Martin

The problems are all numbers again.

It is estimated that there are some three million diabetics in the UK – a
million of them undiagnosed - whilst the current capacity of the NHS
podiatry service is 2.42 million patients. Clearly the NHS will have to
reprioritise its delivery of care once more if it is to meet the targets of
the NSF that was published last year.

The care of the diabetic foot has always been somewhat of a hit or miss
affair. There is a lot of duplication around – patients often have their
feet screened by the podiatrist, the practice nurse, the GP and the
diabetic clinic – sometimes all within a few weeks of each other. There is
little coordination between the separate departments/clinicians in planning
and delivering effective procedures. In my experience, only a handful of
trusts have any real integration between the various disciplines. Sharing
knowledge is not that big in the public sector as yet – too may territories
are still jealously guarded. The same can be said for referral pathways
especially to the surgical footwear/orthotist service – where I always
though that podiatrists had an equal if not greater need than orthopods of
their input.

Perhaps if podiatrists were to limit their intervention to those patients
with diabetic foot syndomme, then the situation might be salvageable.
Rather than treat & screen every diabetic patient within community
settings, concentrate podiatry provision to those patients with serious
pathology – and do so from a hospital multi-disciplinary setting. But then,
is that really the direction we want to take podiatry in? More restrictions
to the public service?

What I haven’t heard is any credible plan to develop or expand NHS
provision. I asked a question at the end of my post over the weekend if the
opportunity to redefine the profession’s contract with the state still
existed. I believe the profession had such an opportunity several years ago
when the crisis with demand/supply was becoming apparent. We did not take
advantage of the circumstances at the time – instead we ‘solved’ the
problem by quietly discharging hundreds of thousands of patients instead.
Are we going to do the same again?

Martin, the point you make is a valid one – what about the other high-risk
patients who are not diabetic – those who perhaps have equal or
greater ‘need’ of our care? There is no clear policy on who can access NHS
podiatry services – the DofH has consistently refused to specify which
patients are eligible for podiatry - and with the drive towards ‘localism’
through ‘shifting the balance of power’, access will be increasingly
dependent on the ability of local NHS trusts to finance the service
expansion in line with patient demand. What are the chances of that
happening in the present climate?

Rather than applying management initiatives to restrict access and reduce
the level of podiatry provision, shouldn’t we be considering methods of
expanding capacity and improving access for all those in need? I hate to
keep banging the drum again, but I believe were going in completely in the
wrong direction.

Best wishes

Mark Russell
<<I thought you wrote 3 months ago you were leaving podiatry. Have you
decided to stay?>>

Only for a very limited time!

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