Where does first contact podiatry fit into primary care?
The initial FCP appointment does not replace community podiatry services but aims to triage and expedite treatment, and patient management to support onward referral to other services. This can include other specialist departments: examples include podiatric and orthopaedic surgery, rheumatology, vascular, diabetes, MSK, community podiatry, mental health, and social care.
Here Dr Lindsey Cherry and Dr Clare Pollack, GP supervisor, discuss how first contact podiatry fits into primary care and the evolution of the role since Lindsey began her training in primary care.
Example employment models
Models of employing FCP
- Secondment from NHS Trust to the primary care network
Where the staff are seconded to the primary care network (PCN) for an agreed period, but employment remains with the NHS trust. - Direct employment by the PCN
The PCN directly employs the team utilising the Additional Roles Reimbursement Scheme (ARRS) funding to fund the role. - Direct employment by GP practice on behalf of PCN
GP practice utilises the ARRS funding and directly employs the podiatrist. - Host employment model (non-GP host employment model)
An example of this is where the podiatrist remains employed by the NHS trust, retaining the benefits and support of the NHS trust and the podiatrist is contracted to the PCN utilising the ARRS funding. This from the stakeholder engagement of the workforce reform project was the most successful model of employing and retaining the FCP. - Private procurement
Establishment of private companies to provide first contact services to the PCN.
What to have in place for employing/sub-contracting first contact podiatrist into the PCN
Checklist
- Estates and facilities, rooms, and facilities
- Triaging plan for reception staff to populate FCP lists with lower limb presentations
- Equivalent referral rights
- Access to imaging, bloods requesting and all systems within the practice for the FCP podiatrist
- Supervision access options and protected time for the FCP
- A clear plan for clinical supervision, training and assigning of clinical supervisors: Consider service swap/training/provision and outline of additional benefits of target/bonuses
- Utilising the FCP podiatrist for the intended purpose
- Integration.
Supervision requirements for first contact practitioners
The roadmap states Advanced Practitioner, Consultant Practitioner or a GP who has completed the two-day primary care supervisor training can be the lead roadmap supervisor.- Further information is available here about how to become a roadmap supervisor and the course available.
- Minimum standards for supervision are explained here.
70 hours of supervision is required for the roadmap and this is overseen by the lead roadmap supervisor but can be collated amongst a variety of supervisors.
Funding opportunities and supervision
Current FCPs in the UK provided feedback about their supervision needs and challenges during the RCPod HEE workforce education reform project. Recommendations were published that GP supervision needs to be accounted for and funded in addition to the ARRS as in some instances it was not. In this scenario in the absence of ARRS funding to support the supervision an emphasis on service exchanges and the value of in-house training the FCP can provide to the PCN was recommended.
In an article published in August 2022 Clinical director and GP partner Dr Joe Robson shares his experience of working alongside first contact practitioner podiatrist Richard Keating, a year into the role. He discusses the recruitment drive to employ an MSK team of both physiotherapists and podiatrists, how well the role works, that Richard is mostly an autonomous practitioner, and what benefits it has brought the primary care team, service and patients. Read more here.
Why every primary care network should have a first contact podiatrist
The integration of additional roles (physiotherapists, paramedics, occupational therapists, dieticians, podiatrists) into primary care networks was part of the government's manifesto to improve access to general practice. This was supported by the Additional Roles Reimbursement Scheme (AARS), available for Band 7 FCPs utilised by GPs within primary care networks from 2019.
There are now 59 FCPs across the UK utilised by this scheme. It was previously identified by The Kings Fund (2022) that the low initial uptake of the ARRS roles was due to:
‘a lack of shared understanding about the purpose or potential contribution of the roles, combined with an overall ambiguity about what multidisciplinary working would mean for GPs’ and they recommended a successful implementation of the scheme requires extensive cultural, organisational and leadership development skills that are not easily accessible to PCNs. (The King’s Fund (4 March 2022))
See also:
- 60 seconds with Sam Bell
This first contact practitioner, based in Blackpool, talks about her emerging role, professional challenges and proudest achievements. The Podiatrist, September/October 2022. P 50