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Foot health and primary care editorial

Foot health and primary care

To raise awareness of podiatry and its role in primary care during Foot Health month, Lawrence Ambrose, Head of Policy, and James Coughtrey, Head of Education and Professional Development, from the College of Podiatry, wrote an editorial for the Journal of General Practice Nursing.

This article was first published as a guest editorial in the Journal of General Practice Nursing. Reproduced here with permission.


April is ‘foot health month’ — an annual series of events across the UK that aim to promote better awareness of health issues relating to the foot, improve people’s self-care and inform the public about how to access services to treat problems and avoid serious complications with their feet. Foot health is a massive issue about which remarkably little is understood outside of medical circles. Polling data collected for last year’s event showed that foot pain is virtually endemic in the UK, at close to 60% of respondents, yet is mostly suffered in silence, with fewer than half of respondents seeking help. When treatment is sought, however, it is often from general practice.

For this reason, this year, the College of Podiatry is expanding its reach by seeking to engage with other healthcare professionals, such as general practice nurses (GPNs), as well as the public. As a college and national representative body, we engage with a range of professions and with different levels of government, but in 2019 we are also reaching out to general practice during ‘foot health month’. As part of the college’s public engagement campaign, we have sent information leaflets to GP practices around the UK, along with letters to GPs, GPNs and practice managers. You may have received one.

The context for all this, of course, is the new GP contract in England, which identifies the need for greater allied health professions’ (AHPs) involvement in primary care. We believe that there is a huge amount that podiatrists can do to help lighten the burden on practices. According to analysis of data from the Clinical Practice Research Datalink, 3% of GP encounters in the four years from 2010–13 were for foot pain, and during the same period, there were 567,095 recorded encounters for foot or ankle pain from 346,067 patients. Assigning first point of contact roles to podiatrists in this context could make a huge difference — not least because a large percentage of podiatrists are also non-medical prescribers. Podiatrists’ systemic health training and specialisms in areas such as the diabetic foot and musculoskeletal (MSK) conditions mean that they can provide a wider range of clinical competencies than people are aware of.

The NHS Long Term Plan (NHS England, 2019) prioritises the provision of care in community settings — arguably to relieve some of the strain faced by hospitals (although presumably adding to the demands on general practice). The plan also highlights the importance of prevention, which if successful will alleviate pressure across the system. In a modest way, the public awareness elements of the ‘foot health month’ campaign can support prevention by sharing useful tips and foot health advice, while also highlighting the excellent work that many NHS and independent podiatrists are doing to support people. But, this alone will not ensure that the best services are available for patients close to their homes. Awareness may increase, but provision of the service within the NHS is key.

This is not just an English issue. Scotland and Wales are both moving towards similar models of supporting primary care.

The Scottish Government outlined its strategy for primary care in their NHS Health and Social Care Workforce Plan (part 3). This plan clearly expressed the importance of AHPs in transforming the healthcare system towards focusing on prevention and early intervention. This chimes with the new GP contract (2018), which outlined the importance of GPs working with AHPs in primary care to deliver improved patient outcomes and healthcare services closer to patients’ homes.

Since the introduction of the workforce plan and the new GP contract, NHS boards and integrated joint boards have made some progress in realising these new ambitions. In some areas, podiatrists are working to relieve the pressure on vascular teams. Through structured exercise programmes, they increase pain-free walking, and by integrating patients into established community-based cardiac rehabilitation programmes, they improve quality of life. This is freeing up capacity in secondary care and improving outcomes for patients. Progress remains slow in fully realising the potential of AHPs to transform primary care, however. The Scottish government has identified podiatrists as key specialists for care of the foot and lower limb, and our aim is that podiatrists will ultimately be working as part of the multidisciplinary team within GP clusters, which will free up GP capacity and allow patients to see the right professional, first time.

The Welsh government’s primary care strategy is to focus on early intervention and prevention. The importance of this strategy is highlighted by population statistics showing that more and more people are living with multiple, complex long-term conditions, which require secondary care intervention.

The strategy in Wales similarly seeks to make use of AHPs’ skills, and there has been some increase in their delivering first point of contact services within primary and community care. In some Welsh NHS boards, self-referral routes have allowed people direct access to podiatry services, for example, through walk-in centres. However, this is not universal and podiatric care provision for Welsh patients is patchy across board areas.

Clearly, there is still a long way to go to get to the point where AHPs will take the strain that would be so welcomed by other struggling services, enabling all patients to be seen by the right professional at the right time. While we may have to wait for services to realign fully, a shorter term remedy may be improved and standardised interprofessional links between primary care services and AHPs in community health services which can support their work.

Podiatrists across the UK, whether in the NHS or private practice, seek to work closely with general practitioners and surgeries. We refer and take referrals from our colleagues elsewhere in the health system on a daily basis. But, in some cases, this requires better mutual understanding and awareness. We hope our campaign plays a part in bringing other professions closer.