Challenging medical dominance: podiatric surgery in the National Health Service

Borthwick, A.M. (1999) Challenging medical dominance: podiatric surgery in the National Health Service. British Journal of Podiatry, 2 (3), 75-83.

Record type: Article

Abstract

This paper examines the emergence of NHS podiatric surgery as a challenge to the dominance of medicine and its control over the provision of foot surgical services. The practice of surgery by non-medically qualified podiatrists and its integration within mainstream NHS service provision is evaluated as possible evidence of the diminishing authority of medicine in determining the scope and boundaries of paramedical practice. To date, a growing body of practising podiatric surgeons have obtained NHS consultant appointments and access to surgical facilities within the hospital environment. This trend has been facilitated by the enhanced authority of NHS general managers in the wake of the post-Griffiths reforms, alongside the purchasing freedom of fundholding GPs. Although the Royal College of Surgeons (RCS) and British Orthopaedic Association (BOA) failed to prevent or halt these developments, the medical profession continues to be engaged in a bid to retain overall control of the market for foot surgical services through a strategy of delegation. Furthermore, future prospects for NHS podiatric surgery may be limited under plans to extend medical authority in healthcare commissioning through Primary Care Groups.

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