Allied Health Professions Day – What does the future hold for podiatrists?

14 Oct 2020

Today marks Allied Health Professions (AHPs) day, which gives us all an opportunity to recognise and highlight the contributions of AHPs.

Podiatry is one of the fourteen professions within the AHPs.

In this guest blog, David Wylie, Vice Dean of the Faculty of Podiatric Medicine and Director of Professional Education reflects on the challenges and opportunities ahead for podiatry and its professional relationships.

I qualified as a Podiatrist in 1982. That places me at the tail end of the ‘baby-boomer’ generation of practitioners who were the first to qualify with local anaesthesia as part of their pre-registration training.

We were also the first generation to benefit from the introduction of more formalised postgraduate learning. Those from this generation who elected to engage with these opportunities have, for the last 38 years, led the profession forward educationally, clinically and professionally. It is a professional journey every bit as radical as the social revolution that took place within the wider culture across the UK over this generation.

Education has, of course, led the way. There is no doubt that the drive toward higher academic rigour has revolutionised undergraduate podiatry training and placed the emphasis far more firmly on a more robust understanding of biomedical sciences, pharmacology and functional anatomy and biomechanics, accompanied by the ability to critically evaluate evidence.

Graduate Podiatrists are now able not only to administer local anaesthetics, but to supply antibiotics, analgesics and other medicines directly to patients using their prescription only medicines qualification. This places them ahead of the AHP curve in being ‘prescriber ready’ and offers opportunities to provide leadership within the AHP professions in this important area. 

The future impact of postgraduate educational opportunities at Masters and Doctoral levels cannot be underestimated. Continuing education challenges individuals to question and critically evaluate clinical, professional and organisational practices at all levels.

Role development has followed. The desire within an aspirational workforce for extended skills to support medical and surgical redesign in key clinical areas has delivered senior clinical posts in medical and surgical related specialisms, particularly diabetes, rheumatology and orthopaedics, but further impact requires to be realised in dermatology, tissue viability and vascular services.

As ‘baby-boomer’ minds begin to wander towards retirement, the profession faces a new challenge. A challenge that will be most acutely felt by Gen Y-ers; those born between the early 1980s through to the early 2000s; particularly those between their mid-twenties and mid-thirties who may have to continue working well into their 60s due to the pension reforms and the demographic dystopia they have inherited.

Put simply, the challenge is this: what will Gen Y make of the legacy handed down by the ‘baby boomers’? The answer to this question will determine the nature of Podiatry over the next 35 years.

Look with me briefly into that crystal ball to identify a few of these profession-defining issues.

Managerially and organisationally, radical changes are needed in the way Podiatry is delivered across the traditional divide between primary care, community services, and acute hospitals. This dichotomy, largely unaltered since the birth of the NHS, is a barrier to the personalised and integrated foot services patients need. Those working in the NHS will increasingly need to dissolve these traditional boundaries.

Long-term conditions are now the central focus of the NHS; caring for these needs requires a partnership with patients over the long term rather than providing single, disconnected ‘episodes’ of care. The COVID-19 crisis created a ‘forced redesign’ of many health care delivery models and podiatry has been quick to seize opportunities in virtual triage and video consultations. Consolidating these into evidence based care pathways will help challenge the paternalistic health care zeitgeist by supporting individuals in self care to a level not previously deemed possible. 

Gen Y Podiatrists will need to manage networks of care integrated around patients – not just organise podiatry services.

Gen Y podiatrists will also need to learn much faster from the best examples. Increasingly, these will emerge not just from within the UK but internationally. They will also, as they introduce them, need to evaluate new care models to establish which produce the best experience for patients and the best value for money.

One of the biggest challenges faced by Gen Y Podiatrists is to maximise the utilisation of independent prescribing. This is an even greater game-changer than that of local anaesthetics in the late 1970s, yet many podiatrists with the ability to administer local anesthetic limit its application to digital blocks for nail surgery.

The podiatry profession cannot allow this to happen to independent prescribing. If it does it will severely curtail the impact of Podiatry’s contribution to the wider health system and – importantly – maximising its contribution in ameliorating the workforce crisis facing the medical profession as demand for expertise in foot, ankle and lower limb conditions both medically and surgically continue to rise. 

Regulatory changes in 2019 mean that experienced non-medical prescribers of any professional background can become responsible, as Designated Prescribing Practitioners (DPPs), for a trainee prescriber’s period of learning in practice in a similar way to that traditionally provided by Designated Medical Practitioners (DMPs). There is a need to support these DPPs as they assume this important training role, and Podiatrists are well placed to be in the vanguard of this future-facing initiative.

Currently around 3% of Podiatrists are independent prescribers, compared to 1.8% of physiotherapists – however this falls some way short of prescribing nurses at 6% and pharmacists at around 14%. In order to achieve the professional potential of podiatrists, ongoing educational opportunity and clinical support for prescribers is essential. 

Podiatrists need to engage fully with national and local policy makers in order to reduce secondary care interventions by maximising the podiatric contribution for patients with multiple co-morbidities and poly-pharmaceutical management in the community. They are well placed to support the management of cardiovascular disease, given the early manifestations of this in the foot and lower limb. Once again, education is central to practice development, and RCPSG is well placed to deliver. 

Genneration Y Podiatrists also require to contribute to public health by developing the knowledge and skills necessary to fully participate in the delivery of general health interventions relating to physical activity, smoking, obesity and other public health initiatives at local and national levels. Counselling and negotiating skills also require to be developed and recognised as being of equal importance to technical and academic skills in both undergraduate and post graduate educational programmes and competency sets. 

Finally, Gen Y Podiatrists face the challenge of advising local and national policy makers with reference to workforce planning activities, not only with reference to developing extended roles for podiatrists, but also in influencing the scope of practice, competency frameworks and governance for associate practitioners, particularly in relation to the removal of keratoses with a sharp instrument, and embracing them within the profession and the NHS. 

Gen Y Podiatrists have been handed a Podiatric legacy that their ‘baby-boomer’ predecessors gave their professional lives to secure. Much has been accomplished. 

The establishment of the Faculty of Podiatric Medicine within the Royal College of Physicians and Surgeons of Glasgow has been a landmark achievement in that educational journey, providing educational rigour in relevant medical and surgical specialties as well as opportunities for cross faculty professional learning. 

However, strong and transparent transformational leadership is required in order to improve succession planning for future leaders within podiatry. Leaders who will define the future of the profession, in the words of Michael West, by ‘doing what is difficult, rather than simply managing the inevitable.’

The challenge facing Generation Y Podiatrists is already upon us. For the sake of the next generation, and beyond, failure now is not an option.