Why do I work part-time for the NHS?

Why do I only work part time in the NHS?

I have been asked this several times but I don’t think I had thought about this in any great detail nor had I reflected on my career choices until I came across this interesting patient a few weeks back who called me for an appointment. She gave me a clear, concise history of her foot problem, using medical terminology to describe how she had tried to help herself. But now, she feared that she needed a professional opinion to relieve her symptoms. I was genuinely intrigued by her. I explained that although I understood her issue, I would not be able to advise until I had seen her foot. She stated that, that seemed like a very logical idea and we arranged for an assessment appointment.

She arrived for her appointment and while I treated her foot problem with the appropriate advice; we got carried away with our conversations. As for those you know me, know that I can talk forever. She explained that she had read my professional biography statement from my website and she was fascinated as how I came to work in private practice.

Why did I chose Podiatry/ Chiropody?

The words chiropodist and podiatrist are, in the UK and some other countries, the same thing.

You can loosely breakdown the words into:

Pod = Feet

Chiro = hands on

Iatrist = Doctor

Stick those together in various combos and you get us working on feet. 

Chiropodist - hands on foot

I think I always knew I wanted to work in the healthcare profession. I just was not sure what that would be. I knew medicine was not for me. I don’t think I could cope with the long hours or years of studying nor did I feel that it was achievable. 

I was keen on Dentistry but did not quite get the grades for it so I decided to flip from teeth to feet (or from mouth to foot) – all the better for it as I don’t think in the long term, I would have been able to work in such small confined spaces like the mouth. Feet have a larger surface area!

I think I made the right decision for me because in Podiatry you get instant gratification – something like an ingrown toenail – just cutting the offending nail back and releasing the pus and pressure from the nail bed, and volia, just like magic-the patient feels instantaneous relief when they put their shoe back on and they feel like they are walking on air. 

Or you manage to treat that stubborn verruca which has been lingering for years and the patient (a young teenager) has been extremely complaint with the treatment plan. Or you give a heel lift to someone who wonders why they keep tripping on the kerb since their hip replacement.

My career pathway

Since I qualified some 20 plus years ago, I have mainly worked in the National Health Services (NHS), either full time if possible, or part-time when studying for my Masters. 

Why did I start my career in the NHS, you may ask?

To me it seemed like the obvious choice, I was a new graduate who needed to experience all aspects of Podiatry and I wanted to also learn how Health Services functioned. And where better to get this experience, than to work for one of the largest organisations in the UK. 

I don’t even think I had thought of private practice. In fact private practice was not even on the periphery for me, not even, as a long term plan.

Another important reason was and still is today, is that I have simply been in awe of the NHS ever since I first arrived in the country as a teenager. 

In Kenya, if you needed a GP in Kenya, one always had to pay prior to the appointment, unless the GP had been retained in an informal agreement and one had an arrangement to clear the bill at the end of each month .

The reason being that in Kenya, the healthcare facilities are either public, private, faith based, or Non- Government Organisations. While some public healthcare facilities are well equipped in major cities, this is not my case in my small town. In my town, they were mainly underdeveloped, understaffed, poorly equipped and lacking supplies. 

In the back of mind, this is still a worry for me as my elderly mother resides back home. Even to this day, most people will travel to the city or neighbouring countries where the medicine is much more advanced but that is, if you can afford this. So to come into this country and to find that the healthcare is much more advanced as well as pioneering and a system that treats everyone equally in a local hospital, is aspiring and I wanted to play my part in this organisation. 

As mentioned in my previous blogs, I started off working part-time while pursuing my Masters. It was the perfect job to start my working life as a new graduate. I worked Monday-Friday but only in the mornings and had the afternoon to study for my course. 

The fact that it was in a lovely area of London where I could wander off for a shopping trip was an added bonus. This only, lasted six months before the Trust advertised for a permanent full time position. Unfortunately, I was not an ideal candidate as I needed one afternoon a week for studying which they did not allow. That was a shame! During that time, flexible working was not an option. 

I then locumed around various boroughs’ in London. I thoroughly enjoyed this as there was this adrenaline rush to go off one place on one day and completely different on another day but to also familiarise yourself with a completely new room to work in, how to sterilise the instruments and how to write the notes according to that Trust’s policy, and to follow protocol especially if you needed antibiotics for patients and then arrange a follow up appointment.

I was simply enamoured by all of this. As a locum, you had to able to think on your feet. Some cases were simple and others a little more complex. I am sure I annoyed quite a few of the managers as I always wanted perfection but this is not always possible.

The best bit was, as a locum, you got paid a little bit extra and that certainly put a spring in my step.

Unfortunately due to family circumstances, I had to travel back to Kenya for a few years. I did try and come back annually and kept my locum work as much as possible to maintain my skills.

Once I did return back to the UK, I started working in another London Trust. Unfortunately I did not feel confident to apply at a higher banding as I did not think I had the experience but I was content at my job. I started part-time, only to familiarise myself with all the changes that had occurred over the years I was not in practice. 

During this time, I noticed that things in the NHS had changed, budgets had been scaled down and the NHS had started to become overwhelmed with the amount of people using the podiatry services. For example, before I went to Kenya, Podiatry had been offered to all patients over the age of 65, now it was only offered to patients at risk or high risk. This meant when I started in mid noughties, we had to carry out a tough exercise to reduce our existing case load. This was one of first and toughest challenges that I had experienced within the NHS practice. It was nearly impossible to discharge patients who were overall healthy, had no high risk medical conditions but found it difficult to cut their nails or manage their corns or callus. They had been patients for nearly 15 years, now, in their mid to late 70s and here I was telling them that they had to manage by themselves. 

There was a lot of backlash from this, and it was rather unpleasant. I was a front line member of staff being accused of bullying patients. I was fairly distraught. It is all well and good that managers or ‘powers that be’ decide this but to actually carry this out physically is completely different matter.

I also realised that many of my peers were running the podiatry departments or had specialised in different areas of podiatry such as long term conditions, nail surgery, diabetes or biomechanics. This made me think that maybe I needed to evolve too, not because of peer pressure but more to increase my skill set, to make me an invaluable part of the team. I needed to think about a speciality too. But what could I do? I had to wrestle with questions such as, could I study any further after a long break from studying? 

I had a deep think and the only think that tickled my fancy was Biomechanics. But I had not done much of it in college and I was not even sure where to start? In fact in college, Biomechanics scared me – I did not realise understand forces, loads or pressures on the foot and the body.

What is Biomechanics?

Biomechanics is the science of movement of a living body, including how muscles, bones, tendons, and ligaments work together to produce movement but focussing mainly on the mechanics of movement. 

This kind of ties in with my Masters in Sports sciences so I felt drawn towards it because Biomechanics in sport is concerned with the analysis of the mechanics of human movement in order to minimise the risk of injury and improve sports performance. I have always been passionate about sport but whilst growing up in Kenya, this was never really offered as an option to girls.

I was lucky enough that I had good support from my manager who suggested we try baby steps. She suggested that I try and set up a Heel pain clinic in the department. She sent me to her previous Trust where they had set one up successfully. This went well and I managed to set one up in my current Trust. I tried to attend as many courses as I could and if the cost of it was too high, my manager would support me further with either some allowance towards it or time off. I was grateful.

I set up my heel pain clinic. I even managed to audit the services to show its success rates.

I was content working within the Trust. I had managed to achieve more than I had planned too and to be honest I never thought I would leave. I remember the manager in a team meeting, asking all of us what our 5 year plan is and although at the time I joked, that “it was to get to Friday”, realistically speaking, mine was to stay put in the Trust until I retired. I never envisaged leaving! All my other colleagues’ stated they would leave within one year or two but in actual fact it was me who left after 6 months and they are still working there!

There was no long term foresight from my side. I was happy with what I had achieved. Then suddenly this opportunity came along and I applied for it. In previous articles, I have already mentioned that my mentor from my first part-time job was now the manager of a Central London Trust. I had enjoyed working with him and I also had a good working relationship with him. He was a visionary and always thinking of ways to improve the department- constantly improving the Podiatry image, even as junior podiatrist nearly 10 years ago.

I think my sub conscious needed a new challenge. Plus this new role involved setting up podiatry services within the hospital and also came attached with a biomechanics post. And I was hungry to learn more! My interest had been piqued. I knew I still had a lot to learn when it came to Biomechanics and I wanted to further better myself. 

When I met the Biomechanics lead in my interview with the manager, I was totally in awe of him. He did not take me apart when I said something wrong in fact he guided me and probed me till I got there. He did not make me nervous. I wanted to learn from him. I had decided even if I don’t get the job, I wanted to come and volunteer working with him. 

I was lucky enough to get the position and my biomechanics skills improved from strength to strength. I am eternally grateful for his insights into improving my biomechanics skills and my confidence. His mantra was simply, ‘call out what you see, start from the top of the head and work yourself down to the feet’ don’t worry about the technical terminology – this will improve as you get more confident and never over complicate things and his final saying was – there is never a stupid question.’ He was and even today he is still available any time (although he has done a 180 degrees on his profession!), if want to talk things through or I need a second opinion.

This job within the hospital lasted for 5 years before I went back to working within the Community as a full-time member of staff. However, I struggled to fit in. The services had been through many changes and could only currently offer services to ‘at risk or high risk’ patients. 

The Biomechanics services existed but minimally and that too had also been altered. We could only see the patients for a total of 2 visits and sometimes, patients could not always retain all the information. Most patients can feel overwhelmed in the first appointment with information overload. Sometimes, it can take time to explain everything to the patient I felt I was always playing catch-up but if I called them for a 3rd appointment, I would have to justify with a reasonable explanation and I was not always successful in pleading their case. This meant the patient would then have to enter the system again which meant that we would be starting the process all over again. 

If I issued any orthoses, then I had to modify them in clinic whilst the patient was with me, but I had to clock watch constantly so that I did not fall behind. If I suspected that the patient had arthritis, and they may need an x-ray, this needed to be referred to the GPs and I would not necessarily be able to review the x-rays or the result. I felt like I was working with my hands tied behind my back and still expected to provide an adequate service. 

I reflected on my situation and felt that I was not working to my best level for my patients or for myself. I did not feel any job satisfaction and my skills were not best utilised. 

Working in the NHS runs on selflessness – this I understand, and which is why I joined the NHS, but sometimes when the service has budgets reduced, it means that the staff are making up for the reduced service provision at a cost to themselves.

For me, it meant that I was under performing and it was time out for me! 

This was not an easy decision, but I wanted to only serve patients with who I could provide a better outcome. 

I had still managed to maintain one day in the hospital which as you all know is the biggest highlight of the week, I love working in a multi-disciplinary team. At same time, I was approached by one of consultants to assess his private patients biomechanically and provide appropriate treatment. 

And this is where my private practice journey started, and it helps me to provide a service that allows patients to feel safe, supported and empowered.  They can ask any questions at any point and I work to make the information and treatments I provide easy to understand and effective.

All with the aim of being the best I can be and giving my patients the best outcome.