Background
Methods
Participants
Procedure
Results
Themes with key quote | Subthemes |
---|---|
Theme 1: Evolving Professional Culture
“Historically the commissioner’s never quite got around to finishing off writing the specification”
| AHPs understanding of Podiatry Commissioning Patients understanding of Podiatry |
Theme 2: ‘Condition vs Complaint’
“Is it about the patient who’s got diabetes or is it that they’ve got diabetic lower limb complications? Because the two are quite different.”
| Inequalities and eligibility Private sector versus NHS The current bandwagon Importance of Podiatry in Arthritis |
Theme 3: Transforming and Sustaining Podiatry
“We really need to go to the top and make podiatry the same as dental care, the same as eye care, the same as hearing, audiology, you know, we’re just off the radar.”
| Equipping Podiatrists Building Podiatry Proposals for future shape of Podiatry |
Theme 1: Evolving professional culture
“I know with my locality, the proposal that was sent by the CCG, it was decided that actually they lacked the understanding about podiatry. And so it was, we would buy our local level and then send back to them, because otherwise they didn’t quite comprehend what we did. And so we were able to divide it into our separate areas, like nail surgery, routine care, diabetes and then send it back to them so that they had more of an understanding of what we actually did. So that is a problem.” [Podiatrist: LB1]
“[HB1]: I think it’s still fairly common, from feedback from staff for …the start of the consultation with a new patient is actually getting them to understand why you want to know this.” You know, “what’s the medication got to do with you” et cetera. And that can actually take up some of the initial time that actually when explaining about why it’s important and actually you know “the feet are actually attached to the rest of your body”, that type of conversation.
[HG2]: That’s the “what’s that got to do with my feet?”
[HB1]: “Yes… a big sum of that time is actually about just starting to drill down and set the scene with the patient about what we’re trying to achieve. And then on to what they want to achieve. With a bit more understanding why we’re taking medical history and how it’s relevant to what’s happening in their feet.”
“We’ve lost a lot of that middle-management podiatry managers, we haven’t got anybody really fighting for our service at the moment. And just replying to the comment about NHS practitioners, I’ve never, in the whole time that I’ve practiced podiatry, ever seen such disillusionment. I think that everybody’s burnt out at work, I think that they’re being managed by people that don’t actually understand what’s happening.” [LG1]
Theme 2: ‘Condition vs Complaint’
“I’m really reluctant to do that because a) you’ve got people with multi-pathologies and b) is it about the patient who’s got diabetes or is it that they’ve got diabetic lower limb complications? Because the two are quite different. And you know again it’s about back to ‘we shouldn’t just be providing services to people with diabetes, it’s about services for people with lower limb complications’… back to what I said earlier about some services that have got severe restrictions, you know you could be a 27 year old with diabetes playing rugby but you could technically get service because you’ve got diabetes as opposed to actually having a need.” [HB1]
“They tend to put the commissioned service versus service level agreements. So, a lot of diabetes services are commissioned. So they ‘have’ to provide that service, so even though we, in the acute trust run, you know, quite a full rheumatology foot service, as soon as we’re a man down in diabetes, people get pulled from arthritis clinics, from rheumatology, to cover diabetes. And that is just based on, purely commissioned services versus service level agreements. We have a service level agreement to provide treatment for Rheumatology patients…” [HG1]
Theme 3: Transforming and sustaining podiatry
“It {resolving current constraints to podiatric access} is multifaceted; it is conversations with the commissioners about getting specification rights in the first place. It is discussions internally within health trusts around priorities and in some ways protecting what we’ve got …So the only way we can get around that {current constraints to podiatric access}, as I can see, is raising the profile of the profession. Raising the knowledge and raising the value of what we do and the cost efficiency of what we do.” [HB1]
“Podiatry provides an opportunity to pick up long term conditions in the early stages, so we know that mechanically, arthritis in the foot is the second most common site for presentation so podiatrists can be a guard responsible for aiding, for new diagnosis for a patient and show them …you know some red flags for podiatry to go in, because they’re likely to be the people who see the patients when they present with those conditions…“and I’ve got sore feet” you know… “and actually got sore hands too”. But then it’s about getting the training of podiatrists as well, you know, they not just looking at the feet. If there are some red flags that come up like they do with diabetes…what do they do in class about diagnosing arthritis? We all should be...we shouldn’t just be doing the squeeze test to feet, we should be doing the squeeze test on the hands.” [HG1]
“We need care pathways … You know, I think we need to subdivide all the things that podiatry offers and have a tick box assessment sheet that we can actually offer to somebody that’s diagnosed with arthritis and make sure that there is an effective referral system…for that patient to know what care is available and what they can expect if they're presenting with certain conditions.” [LG1]
“I think there certainly needs to be evidence to show that there should be a pathway whereby all these patients get some sort of similar assessment to identify what their initial needs are. And maybe on an annual basis or even a three-yearly basis or something, just to ensure that then things can be identified early on to start actually taking place, whether it be footwear, whether it be on education or whether they need to change medication or whatever else... It has to be put up the agenda.” [LG1]
“Pathways. Referral pathways, just like diabetes ...a bit more streamlined and a bit more easy to access.” [HG3]
“Make it more equal over the UK rather than just dependant on personality, and really that sums up what people said – going through more pathways, focussing on multidisciplinary teams.” [HG4]
“If we had a more multidisciplinary coordinated approach it would be better for the patient. I know that we have access to all these other professions but sometimes those communications, are blocked, not blocked but they are strained because you’ve got to write a letter, and that’s got to go off, then someone’s got to sign it and… whereas if you had a better, multidisciplinary approach like we do in terms of diabetes then those patients would go through proper routes a lot quicker” [HG1]
“And it's not just our profession that’ll link with them [public health], for the benefit of our patients because, you know, podiatry is one of them, you could have ENT in there, you could have physio in there, you’ve got other disciplines in there. They can all push this agenda forward and start saying, yes, here’s another one, it's a long-term condition that we need to be doing more for.” [LG1]
“Can I, can I bring something in there that’s quite important? We actually have a good NHS private practice working relationship in our area, the culture that we historically have had is that when a patient is deemed no longer eligible for treatment, that they’re discharged to the third sector. And you know, if you actually have a dentist, and the NHS can't meet your dental needs, you’re recommended that you can seek dentistry privately, the same with seeing an optician.” [LG1]