Health CommitteeWritten evidence from The Society of Chiropodists and Podiatrists (ETWP 17)

The Society of Chiropodists and Podiatrists wishes to respond to your invitation to submit evidence for its inquiry into education, training, and workforce planning. For ease of reference each paragraph of our response relates to a specific bullet point of your original statement. We have included a short summary as requested. We would also draw to your attention the fact that we have made a submission to the Centre for Workforce Intelligence.

Summary of Response

Over the last three years there has been a 10% reduction in commissioned numbers across these 13 Schools. However, we are encouraged by the NHS London Board’s agreement that podiatry commissions be increased by 5% for 2012–13 and by a further 37% for 2013–14. This will however still not be sufficient to meet future demand.

Our Faculty of Management estimates that the predicted increase in diabetes will require some extra 8,500 WTE podiatrists in the next 10 years to meet that need alone.

There is no School of Podiatry in East Anglia, although need in that area is as great as any other of the UK.

The right number of appropriately qualified and trained healthcare staff (as well as clinical academics and researchers) at national, regional and local levels

We recognise the importance of having the correct numbers of staff in place, at all levels. Our current numbers of practising podiatrists are given below, together with an indication of age grouping. This information is drawn from our membership database. As of 1 December 2011, Society of Chiropodists & Podiatrists had 8,463 members in practice in the UK. In February 2011, there were 12,716 podiatrists on the Register of the Health Professions Council.

Age

% of practising members

Under 25

4%

26–35

21%

36–45

31%

46–55

30%

56–65

12%

Over 66

2%

Currently, there are 13 Schools of Podiatry who, between them, produce about 450 graduate podiatrists each year. Approximately 50% of all new podiatry graduates have chosen podiatry as a second career. Over the last three years there has been a 10% reduction in commissioned numbers across these 13 Schools. However, we are encouraged by the NHS London Board’s agreement that podiatry commissions be increased by 5% for 2012–13 and by a further 37% for 2013–14. This will however still not be sufficient to meet future demand—see below.

We believe a key point in commissioning is the need to do this at national level. For example, there is no School of Podiatry in East Anglia, although need in that area is as great as any other of the UK and there are Colleges in almost all other regions of the UK Please note that all the above refer to pre-registration training.

That training curricula reflect the changing nature of healthcare delivery, including medico-legal context

The changing nature of healthcare delivery impacts upon training at both pre- and post-registration levels. The College supports a number of Special Interest Groups in subjects such as: biomechanics, rheumatic care, diabetes, dermatology, forensic podiatry, homeopathy, podopaediatrics, and therapeutic footwear. Through the College’s system of accredited courses for CPD, podiatrists may develop their knowledge and skills to extend their scope of practice and thereby meet identified foot-health needs. Additionally, we have a range of non-clinical programmes available and these include CPD courses in medico-legal work.

Within the field of podiatry is a separately certificated extended scope practice in podiatric surgery. This requires podiatrists to complete an MSc followed by clinical training resulting in the award of a fellowship and, after a period as a registrar, the Certificate for the Completion of Podiatric Surgical Training (CCPST) is conferred upon successful applicants. Outcome measures demonstrate the effectiveness of these surgical interventions and they offer cost savings for similar work carried out by medically-trained surgeons.

All our developments in training are needs-driven and, increasingly, podiatrists may be found working with long term conditions such as rheumatoid arthritis, and diabetes mellitus. Our Faculty of Management estimates that the predicted increase in diabetes will require some 8,500 WTE podiatrists In the next 10 years in order to meet that need alone. A recent American study1 concluded: “In a sample of commercially insured patients with diabetes and foot ulcers (non-Medicare and Medicare-eligible with employer-sponsored supplemental insurance), care by podiatrists prior to the first evidence of foot ulcer appears to prevent or delay hospitalization and amputation.” The potential saving to the NHS by investing in podiatry is considerable, and must surely feature in any discussion of commissioning.

That all providers and commissioners of healthcare (both NHS and non-NHS) play an appropriate part in developing the future workforce

Our Faculty of Undergraduate Education is actively working with practitioners across the full spectrum of provision to assist in the development of the future workforce. With the increasing emphasis on high-end podiatry in the NHS, the Faculty has sought to encourage independent practitioners to offer placement opportunities, as well as requiring all pre-registration programmes to offer multidisciplinary experience.

Multi-professional and multidisciplinary leadership and accountability (encompassing the full range of healthcare professions, specialities and grades) at all levels

Principally through our Faculty of Management, we have had input into the National Leadership Council development of the competency framework for clinical professions. Additionally, podiatrists are employed multidisciplinary settings such as musculoskeletal triage, and other multidisciplinary pathways where leadership and accountability are part and parcel of everyday work.

High and consistent standards of education and training

Through its quality assurance processes, the Society of Chiropodists and Podiatrists (SCP) has established an independent system which operates at a higher level than that required by the regulatory authority, the Health Professions Council (HPC), for pre-registration training. For full membership of the SCP an honours degree in Podiatry (or Podiatric medicine) is required. Under the auspices of the College of Podiatry a system of quinquennial review operates and all programmes are expected to develop and reflect the ever-changing foot-health needs of the population.

Regarding post-registration training and education, the SCP operates a system for the approval of CPD events, courses, clinical updates (including mandatory updates for those who use local analgesics, as well at least basic life support for all members), and other types of supported learning. The content of these learning events is always needs-driven, and members wishing to extend their scope of practice must do so by taking a Society-approved course. As mentioned above, we have a number of Special Interest Groups, which play a major part in the identification of education trends.

That the existing workforce can be developed and re-skilled for the future (through means including post-registration training and continuing professional development)

Some 56% of our current membership will probably be practising for the next 20 years, and 85% for the next 10 years. Against this background, we have invested in processes to provide updates for members, have contributed significantly to the project on independent prescribing for podiatrists, and our members have undergone two successful audits by the HPC to ensure adequacy of their CPD. Our annual conferences (normal attendance 1,200) are a popular source of updating, as are our two principal publications: Podiatry Now, and The Journal of Foot and Ankle Research. Should the independent prescribing project bear fruit, this will create another learning need for our membership. We have made preparations for this.

Open and equitable access to all careers in healthcare for all sections of society (by means including flexible career paths)

As a Society we are committed to equality and diversity. All our policies are written to reflect this view, and we always seek to operate with these views in mind. The fact that bursaries are available to podiatry students does much to level the playing field for all aspiring podiatrists.

The other points of the consultation will be addressed through our contribution to the submission from the Allied Health Professions’ Forum.

December 2011

1 T B Gibson et al, Podiatrist Care and Outcomes for Patients with Diabetes and Foot Ulcer,
http://www.apma.org/diabetesstudy, accessed 09.12.11.

Prepared 22nd May 2012