August 2020

 Issue 23 – August 2020

• Chair's message
• COVID-19 update
  • Keep up to date and look after yourself
  • Continuing professional development
  • Endorsement for scheduled medicines
  • Telehealth services
• Board news
  •  New guidelines for practitioners and students on blood-borne viruses
• Meet the Board
  • Kate Storer, practitioner member from the Australian Capital Territory
• Registration
  •  Latest workforce data released
• Students and graduates
  • Protecting our health practitioners of the future: clinical education principles
  • Graduate registration in 2020
• National Scheme news
  • Podcasts on the pandemic and beyond
  • False and misleading advertising on COVID-19
  • Changes to mandatory notifications requirements are now in effect
  • No place for racism in healthcare
  • A strategy for embedding cultural safety into the health system
  • Keep in touch with the Board

Chair’s message

I’d like to welcome student and graduate podiatrists to the Podiatry Board of Australia newsletter. You will now receive the newsletter alongside your registered colleagues. This is the first time we have sent our newsletter to students across the country. You are a valued part of our profession and we hope you will find the Board newsletter helpful now and for your future.

The COVID-19 pandemic has profoundly impacted on our lives over the last few months, both personally and professionally. It is a rapidly changing situation, and at the time of writing this a State of Disaster has been declared in Victoria. The stage 4 restrictions currently in place align with this and are focused on saving and protecting lives through restricting non-essential movement across the state. They also mean that routine podiatry care is not permitted. We know how difficult this is for Victorian practitioners and students and have provided further information for you in this newsletter.

For all podiatrists, podiatric surgeons and students, see our COVID-19 update below for information and links to resources to help and support you.

On behalf of the Board, I thank the profession for adhering to public health requirements and providing safe care to those who need essential podiatry care during this challenging time.

Cylie Williams
Chair, Podiatry Board of Australia

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COVID-19 update

Keep up to date and look after yourself

For Victorian practitioners

Under the current Victorian permitted work arrangements, routine podiatry services are not permitted. Podiatry care must only be provided if the absence of, or delay of this care, would result in a significant change/deterioration in the patient’s functional independence necessitating escalation of care.

This means you must critically consider if the podiatry service is essential for the patient.

We acknowledge the effect this is currently having on podiatrists and podiatric surgeons based in Victoria, given how quickly advice can change. Please keep checking the Victorian Department of Health and Human Services website for information about the current restrictions and requirements that apply to you and your work setting(s).

For all practitioners

As the COVID-19 situation evolves across Australia, there will be new and regular updates from many important sources, including governments, local health departments and professional associations, with advice for practitioners about government requirements and how to best meet them. It’s important that you regularly check the Australian Government Department of Health website and your local state/territory health department’s website to make sure you’re across the latest updates.

The Board is working with Ahpra to provide helpful information, including answers to common questions, which is being regularly updated on the Responding to COVID-19 hub. We encourage you to check the hub if you need further information or resources to support you.

We particularly encourage you to look after your health during this difficult time, including to seek help when needed. As well as your general practitioner, there are many organisations that provide information and support for your mental health, including:

• Beyond Blue 
• Lifeline Australia 
• Heads Up 
• The Black Dog Institute

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Continuing professional development

We encourage you to continue to do CPD that is relevant to your scope of practice. However, we know that for many of you your plans for CPD this year have been affected by COVID-19.

The Board will not take action against practitioners who have not been able to complete their CPD activities this year as a result of COVID-19.

Some suggestions for CPD activities that don’t require you to interact directly with others include:

• online learning and internet research
• written reflections on experience in day-to-day clinical practice
• reading books and journals relevant to your practice
• quality assurance activities, such as accreditation, clinical audits or review of records
• conducting an infection prevention and control audit of your practice using the self-audit tool published on the Board’s website, and
• professional or interprofessional interactions such as meetings, case reviews, and clinical forums which can be done online.

CPR

We know that some of you may not have been able to meet the Board’s requirement to have current training in CPR, management of anaphylaxis and use of an automated external defibrillator this year as approved training organisations may not be delivering the training in the current environment. While the Board won’t take any action this year if any component of this training is not current, we encourage you to do the training as soon as it is safe to do so.

In June, the Australian Resuscitation Council published some FAQs about resuscitation during the COVID-19 pandemic.

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Endorsement for scheduled medicines

In early April, we recognised that due to the exceptional circumstances brought about by the COVID-19 pandemic, practitioners working towards endorsement for scheduled medicines under Pathway B may not be able to complete their period of supervised practice within 12 months. The Board provided a three-month extension for all practitioners in Pathway B to complete their period of supervised practice. In late June, the Board provided a further three-month extension.

We encourage practitioners in Pathway B to continue with your learning and attend observational clinical placements where they are available. in line with the COVID-19 guidance in your state or territory and it is safe for you to do so.

We also encourage you to continue to have discussions with your mentor, develop your clinical studies and submit them for initial assessment and work on your portfolio of evidence as much as you can.

We will continue to monitor the situation and may review this extension period if needed.

Updated FAQs

We have updated our endorsement for scheduled medicines FAQs which are published on the Endorsement for scheduled medicines page of our website.

We’ve added some new FAQs about local anaesthetics in clinical studies.

The use of local anaesthetic falls within the capability of all registered podiatrists. A clinical study with local anaesthetic only does not demonstrate the additional capabilities required for endorsement for scheduled medicines and you shouldn’t submit a clinical study that has local anaesthetic as the only scheduled medicine.

While you can include local anaesthetic in a clinical study, the clinical study should also include other scheduled medicines from the National podiatry scheduled medicines list. For example, an antibacterial may be prescribed in conjunction with the administration of local anaesthetic for the management of an infected ingrown toenail.

If local anaesthetic is included in a clinical study, you don’t need to include the local anaesthetic in the written prescription that accompanies your clinical study. Clinical studies should be reflective of podiatry clinical practice and local anaesthetic is administered as part of podiatry clinical practice without a written prescription.

However, all the necessary elements of safe practice relating to the use of local anaesthetics, including dosage calculation and counselling/education, must be included as part of the clinical study.

Example portfolio

The Board published an example of a portfolio of evidence on the Endorsement for scheduled medicines page of our website in December 2019.

The sample portfolio, which includes an example of an evidence matrix and log of activities as well as two clinical studies and some reflective pieces, is intended to provide guidance only and is not a representation of a completed portfolio.

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Telehealth services

The Board’s expectation is that telehealth should only be used if it is safe and clinically appropriate for the podiatry service being provided. You must adhere to the same principles you apply when providing services during a face-to-face consultation.

Telehealth guidance has been developed outlining Ahpra and the National Boards’ expectations of how registered health practitioners will use telehealth in the context of the COVID-19 pandemic. This guidance also includes information on other resources about telehealth that are available.

You should also check with your professional indemnity insurance (PII) provider to ensure your PII arrangements cover you for telehealth.

Additional resources

In addition to the resources about telehealth included in the Ahpra and National Boards’ guidance, Safer Care Victoria has recently released new guidance developed with the Victorian Department of Health and Human Services to help allied health professionals use telehealth. It aims to provide health professionals with an understanding of how telehealth can be used to deliver allied health clinical services in public health settings, and the associated benefits.

The Allied health and telehealth guidance is published on the Safer Care Victoria website.

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Board news

New guidelines for practitioners and students on blood-borne viruses

New Guidelines for registered health practitioners and students in relation to blood-borne viruses came into effect on 6 July 2020.

The Board’s new guidelines apply to:

• registered health practitioners and students who perform exposure-prone procedures, and
• registered health practitioners who are treating registered health practitioners or students living with a blood-borne virus who perform exposure-prone procedures.

The Communicable Diseases Network Australia (CDNA) developed the Australian national guidelines for the management of healthcare workers living with blood borne viruses and healthcare workers who perform procedures at risk of exposure to blood borne viruses (CDNA guidelines).

Podiatric surgeons who perform exposure-prone procedures must declare that they commit to comply with the CDNA guidelines when they apply for registration and when they renew their registration each year.

Podiatrists are not required to make this declaration because the routine procedures carried out by podiatrists, such as a nail avulsion, are considered non-exposure-prone procedures.

Health practitioners and students living with a blood-borne virus who perform exposure-prone procedures can practise their profession if they comply with the CDNA guidelines.

The Board’s guidelines support practitioners and students who perform exposure-prone procedures to comply with the CDNA guidelines.

Among other things, the CDNA guidelines recommend that practitioners who perform exposure-prone procedures take reasonable steps to know their blood-borne virus status and should be tested for blood-borne viruses at least once every three years. The Board will not ask for test results for the purpose of registration or renewal of registration but can take action if a practitioner makes a false declaration about complying with the CDNA guidelines.

More information, including links to helpful CDNA resources, is published in the news item.

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Meet the Board

Kate Storer, practitioner member from the Australian Capital Territory

Can you tell us a little bit about your background?

I studied at University of South Australia and have been a registered podiatrist for over 15 years. I’ve worked in a mix of private practice, community health and tertiary centres. At present I have a strong focus on diabetes-related and other high-risk foot complications, and I am now solely based in public practice.

In 2015 I completed an MBA (health specialisation), and currently I manage the Canberra Health Services High Risk Podiatry Service and coordinate the Interdisciplinary High-Risk Foot Service for the ACT and surrounding south-east NSW region. I have been a practitioner member of the Podiatry Board of Australia since 2015.

Can you tell us a bit about your experience of working with the Podiatry Board of Australia?

I started my first term with the Board in 2015 and I am nearly two-thirds of the way through my second term. I feel very privileged to be given this opportunity and have learnt a great deal from working in this regulatory space.

I have particularly enjoyed my current role as Chair of the Strategic Planning and Policy Committee, a sub-committee of the Board. My colleagues on the Board come with a breadth of knowledge and experience and this allows for robust decision-making. Many of the Ahpra staff have years of regulatory experience and the Board is fortunate to work with such a professional agency.

What contribution do you think the Board and regulation of podiatrists makes to patient safety?

For all the Board functions patient safety is always at the forefront of our decisions and actions. This includes ensuring the workforce meets the needs of our community including access to culturally safe healthcare. Now that the National Scheme is in its 10th year there have been increasing opportunities to review data and evaluate regulatory decisions in relation to the Board’s functions.

As a practitioner what attracted you to working with the Board?

Before becoming a Board member, I took on a role as an allied health representative on the Clinical Review Committee for Canberra Hospital. This interdisciplinary committee was set up to improve patient safety and it was from my involvement in this committee that my interest in regulation evolved.

What would you advise practitioners is important for good practice?

I think timely, appropriate and culturally safe communication is really important for safe practice. This relates not just to communication with patients and carers − interdisciplinary communication is vital to good practice.

What are the top three things the Board and Ahpra should do to bring out the best of the National Scheme?

• Continue the work of the National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025.
• Use real-time data and evaluation, especially in relation to effectiveness of regulatory decisions.
• Continually evaluate and review stakeholder engagement to ensure the Board and Ahpra are meeting the needs of the community. 

Do you have a motto or belief by which you live your life?

Not usually, but in the midst of this pandemic, my kids have regularly been throwing around the motto ‘wash your hands and be kind’ with an emphasis on the kind part. The kids have coloured posters with that motto on it and have stuck them up around our house. I think that motto is quite topical and fits with all healthcare practice even before the pandemic.

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Registration

Latest workforce data released

The Board has published quarterly registration statistics for the period 1 April-30 June 2020. There are 5,608 registered podiatry practitioners as at that date.

Registration type and subtype by principal place of practice

Registration type by principal place of practice percentages

For further information, including registration by age and gender and details of endorsements, visit our Statistics page.

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Students and graduates

Protecting our health practitioners of the future: clinical education principles

National Boards, accreditation authorities and Ahpra, with the Australian Government through the Health and Education portfolios, have issued national principles for clinical education during the COVID-19 pandemic.

This unique multi-sector collaboration to protect Australia’s future health workforce is helping students learning to become health practitioners during the COVID-19 pandemic continue their studies and graduate.

Some student placements have been paused, cancelled or otherwise modified as health services respond to the pandemic. This has led to uncertainty and change for students and educators as education providers, accreditation authorities, clinical supervisors and others explore alternative options for students to progress towards graduation.

The principles aim to provide helpful guidance about how placements can occur safely, taking into account the significant changes across the health and education sectors due to COVID-19. Visit the National principles for clinical education during COVID-19 to find out more.

We thank students, educators and supervisors for their patience and flexibility.

Graduate registration in 2020

Graduating this year? The graduate registration campaign will start soon, so keep an eye on the Board’s website for the announcement as well as tips to help smooth the process as you register for the first time.

We’ll provide updates in our next newsletter in October.

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National Scheme news

Podcasts on the pandemic and beyond

Ahpra has released many podcasts on areas of interest to all health professionals in the Taking care podcast series. The topics covered in the podcasts include pandemic and non-pandemic-related issues and some feature podiatrists.

One episode, A glimpse of healthcare in our rural and remote communities, featured a discussion with a podiatrist, a pharmacist and an optometrist about their experience of working in rural and remote areas. Host Tash Miles leads the conversation with pharmacist Hannah Mann, podiatrist Amy Nelson, and proud Murrawarri woman and optometrist Lauren Hutchinson, about this important and unique part of the Australian health landscape. We hear about some of the benefits and challenges faced by patients and practitioners in rural and remote areas of our country.

In another episode, Telehealth in the pandemic era, podiatrist Michael Nitschke talks about how he has pivoted his practice to support his patients, physiotherapist Dr Viktoria Molloy discusses how she’s adapted her practice, and occupational therapist Leanne Hopkins speaks about telehealth for occupational therapy.

Ahpra releases a new episode every fortnight, discussing current topics and the latest issues affecting safe healthcare in Australia.

Download and listen to the latest Ahpra Taking care podcast episode today. You can also listen and subscribe on Spotify, Apple Podcasts and by searching ‘Taking care’ in your podcast player.

If you have questions or feedback about the podcasts, email communications@ahpra.gov.au.

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False and misleading advertising on COVID-19

Ahpra and National Boards recognise the vital role of registered health practitioners in treating and containing the COVID-19 emergency. We know you are working hard to keep people safe in a demanding and fast-changing environment.

A consequence of the current situation is greater public awareness of individual health and wellbeing, leading to many questions about treating and containing the disease. Members of the public are likely to seek reassurance and answers about COVID-19 from their trusted health professional. While most health practitioners are responding professionally to the COVID-19 emergency and focusing on providing safe care, Ahpra and National Boards are seeing some examples of false and misleading advertising about COVID-19.

It is vital that health practitioners only provide information about COVID-19 that is scientifically accurate and from authoritative sources, such as a state, territory or Commonwealth health department or the World Health Organization (WHO). According to these sources, there is currently no cure or evidence-based treatment or therapy which prevents infection by COVID-19 and work is currently underway on a vaccine.

Other than sharing health information from authoritative sources, you should not make advertising claims about preventing or protecting people from contracting COVID-19 or accelerating recovery from COVID-19. To do so involves risk to public safety and may be unlawful advertising. For example, Ahpra and National Boards are seeing some advertising claims that spinal adjustment/manipulation, acupuncture and some products confer or boost immunity or enhance recovery from COVID-19 when there is no acceptable evidence to support this.

We will consider action against anyone found to be making false or misleading claims about COVID-19 in advertising. For a registered health practitioner, breaching advertising obligations is also a professional conduct matter which may result in disciplinary action, especially where advertising is clearly false, misleading or exploitative. There are also significant penalties for false and misleading advertising claims about therapeutic products under the Therapeutic Goods Act 1989.

For more information, see Ahpra’s Advertising resources web page.

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Changes to mandatory notifications requirements are in effect

On 1 March 2020 the amendments to the Health Practitioner Regulation National Law (the National Law) in relation to mandatory notifications took effect.

The amendments apply in all states and territories except Western Australia and affect the mandatory reporting obligations for treating practitioners.

The threshold for reporting a concern by a treating practitioner about impairment, intoxication and practice outside of professional standards has been raised. The threshold is now reached when there is a substantial risk of harm to the public.

The National Boards and Ahpra have jointly revised the mandatory notifications guidelines to reflect these amendments. The guidelines are relevant to all registered health practitioners, and registered students in Australia.

The guidelines aim to explain the mandatory notifications requirements in the National Law clearly so that practitioners, employers and education providers understand who must make a mandatory notification about a practitioner or student and when they must be made. They also aim to make it clearer when a notification does not need to be made.

Changes to the guidelines include the following:

• A new, higher reporting threshold for when treating practitioners must make a notification about their practitioner-patients. This is to give a practitioner-patient the confidence to seek help if they need it without undue concern about a mandatory notification.
• There are now two separate guidelines in place. One is for mandatory notifications about practitioners, and one for mandatory notifications about students. As there are only limited circumstances when a mandatory notification must be made about a student it was decided to develop a separate guideline that is only about students.
• Restructuring of the guidelines about practitioners according to notifier type (that is, treating practitioner, non-treating practitioner, employer) so that relevant information for each notifier group is easier to find.
• Updated flowcharts to help potential notifiers assess whether they need to make a mandatory notification.
• Introduction of risk charts that highlight risk and mitigating factors that may be relevant to deciding if a mandatory notification is required.

To help explain the requirements and raise awareness, Ahpra and National Boards have released a range of information materials to both ensure patient safety and support practitioner wellbeing. Read the revised guidelines for practitioners and students and the additional resources developed to help explain mandatory notifications.

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No place for racism in healthcare

In April, the Australian Indigenous Doctors’ Association (AIDA) issued a media release detailing instances of medical practitioners denying Aboriginal and Torres Strait Islander people access to culturally safe healthcare. They were seeking testing for COVID-19. These cases in rural New South Wales and Western Australia involved refusal of care on the grounds of patient identity and racist stereotypes of Aboriginal and Torres Strait Islanders not practising self-hygiene.

Racism from registered healthcare professionals will not be tolerated, particularly given the vulnerability of Australia’s Aboriginal and Torres Strait Islander Peoples to the virus. They continue to experience prejudice and bias when seeking necessary healthcare. Discrimination in healthcare contributes to health inequity.

We encourage Aboriginal and Torres Strait Islander people who have experienced culturally unsafe incidents of care or refusal of care by a registered health practitioner to submit a notification or complaint to Ahpra.

In February 2020, the National Scheme’s Aboriginal and Torres Strait Islander health and cultural safety strategy 2020-2025 was released, proving our commitment to achieving patient safety for Aboriginal and Torres Strait Islander Peoples as the norm and the inextricably linked elements of clinical and cultural safety. The strategy strives to achieve the national priority of a health system free of racism. See below for more information about the strategy.

We remind all registered health practitioners that they are required to comply with their profession’s Code of conduct, which condemns discrimination and racism in health practice.

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A strategy for embedding cultural safety into the health system

An ambitious strategy from Aboriginal and Torres Strait Islander health experts, regulators and health organisations committed to embedding cultural safety into the health system has been released by 43 entities including Ahpra and the National Boards.

The National Scheme’s Aboriginal and Torres Strait Islander health and cultural safety strategy 2020-2025 is endorsed by organisations, academics and individuals, including the entities who set the education standards for the 183,000 students who are studying to become registered health practitioners and the regulators of Australia’s 750,000 registered practitioners.

Development of the strategy was led by Aboriginal and Torres Strait Islander organisations and individuals via the Aboriginal and Torres Strait Islander Health Strategy Group, which represents all signatories to the strategy.

Aboriginal and Torres Strait Islander health and cultural safety strategy 2020-2025

The vision

Patient safety for Aboriginal and Torres Strait Islander Peoples is the norm. We recognise that patient safety includes the inextricably linked elements of clinical and cultural safety, and that this link must be defined by Aboriginal and Torres Strait Islander Peoples.

The objectives

Cultural safety: A culturally safe health workforce through nationally consistent standards, codes and guidelines across all registered health practitioners in Australia.

Increased participation: Increased Aboriginal and Torres Strait Islander participation in the registered health workforce and across all levels of the scheme regulating registered practitioners nationally.

Greater access: Greater access for Aboriginal and Torres Strait Islander Peoples to culturally safe services from registered health practitioners.

Influence: Using the Strategy Group’s leadership and influence to achieve reciprocal goals. This includes developing a nationally consistent baseline definition to be used across the scheme regulating registered practitioners nationally, which has already been achieved in partnership with the National Health Leadership Forum.

As part of the strategy, we have already reached some goals:

• partnering with the National Health Leadership Forum (the forum for national Aboriginal and Torres Strait Islander health peak organisations) to develop, consult on and finalise a baseline definition of cultural safety for the scheme for regulating health practitioners
• commissioning high-quality cultural safety training to ensure that the regulation of health practitioners, including the development of standards practitioners must meet and the handling of notifications (concerns about registered health practitioners), is culturally safe, and
• recommending and advocating for changes to the Health Practitioner Regulation National Law to ensure consistency in cultural safety for Aboriginal and Torres Strait Islander people.

For more information, read the news item.

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Keep in touch with the Board

• Visit www.podiatryboard.gov.au for the mandatory registration standards, codes, guidelines and FAQ. Visiting the website regularly is the best way to stay in touch with news and updates from the Board.
• Lodge an enquiry form via the website by following the Enquiries link on every web page under Contact us.
• For registration enquiries, call 1300 419 495 (from within Australia) or +61 3 9275 9009 (for overseas callers).
• To update your contact details for important registration renewal emails and other Board updates, go to the Ahpra website: Update contact details.
• Address mail correspondence to A/Prof. Cylie Williams, Chair, Podiatry Board of Australia, GPO Box 9958, Melbourne VIC 3001.

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