It is rare for something to come along that will have a profound effect on the way in which we all practice. Most advances are incremental, building on what has gone before, but this summer sees the launch of a document that I believe will have a revolutionary influence on the care of people with diabetes. Strong words, but they have substance behind them.
When I became involved in FDUK (Foot in Diabetes UK; then Podiatry in Diabetes UK), and joined the Editorial Board of The Diabetic Foot Journal, in the 1990s, a goal of mine – and of many others including, but not limited to, Neil Baker, Alistair McInnes and Louise Stuart – was to devise a set of standards that would define what it is that makes diabetes specialist podiatrists “special”.
The progress of this has been recorded in the pages of The Diabetic Foot Journal, so it is fitting that you have received the first copies of the realisation of part of that goal with the journal: the Podiatry Career and Competency Framework for Integrated Diabetic Foot Care – A User’s Guide. The framework covers all levels of competency in the care of the foot of the person with diabetes, from simple screening through to complex management of active ulceration.
The framework is the product of more than 5 years’ work undertaken by a number of dedicated individuals who are now known collectively as TRIEPodD UK (Training, Research and Integrated Education for Podiatry in Diabetes across the UK). Special mention must go to Joanne McCardle, who has driven the framework forward, ably supported by Duncan Stang and – in its earliest incarnations – Jodi Binning. Graham Leese has made two important contributions to the process of developing the framework: his excellent advice on the content, and funding from the Scottish Diabetes Group. I also did a few things to help along the way.
A number of groups and organisation are also deserving of recognition in the framework’s development and launch. In the early stages, Skills for Health were key partners in defining the competencies of clinicians operating in the top tier of specialist foot care teams. When it was decided that the framework should be rolled out to all levels of practice in diabetic foot care, Skills for Health’s “skills escalator” model was adapted to the task and they mapped their national occupational standards to the competencies.
The Society of Chiropodists and Podiatrists have had a major role in the preparation for the launch of the framework user’s guide, and will hopefully remain involved in supporting activities that unfold around it. FDUK have both endorsed the framework and provided important feedback. A number of industry sponsors (Algeos–Diaped, Coloplast, ConvaTec, Mölnlycke, Pfizer, Sanofi, Smith & Nephew) provided educational grants that made possible, in conjunction with The Diabetic Foot Journal team, the publication and distribution. The design of the copy provided here also owes a debt of gratitude to the nursing group TREND, as the excellent format of its competency framework was adapted to meet the needs of our version.
The document has been widely available for consultation. Following a Skills for Health-sponsored consultation day in 2009 (involving mainly Scottish managers, podiatrists, staff-side representatives and health education institutions), the document was made available for review on the internet and even has its own Facebook page! Joanne McCardle has presented at a number of local and national professional conferences on the framework, to audiences of managers, podiatrists, physicians and others – so many of you will already be familiar with the framework.
A number of health boards have begun using the framework with their staff to ensure it has consistency and validity. Their feedback indicates that it does.
While the podiatrists sit at the heart of the framework, other healthcare professionals (e.g. diabetes specialist nurses, orthotists, tissue viability nurses, healthcare technicians and so on) can apply aspects of the competencies to their practice – I think many junior doctors and new consultants could also use the document to achieve an appropriate level of competence for their practice.
Managers can benchmark services using the framework. In England, commissioners can use the framework to define a “competent provider”, and providers can use it to prove they are competent.
Hopefully, the framework will gain wide acceptance and use, and ultimately improve foot care for all people with diabetes, wherever they live in the UK and whatever their level of ulcer risk.
If I were a person with diabetes I would want to know that my health care provider had achieved the required level of competency to screen or treat my feet. Wouldn’t you?
To request additional copies of the Podiatry Career and Competency Framework for Integrated Diabetic Foot Care – A User’s Guide, please email: tdfj@sbcommunicationsgroup.com
