The Royal College of Podiatry is the professional body and trade union for podiatrists in the UK. The College represents qualified, regulated podiatrists across the UK and supports them to deliver high-quality foot and lower limb care, and to continue to develop their skills, both within the NHS and independent practice.
Prevention is a key focus for the podiatry profession. This emphasis enables podiatrists to provide patients with early interventions, enabling preventative care and treatment, keeping individuals independent, mobile and active. Effective prevention and early intervention may avoid people needing acute care and importantly ward space. Ultimately these types of preventative interventions increase the health and well-being of our population while reducing health spend in the medium and long term.
Currently strained NHS resources in Scotland are directed to immediate issues, acute care, seeking to address the crises of the day. Many of the crises faced are related to workforce issues, affecting all health and social care professions. While each profession’s workforce crisis differ in their appearance, the result is the same – there are not enough staff to meet demand in the current structure.
While there is no magic money tree, there is also, no magic workforce tree and working smarter should form part of NHS reform. Smarter, does not mean harder. We have heard suggestions of 7-day weeks for clinics, but what we have not seen is any suggestion of spreading workloads, where advanced practitioner’s hold the appropriate skills. Many of the smaller professions are not applying their maximal skillset due to existing structures of care. Utilising appropriately these full skillsets will allow for reduced pressure on other clinical staff and hospital beds in spite of ever-increasing demands on our health service.
Podiatric Surgery clinics provide a service example of how this can work in practice to the benefit of patients, staff and budgets. Changing service delivery from inpatient orthopaedic led foot surgery services to podiatric day case surgery within community hospital settings, has produced substantial improvements – reduced impatient admissions, increased bed allocations for other services and leaving this elective surgery unaffected by trauma emergencies. Furthermore, the majority of the surgeries will utilise regional anaesthetic techniques rather than general anaesthetics, reducing the need for anaesthetist involvement.
Furthermore, preventative care reduces demands and costs. In patients with diabetes, podiatrists actively reduce the risk of amputation through early intervention and prevention of associated diabetic foot ulcers. The cost of lower limb amputation is high not only for patients; amputation has a 5-year mortality rate of over 60%[1], but also for the health service. It is estimated that managing the diabetic foot, coupled with the cost of associated lower limb amputations, costs the NHS up to £1 billion annually[2].
While using the full skillset of our NHS podiatrists, it cannot be forgotten that another podiatry workforce exists, those in independent practice. Trained and regulated in an identical way to their NHS colleagues, private practitioners offer similar prevention and early intervention services. Over a number of years, due to NHS Podiatry services having to increase their access criteria, independent practitioners have become the sole option for some aspects of preventative podiatry care.
The COVID pandemic saw the NHS reduce and refocus services to allow for the substantial pressures bought on by the global virus. This saw NHS podiatrists only reviewing high risk patients, such as wounds, leaving individuals to self-care or seek alternative care. Since NHS podiatry services have opened up, they are seeing higher acuity and huge demand, leaving many services mainly seeing high risk patients.
While the previous paragraph suggests that reducing NHS podiatry services has a detrimental impact on patients, and in the longer-term healthcare budgets, it must be noted that this was done without notice and preparation. Further experiences suggest that educating patients and carers can improve self-care and, help ensure good foot and lower limb health.
CPR for feet[3] was developed by podiatrists for use by all health and social care staff. The resource educates staff on the overall need for appropriate foot checks, appropriate protection and appropriate referral. This wide-ranging workforce are now able to identify issues at an earlier stage and initiate appropriate referrals for early intervention, benefitting both the patients and our health services.
Overall, enabling the future sustainability of NHS Scotland will require a change in focus from reactive to preventative healthcare. This will necessitate open communication and substantial reallocation of resources. To target the limited resources in the best possible way for the future benefit of the population and the NHS, a full review of all existing health and care pathways must take place. Engagement with the entire health and social care workforce will identify opportunities to provide healthcare differently, and more effectively.
One final point remains, all those involved need to be open to fundamental change in the way services are delivered and trust the different experts in their fields.
Louise Slorance is Policy & Public Affairs Officer (Scotland) at the Royal College of Podiatry
[1] https://www.jfas.org/article/S1067-2516(20)30333-1/fulltext
[2] https://resolution.nhs.uk/2022/06/13/diabetes-and-lower-limb-complications-a-thematic-review-of-clinical-negligence-claims/
[3] https://learn.nes.nhs.scot/6801
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