David Wylie considers the challenges facing podiatrists in the UK.
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 35 years, led the profession forward educationally, clinically and professionally. It is a journey every bit as radical as the social revolution that took place within the wider culture across the UK over this generation.
Education has 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.
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.
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. 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, and yet many podiatrists with the ability to administer LA limit its application to digital blocks for nails surgery.
The profession cannot allow this to happen to independent prescribing, since the impact of Podiatry’s contribution to the wider health system will always be limited. 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.
Gen 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.
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 framework and governance for associate practitioners, particularly in relation to the removal of keratoses with a sharp instrument.
Gen Y Podiatrists have been handed a Podiatric legacy that their ‘baby-boomer’ predecessors gave their professional lives to secure. Much has been achieved.
However, strong and transparent transformational leadership is required in order to improve succession planning for future leaders within the profession. Leaders who will define the future of the profession, in the words of Michael West, by ‘doing what is difficult, rather than simply manage 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.
David A Wylie
Dean of the Directorate of Public Sector Management
Society of Chiropodists and Podiatrists
Fellow of the Faculty of Podiatric Medicine
Royal College of Surgeons and Physicians (Glasgow)