really one for point scoring. . It would be outside my scope of practice and therefore I would have no grounds to attempt any treatments .

That is the part you convienently ommit the "protection of the public" that is already in place !!

Scope of practice is in essence knowing your limitations in relation to your knowledge , situation and capabilities .

You have a scope of practice which is different to mine . You see a different type of patient in your working environment than I do in mine .

I believe my training and knowledge are congruant to my practice as I'm sure yours are to the situation you choose to work in . We ALL have room for improvement and advancement of knowledge. I don't believe that restricting practitoners learning opportunities helps the profession in general

I have stated in the past I agree with the principle of a General Podiatric Council an would support any move to acheive that end but not at the expense generalised exclusion of any section of the profession .

One final point ,

I think to "sex up" the importance of the profession into a "life saving"discipline is again something I don't hold in very high regard.

I believe for the vast majority of the general public , anyone who promotes that thinking brings an amount of ridicule and scorn on the profession .

We do important vital work but it is not A&E medicine or " cardio-thoracic surgery".

Cheers

Derek

 

Derek

I’m afraid you’ve lost me once again. Maybe it’s the medication? I suspect I’d have to synthesise a whole lot of ergot before I could begin to contemplate your reasoning, for I can tell you’re an avid fan of the G.Bush Jnr. School of Logic. Unfortunately I am not. Two plus two has always made four in my book.

I’m sorry that it took you eight years to gain your diploma/degree and I wish I could say that I was surprised. Never mind though, you got there in the end. But if that was the case I cannot understand why you had to be grand-parented onto the register. Tell you what though, keep me in suspense. I’m not sure I could cope with another epic of DTT proportions….not without the hallucinogen! Let’s just agree to disagree, mhmm?

Kind regards

Mark Russell

 

Mark

I am so sorry to see you are so immature in your outlook you have to resort to this type of dialogue.

You perhaps should "get out more" then perhaps you could take a dent to your ego in a less pathetic manner.

The reason it took me 8 years to get my diploma in podiatric medicine was sheer hard work in building a practice supporting a home and family at the same time , and of course mainly what the syllabus and exam schedule dictated .

I'm really sorry you can't cope with the fact you have met your match and have no useful answers save personal insult .

I have no wish to continue with this unless you can return to some sense of reason and courtesy so until then I withdraw.

In sympathy

Derek

 

Please don't stop posting on this topic, it's one of the best threads on the net so far!

A big HOORAY to Mark and DTT!

PS.

One point I would like to make is with regard to re-validation.
I asked the HPC quite some time ago if there was ANY scenario where the Grandparented would need to get re-qualified.

For example a woman has a maternity career break, has 5 years off the register etc. Would she have to then get a BSc(Hons) Podiatry to return to the register? As because she was grandparented she had a non-approved qualification.

The answer was NO. Once you have been on the register, you can apply to get back on it (fairly easily unless you've been struck off). If you've been out of practice for 3+ years you need to do some supervised practice, and maybe a refesher, that is all. I'll go and look up the exact wording if you like (it's late now)...

So my point is that with the current set up re-validation by exam (and particularly in asking the grandparented to take an exam which is effectively asking them to sit an entrance exam) is VERY unlikely to happen.

Similarly someone with a DPodM gained at Uni is not forced to top-up to a BSc(Hons). And YES I do appreciate that an ex-SRCh is better trained, but the reality is what we now have with the HPC.

If you legally have given someone the right to the title Chiropodist/Podiatrist or any of the 13 HPC regulated titles the there would be human rights issues with regard to taking away that right, as it was the statutory process that gave them that right in the first place, hence grandparenting...

As I've said before I think the HPC is an excellent thing.

Please don't slap me Mark, or Admin.

Cheers,

Robin.

 

Hi Robin

I'm glad you enjoyed the debate as did I until it was reduced to personal attack and insult.

I have said I would not enter any forum that , as has happened with so many other sites , bring the profession into public disrepute in this manner.

That is the reason I have withdrawn from any further discussion with Mark and will not re enter until common courtesy and manners are restored.

Sorry to dissapoint you

Best wishes

Derek

 

Hi all

quote

'Similarly someone with a DPodM gained at Uni is not forced to top-up to a BSc(Hons). And YES I do appreciate that an ex-SRCh is better trained, but the reality is what we now have with the HPC.'


'As I've said before I think the HPC is an excellent thing.'


Well Robin, thats two of us!

I agree this was a good debate, then it became fun, then the light sabres came out and I was outta here

Cheers

David D

 

Hello David d

Yep shame when the "fun" went out of it but there we are .

Everyone takes themselves ever so seriously these days .

Hah hum .

Can I just ask , if you have "all the qualifications available" from your teaching body if it is the same as mine ( which I believe it is) , then you must also hold a Diploma in Podiatric Medicine ??

I think as the HPC is here to stay like it or not we have to work with it but a small problem that could occur in the near future :-

The increase in the need for intensive care / high dependancy beds in England & Wales to cope with the demand produced by Gptd pods marauding the public's footcare !!!

Now there's a thought

Best wishes

Derek

p.s We can talk amongst ourselves you know people !!!!

 

Hi all

Quote

"Can I just ask , if you have "all the qualifications available" from your teaching body if it is the same as mine ( which I believe it is) , then you must also hold a Diploma in Podiatric Medicine ??"


Yes, I am also an 'F' if you understand me?

I didn't understand your last post though !

Cheers

David D

 

Hi DavidD

Yes then you have the same qualifications as myself. Minus the degree of course (well done again on that)

The comment about ITU /HDU beds was tongue in cheek .

As we (Gptd) have been portrayed as these terrible people who are a danger to the public and who will destroy the fabric of the nations foot care in the run up to the formation of hpc regulation , perhaps the increase in those beds will be required ???

o/k with it now ??

Cheers

Derek

 

Hi chaps.
No need to be so coy..... .
Mike Batt offered me a fellowship of the British Chiropody and Podiatry Association when I joined (after leaving the SCP). I'm happy to let anyone know that I use these letters on occasion.
I'm also happy to let everyone know that I support SMAE, and have used some of my academic and practical experience to write educational CDRoms for SMAE. Other well-respected colleagues from the former SRCh-sector are similarly involved in podiatry education for SMAE.

This site is for all foot health professionals - that includes you. Your views and opinions are every bit as valid as anyone else's, and on the UK forum especially so.

Back to the thread........

Regards,
David

 

Hi DavidH

I don't think it's a matter of being "coy" more I think trying to avoid starting a them and us argument .

The fellowship you were offered is an honourary title for the professional assocation .

One to which we refer is within the academic structure of the teaching body.But may be confered in certain circumstances I believe ie past academic achievement etc .

I'm sure if anyone were that interested they could check and find out all the relevent information which is mostly available on the institutions web sites .

best wishes

Derek

 

Damn and blast,

I was actually speaking in code, now how can I perform 'chiropody by stealth' now that my cover is blown?

regards

DD

 

Ddivad

uoy evah neeb dnuof tuo neht

ah ah
kered

 

Since our local PCT engage age conern to cut toe nails I asked the question " if person suffered a serious condition after having there nails cut, what would happen if they sued?" I got no reply.

"Are age concern toe nail cutters insured?" after all we are or we could not cut toe nails in our practise. There is enough private HPC reg podiatrists who could include NHS work into thier practise similar to dentist.

Will age concern pull teeth next due to the costs involved I think it is more than £10 dentist charge?

 

Hello
I am a newbie and I am a Nail Tech and Instructor of 18 years in Va.. I in the past four years have worked as a contract Nail Tech seeing to resident general nail care in two different Assisted living facilities. I do not do residents who are diabetics or who have lower extremities problems. I do see and hear of problems with CNA'S cutting, filing, etc. of residents nails. Their nails are cut to close and residents bleed with no more than a band aid applied. No cleaning, no sanitation of clippers and also sending residents in to have pedicures with open wounds, nail fungus, etc.

I am constantly reminding them that this is not an acceptable practice and they should have the podiatrist take care of them. I refuse to provide the service until the podiatrist gives consent for the resident to have the service. I often ruffle feathers trying to protect residents and myself.

Please, could you give me your thoughts on CNA'S doing and insisting that I do these services.

 

I once asked an age concern "nail cutter" about sterilisation. She explained that the patients buy their own instruments so don't need sterilising. I asked what happens if the cat sits on those instruments or the dog licks them, and she said that was the patients responsibility not age concerns! I think legally it might be rather different!
I've also had patients on warfarin and diabetics who've been receiving the nail cutting service as the nail cutter felt sorry for them!