Workforce/HR/Employment law Primary Care Networks

The role of a podiatrist within Primary Care Networks

GP partner Dr Pipin Singh explains the work podiatrists can do in Primary Care Network teams and what to consider when recruiting to the role

As part of the latest plans to expand the workforce in primary care, podiatrists have been identified as one of the professions that qualify for the Additional Roles Reimbursement Scheme (ARRS) funding through Primary Care Networks (PCNs).

Podiatrists are experts in the lower limb, foot and ankle including the biomechanics of the lower limb.

Usually for these conditions GPs have a few options for referral:

Chiropodist (NHS or private)
Podiatrist via locally commissioned musculoskeletal service
Biomechanics specialist via locally commissioned musculoskeletal service
Direct to foot and ankle surgeon (orthopaedic team)
Consultant podiatry surgeon (non-medical doctor)

NHS England is now promoting recruitment of podiatrists within Networks to help provide more responsive service in the community. As with other extended health professional roles funded by the ARRS, NHS England has indicated there is a large enough podiatry workforce to recruit from without destabilising hospital services and the flow between primary care and secondary care.

What can podiatrists do in general practice?

Their role in general practice will involve diagnosing, treating and managing complex foot problems that arise as a result of musculoskeletal, inflammatory, diabetic or vascular disease. There could also be a role for them in minor surgery – for example, to manage ingrowing great toe nails and verrucas.

The podiatrist will also be expected to prescribe, produce and fit orthotics and additional aids and appliances as appropriate.

They should be able to run a podiatry service, which includes keeping control of stock and equipment, plus ensuring a knowledge of when to involve secondary care. The podiatrist should be able to communicate effectively with other allied health care colleagues and feedback where appropriate.

The podiatrist should also be able to provide education to colleagues and take part in any quality improvement productivity (QIP) work that may be needed – such as audit, significant events and incident reporting.

Annex B of the Network DES service specification sets out the minimum requirements of the podiatrist role where employed by PCNs under the ARRS.

How would they be integrated into the team?

The podiatrist should have a designated person at the PCN to feed back any problems to and provide support, ensuring a smooth running of the service.

Within the practice there should also be a designated member or members of the team to act as a link for the podiatrist to liaise with. This is likely to involve clinical and non-clinical team members. A clinical issue would likely be directed to one of the GP partners, while administrative issues would go to a senior member of the practice administrative team – for example, the practice manager.

The podiatrist should also be invited to the weekly MDT meeting, to discuss any complex cases. This also provides an opportunity for the practice team to share any cases or refer cases that may require podiatry input, such as foot ulceration or a complex diabetic foot problem that the district nurses may be struggling to manage.

All practice team members should be briefed on the role of the podiatrist, the conditions that they can assess and how to book the patients into the respective clinics.

The podiatrist should be informed how to feed back the outcome of assessments to the referring clinicians as appropriate to ensure a smooth and safe patient journey.

How can the role benefit your GP practice and PCN?

Potential benefits from having access to a podiatrist in primary care include:

Reduced waiting times
Free up GP appointments, where patients can be directed to the podiatrist by trained reception staff or even self-referral.
Better communication with primary care – assessments can be directly documented within notes, rather than waiting potentially weeks for a clinic letter
Improved patient satisfaction related to shorter waiting times and reduced likelihood of hospital visit
Reduced costs from avoiding secondary care referrals
Continuity of care if one podiatrist is employed long term within a practice
continuity leads to reduced referrals better patient clinician relationship, improved efficiency with NHS resources
Improved education for primary care physicians
Overall improved patient journey

According to the role outlined under the ARRS, podiatrists would not be involved with routine diabetic foot care, so it is unlikely that practices will directly benefit from, for example, improved diabetic foot care in QOF.

However, the potential positive outcomes described above through good clinical care are likely to have knock-on benefis.

Podiatrists may also be able to play a role in certain long term conditions, such as arthritis (both osteo and rheumatoid) to help reduce progression of disease, reduce the risk of falls, reduce pain and provide advice on appropriate footwear – all improving quality of life.

They can also contribute to health promotion with respect to weight reduction and smoking cessation, which are related to the more common foot problems seen in primary care.

Their involvement in the management of common foot problems such as heel pain, metatarsalgia, hallux valgus, hallux rigidus, hammer toes etc, will also have a huge impact on patients returning to work much more quickly and again improving quality of life. This has wider economic benefits to local areas.

My own experience has been that it leads in particular to more efficient referral pathways in house, with minimal waits and patients being seen quickly with positive outcomes.

The beauty of being able to refer back to the same person if a problem arises – ie, continuity – is also an extremely positive factor.

Any drawbacks?

These could include practical issues such as room space within member GP practices, especially in the context of an ever expanding primary care workforce.

The pace of expansion has accelerated in the last few years but undoubtedly this has not always been matched by increased primary care clinic space.

Podiatrists may also miss their support in secondary care from other podiatry colleagues.

However, if the service is mapped out carefully then all the necessary space, equipment and skill should be made available.

Appropriate clinical governance will need to be put in place, for example, audit, QIP to ensure that the service works safely, efficiently and effectively. This could be in the form of both qualitative and quantitative research.

Salaries and qualifications

The PCN should ensure that the podiatrist has a BSc or pre-reg MSc in podiatry within an approved training programme by the College of Podiatry. They should also be a registered member of the health and care professionals council.

Podiatrist salaries sit on band 7 of the NHS Agenda for Change scale (£38,890-£44,503 outside London, £40,681-£51,393 in London). The maximum amount that can be claimed to reimburse the costs of employing a podiatrist under the ARRS would be £53,724, as outlined in Part 8 of the NHS England Network Contract DES guidance.

Dr Pipin Singh is a GP partner and trainer in Wallsend, Tyne and Wear