Section 1 - Purpose and context

Purpose

This document is designed to delineate the requisite standards for those working as health care professionals/practitioners within the arena of foot health below the level of HCPC registered podiatrists. It is understood that within this space may operate individuals and organisations who provide services that have some overlap but are primarily cosmetic in nature. This document is not designed to address the educational standards within cosmetic foot health and the distinction between them is taken from the following statement made by The World Health Organization.

“Health care professionals maintain health in humans through the application of the principles and procedures of evidence-based medicine and caring. Health care professionals study, diagnose, treat and prevent human illness, injury and other physical and mental impairments in accordance with the needs of the populations they serve. They advise on or apply preventive and curative measures, and promote health with the ultimate goal of meeting the health needs and expectations of individuals and populations, and improving population health outcomes. They also conduct research and improve or develop concepts, theories and operational methods to advance evidence-based health care. Their duties may include the supervision of other health workers”.

World Health Organization, 2013. Transforming and scaling up health care professionals’ education and training: World Health Organization guidelines 2013.

In order to facilitate greater skill mix within the NHS footcare workforce, Health Education England (HEE) has commissioned work to develop threshold clinical and education standards for the newly qualified clinical foot health workforce including FHPs, FCAs and APs in podiatry and other support worker roles that contribute to the foot health workforce; this work does not include registered podiatrists as their standards are defined by the Health and Care Professions Council (HCPC). Later work will further explore articulation with existing pre-registration training routes for podiatrists.

The clinical and education standards provide a clear understanding of the footcare treatments these practitioners are trained to provide upon qualification. The standards are threshold and set out what a newly qualified practitioner can safely provide for their patients in the NHS. It is recognised that as individual practitioners gain experience and undertake additional qualifications, their role boundaries and scope of practice may increase, and the skills set out in this document are threshold.

The clinical standards have been developed using the Institute for Apprenticeships and Technical Education framework and the Podiatrist Standard. They have been informed by relevant National Occupational Standards. The educational standards have been informed by the Regulated Qualifications Framework (RQF) and the Framework for Higher Education Qualifications (FHEQ).

When implementing these standards, a clear process of recognition of standards achieved through their training will need to be developed for existing FHPs. Additionally, there are a number of FHP training providers and care will need to be taken to ensure that new learners are always clear about the standards associated with their chosen programme of study. This will ensure learners are always able to make a fully informed decision about which provider they choose to study with.

Context: Foot Health Workforce

NHS support workers such as FCAs, podiatry assistants and Senior Healthcare Support Workers (SHCSWs) are employed in the NHS working under the supervision of a regulated healthcare practitioner and are educated to Level 3 (A level equivalent). 

FHPs can be educated to academic level 3 or level 4 (recognised as completing the equivalent of half of the first year of an undergraduate programme). FHP training enables practitioners to work on a wide range of less complex and less invasive procedures than podiatrists, in addition to observing patients’ general foot health; some training programmes have not been accredited to a particular educational level. Some of the FHP training programmes require no practical training, others require two weeks of assessed practical training. In addition, some FHPs are registered on an accredited register recognised by the Professional Standards Authority, but this is not a mandatory requirement to treat patients. Currently, FHPs are not employed by the NHS but work in independent practice, often single-handed and many work in domiciliary settings.

To increase the skill mix of the foot health workforce in the NHS, academic level 5 foundation degree programmes for APs in podiatry have been introduced. These practitioners undertake a two-year full-time foundation degree that can articulate with BSc (Hons) Podiatry degrees that lead to HCPC registration. Assistant practitioners in podiatry provide a wide range of treatments as set out in the standards set out below. In addition, in the NHS assistant practitioners undertake wound re-dressings but not the management of patients with severe systemic disease under the delegation of a registered podiatrist and according to local protocols. These treatments can only be provided in clinical contexts where support can be immediately provided by a registered podiatrist and therefore, they have not been specified within these standards.

Academic level and NHS AfC banding: The standards have been written to reflect the academic level of educational attainment required to carry out the activity described in the Standards at levels 3, 4 and 5. In England, academic levels range from level 1 – equivalent to GCSE – to level 8 – doctoral-level study1. The agenda for change (AfC) pay bands start at band 1 and rise to band 9. There is unequal alignment between academic levels and AfC bands. The table on the right provides examples of AfC role banding and examples of the level and route that may have been taken to complete the qualification. It is particularly important to recognise that a level 5 qualified Assistant Practitioner has no equivalence to a Band 5 Podiatrist.

Podiatrists are educated to academic Level 6 (BSc) and some undertake pre-registration masters at Level 7, both include a minimum of 1000 hours of clinical practice. On qualification, podiatrists are employed at typically Band 5 on the AfC banding. Podiatrists are healthcare professionals who have been trained to diagnose and treat complex conditions of the feet and lower limbs. They also prevent and correct deformity, keep people mobile and active, relieve pain and treat infections. Podiatrists can diagnose conditions and administer and supply and prescribe medication; they work in the NHS and in independent practice. The HCPC requires them to engage in processes that check on their CPD and professional development as a condition for their continued registration. Since 2002 newly qualified podiatrists are qualified in prescription-only medicines – Administration (POM-A) and prescription-only medicines - Sale/Supply (POM-S). Many go on to gain post-graduate qualifications in Supplementary Prescribing (SP) and Independent Prescribing (IP). In 2019 the HCPC introduced separate annotation for podiatric surgeons to provide appropriate regulation for their defined and increased scope of practice.

The standards use the phrase ‘podiatrist/registered health care professional’. This recognises the range of different ways in which the NHS delivers foot health treatments. In many cases, services will be podiatrist-led, with the podiatrist providing supervision (direct or indirect) of unregulated support staff and holding overall responsibility for a patient’s treatment. In other services which deliver foot health alongside other treatments, such as those led by medical consultants, this role may be carried out by another appropriately qualified registered healthcare professional - for example, a medical practitioner or physiotherapist. However, the support worker should be responsible to a podiatrist within a wider podiatry service for their clinical and professional support.