The Podiatry Manual Australasian Podiatry Council First in foot health

The Podiatry
Manual
Australasian Podiatry Council
First in foot health
Disclaimer
Every effort has been made to ensure that the information contained in this Podiatry Manual is accurate at the time of publication. Before relying on the information in this Podiatry Manual, however,
users should check the currency of the information contained therein and completeness and obtain
any appropriate professional advice relevant to their particular circumstances. Please contact the
Australasian Podiatry Council to report any errors or to seek clarification of any ambiguities. The
Australasian Podiatry Council accepts no liability for any loss or damage suffered by any person or
corporate body in reliance upon any information provided within this Podiatry Manual or the accuracy, currency, completeness or interpretation of the information provided in this Podiatry Manual.
Copyright
Paper based publications
© Australasian Podiatry Council 2013
This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may
be reproduced by any process without prior written permission from the Australasian Podiatry
Council. Requests and inquiries concerning reproduction and rights should be addressed to the Australasian Podiatry Council, 89 Nicholson Street, Brunswick East, Victoria 3057.
Contents
Useful Information
Module 1 - Overview
1.1
1.2
1.3
1.4
1.5
Introduction
Registration and Accreditation
Role of the Podiatrist
Australasian Podiatry Council
Member Associations
2.1
2.2
2.3
2.4
2.5
2.6
Establishing a Clinical Facility
Clinical Records
Workplace Health and Safety
Clinical Coding
Quality Improvement
Infection Control
3.1
3.2
3.3
Domiciliary Care
Nursing Homes, Hostels and Day Therapy Centres
Foot Health in Residential Aged Care
4.1
4.2
4.3
4.4
4.5
Code of Conduct - Ethical Principles
Documentation, Confidentiality
Negligence
Informed Consent
Strategies to Minimise Risk 5.1
5.2
5.3
5.4
5.5
Medicare
Podiatry and X-Ray Referrals
Department of Veterans’ Affairs
Transport and Work Accident Authorities
Private Health Funds
6.1
6.2
Are you Ready?
Buying a Practice or Establishing a Practice
5
7
7
7
8
9
10
Module 2 - Clinical Practice Guidelines
11
Module 3 - Extended Care
73
Module 4 - Ethics and Legal Issues
77
Module 5 - Third Party Arrangements
85
Module 6 - Before You Start in Practice
11
15
22
59
63
67
73
74
75
77
77
81
82
83
85
92
98
99
101
103
103
107
6.3
6.4
The Goodwill Component
Planning Permits
7.1
7.2
7.3
7.4
7.5
Introduction
Sole Trader
Partnerships
Company
Trust
8.1
8.2
8.3
8.4
8.5
8.6
8.7
8.8
8.9
8.10
Financial Requirements
Banking and Bank Loans
The Business Plan – An Overview
Other Financing Options
Financial Records
Australian Taxation Office
Budgeting and Financial Control
Operating as a Locum
Insurance Programs and Policies
Calculating your fees
9.1
9.2
9.3
Staff Recruitment
Important Issues when Employing Staff
Administrative Staff
108
109
Module 7 - Business Structures
111
Module 8 - Financial Management and Fees
125
Module 9 - Personnel and Employment Issues
149
Module 10 -Marketing
163
10.1 Marketing and Promoting Your Practice
10.2 Promotional Resources
111
112
113
120
123
125
126
129
130
134
137
139
142
145
146
149
154
159
163
165
Module 11 -Policies of the Australasian Podiatry
Council
169
11.1 Accredited Podiatrist Program (APP) Logo
11.2 Affiliated Bodies
11.3 Trade Mark and Logo (Authorised Use)
4
169
170
172
Useful Information
Australasian Podiatry Council Websites – http://www.apodc.com.au and
http://findapodiatrist.org
Podiatry Registration Board of Australia - http://www.podiatryboard.gov.
au
APodC CPD Online - http://www.cpd.apodc.com.au/
Australasian College of Podiatric Surgeons - http://www.acps.edu.au/
Australian Academy of Podiatric Sports Medicine Inc - http://www.aapsm.
org.au/
Contact Lists
Member Associations:
Australian Podiatry Association – NSW & ACT – Suite 20/450 Elizabeth
Street, Surry Hills, NSW 2010. Phone (02) 9698 3751. http://www.podiatry.
asn.au
Australian Podiatry Association – QLD – Coronation Place, 4/10 Benson
Street, Toowong, QLD 4066. Phone (07)3371 5800. http://podiatryassociationqld.org.au
Australian Podiatry Association – SA – Lvl 2, 50 Hutt Street, Adelaide, SA
5000. Phone (08) 8210 9408. http://podiatrysa.net.au
Australian Podiatry Association – TAS – 22 Lantana Avenue, Newstead,
TAS 7250. Phone (03) 6344 2613. http://www.taspod.com
Australian Podiatry Association – VIC – PO Box 248, Collins Street West,
Melbourne, Vic 8007. Phone (03) 9286 1885. http://www.podiatryvic.com.
au
Podiatry Western Australia – Suite 16/88 Broadway Crawley, WA 6009.
Phone (08) 6389 0225. http://www.podiatrywa.com.au
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Module 1 - Overview
1.1 Introduction
This Manual has been produced by the Australasian Podiatry Council
(APodC) and it is provided as a resource for members of state podiatry
associations.
The Manual provides an overview of some of the practice issues which
the Australasian Podiatry Council believe are important to all practising
podiatrists. However, the manual does not replace the need for sound professional advice, for example from a lawyer and / or accountant when contemplating either the purchase of a practice, or when planning to establish
a new practice.
New members receive a complimentary electronic copy of the Manual at
the time of joining their association.
1.2 Registration and Accreditation
1.2.1
Registration
In Australia, podiatry is a registered health profession under the National
Registration and Accreditation Scheme. The scheme was formed under the
Council of Australian Governments and reports to the Health Ministers
Council. The Commonwealth is responsible for the operation of the scheme
which is administered by the Australian Health Professions Regulation
Authority (AHPRA). The Podiatry Registration Board (PBA) is a board
that is supported by AHPRA however it has statutory independence and is
able to establish standards, policies, codes and guidelines nationally.
All podiatrists including students are required to be registered. Podiatrists
are not permitted to practise if they do not hold registration. Registration
also imposes further requirements such as the need to carry professional
indemnity insurance and the requirement to participate in continuing professional development.
All new registrants are advised to review the requirements of the PBA
which can be located at http://www.podiatryboard.gov.au
1.2.2
Overseas Trained Podiatrists
Podiatrists registered in New Zealand are eligible to apply for registration
in Australia under Mutual Recognition legislation. New Zealand podiatrists must not practice as a podiatrist in Australia until they have registered with the PBA.
Podiatrists from other countries must undertake an assessment through
the Australia and New Zealand Podiatry Accreditation Council (ANZPAC) which can be found at http://www.anzpac.org.au
1.3 Role of the Podiatrist
• To improve mobility and enhance the independence of individuals
by the prevention and management of pathological foot problems
and associated morbidity. This is achieved by providing advice on
foot health education, assessment and diagnosis of foot pathology,
identification of treatment and other requirements, referral to other
disciplines as appropriate, formulation of a care plan and provision
of direct care as deemed appropriate and agreed to by the individual.
• To establish collaborative relationships with other health care providers.
• To promote the skills of the podiatrist and provide information regarding footcare and appropriate support to other health professionals and carers.
• To ensure that communication with patients is respectful and remains confidential.
• To be a primary source of information for the community in all matters relating to the foot.
• To practise in accordance with developments in clinical practice,
research and technology.
• To ensure podiatry is conducted in a manner consistent with registration requirements.
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1.4 Australasian Podiatry Council
The Australasian Podiatry Council (APodC) is the national peak body for
podiatry. The Council’s members are the six state podiatry associations and
the role of the Council is to provide national services and policy direction
for the profession. The Council is a not-for-profit public company limited
by guarantee. The Council has a Board of Directors that are nominee directors appointed by the member association (MA) who are responsible for
determining broad strategy and for the governance of the organisation.
The Council has a professional staff who are responsible for management
and operations.
The APodC provides some services directly to podiatrists on behalf of the
state association, such as the national conference, Podiatry Bulletin, CPD
online, and resources – infection control guidelines, podiatry manual, billing guide. These services are provided collectively to all member podiatrists nationally. They are funded in part through member subscriptions
paid by podiatrists to their state association and partly through commercial revenues such as advertising and sponsorship.
The APodC also has a significant role in establishing a national brand for
podiatry, setting standards and advocating for the profession nationally.
The APodC advocates in a wide range of national areas including:
• National Registration and Accreditation
• Medicare and MBS
• Private Health Insurers (including 30% rebate and PHI legislation)
• Pharmaceutical Benefits Scheme
• Health Workforce Australia (National prescribing, workforce education, workforce planning)
• National Council on Safety and Quality in Healthcare (practice
standards) Department of Veteran Affairs
• National Workers Compensation Schemes
• Taxation, GST and other health business issues
• JFAR – Journal of Foot and Ankle Research
9
1.5 Member Associations
The Member Associations in Australia represent podiatry to state governments and the community at large. They provide a range of services for
members to enhance professional competence and improved standards of
practice. Some of these services or programs include:
• Professional development and education - including annual state
conferences and a range of continuing education programs.
• Representation of the profession to state government and state
based agencies.
• Work opportunities - use of the Member Association listing either
to find work or recruit an employee.
• Use of newsletter classifieds. Referral of public enquiries to local
practices.
• Resources - access to the comprehensive resource library including:
multi-media, stands, lanyards. Access to the JFAR journal is open
access.
• Promotions - opportunity to promote the profession in the community and amongst other health professionals, and have access to
quality cost effective promotion resources.
• Recognition - members may promote their affiliation through title
and also use of the trademark P logo.
• Information - provide answers to member enquiries through the
Member office.
• Representation on state industry bodies.
• Liaison with podiatry schools regarding undergraduate and postgraduate education; also short courses.
• Nominating a Director to the Australasian Podiatry Council to develop national policies and programs.
• Newsletters/e-news - newsletters and e-news keeping members
abreast of current local issues, practical information, education,
and association activities.
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Module 2 - Clinical Practice
Guidelines
2.1 Establishing a Clinical Facility
2.1.1
Facilities
When establishing a clinical facility, consideration should be given to factors which will influence the comfort and safety of both the practising podiatrist (and any potential colleagues or other staff) and the clientele. Clinical facilities should be clean (and easy to keep clean) and fittings kept to a
minimum, thus minimising the risk of cross-infection.
In view of potential clientele, consider access to the facility, including proximity of public transport, parking availability and disabled access to the
premises. Toilet facilities should be available for both patients and personnel. If a podiatrist is likely to be working in isolation, extra security measures and medical emergency requirements may require special consideration. Compliance with Infection Control Standards (refer to Module 2.6:
Infection Control) and Workplace Health and Safety requirements (refer to
Module 2.3: Workplace Health and Safety) should be observed.
Note: All items are supplied by the employing body if the podiatrist is in a
salaried position.
• Clean, well-lit and well ventilated clinical room.
• Adequate floor space (minimum recommended 3.5 m x 3.5 m).
• Washable floor surface, eg; vinyl or tiled - not carpet (refer to Module 2.6: Infection Control).
• Hand basin with hot and cold running water, taps with hands off
controls and suitable drying facilities, such as single-use paper
towels (not mechanical or electrical dryers) - refer to Module 2.6:
Infection Control.
• Separate stainless steel facilities for cleaning instruments -refer to
Module 2.6: Infection Control.
• Adequate facilities for sterilisation as per Australian and New Zealand Standards (refer to Module 2.6: Infection Control).
• Minimum of two double power points.
• Rubbish disposal to include general waste, suitable containers for
infectious waste and sharps disposal receptacle - all appropriately
labelled and with suitable arrangements for collection. Suitable arrangements must be made for the clinical facility to be cleaned after
each session, including cleaning of all exposed surfaces and emptying of bins.
• Separate waiting room and reception area.
• Extra space may be required for office and desk (suitable writing
space is required within the clinic for report writing and correspondence).
• Separate area for orthotic manufacture and construction, including
bench grinder with dust extraction, small bench oven, plaster and
materials storage and possibly a vacuum press. Adequate bench
space is required for assembly and adequate ventilation for gluing. Consideration should be given for the inclusion of a plaster
trap below the sink at which plaster-soiled water is rinsed. The area
should comply with Workplace Health and Safety regulations and
allow safe work practice (refer to Module 2.3: Workplace Health and
Safety).
• Lockable storage is advisable for security purposes and necessary
if restricted substances and pharmaceutical prescription pads are
kept on the premises.
2.1.2
Equipment
This outlines the basic minimum equipment recommended by the Australasian Podiatry Council to establish a podiatry service.
• Electrohydraulic patient chair, with reclining back and adjustable
leg rest. A chair that converts to a plinth is recommended as it enables biomechanical assessments to be performed. In multi¬purpose
clinics this also increases the chair’s versatility.
• Hydraulic height-control podiatrists’ chair with adjustable lumbar support, on five castors.
• Cabinet / trolley with castors to accommodate equipment and materials during treatment.
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• Adjustable lamp (e.g. luxo or planet) with magnifier or lamp with
colour corrected globe. Lamp may be portable on castors or attached to trolley.
• Electric nail drill with dust extraction or spray.
• Autoclave - steriliser using steam under pressure (refer to Module
2.6: Infection Control). This is not essential if an off site sterilisation
service is used.
• Adjustable footrest for wheelchair bound patients.
• Disposables - again individuals will have differing preferences however disposable gloves, dressings, various medicaments and
pharmaceutical preparations, plaster bandage and orthotic materials will be among the requirements.
• Diagnostic equipment, including angle grinding tools for orthotic
adjustment and gait analysis facilities for biomechanical assessment, and appropriate vascular, neurological and other clinical assessment tools e.g. doppler, tuning fork, reflex hammer, sphygmomanometer.
• Orthotic fabrication materials might include knives, scissors, glues
and a variety of rubbers and polypropylenes with suitable safety
equipment (refer to Module 2.3: Workplace Health and Safety).
• While a practice may be started with manual records, we advise the
use of computer based billing and patient records for accounting
and invoicing, patient bookings and data collection and collation.
• Internet access. Also consider several phone lines for separate EFTPOS from incoming phone/fax line.
• A secure system for computer backups, recording patient information, with suitable stationery and lockable storage facilities.
• Appointment book (if not computerised).
• Pens, notepaper, envelopes and letterhead writing paper of the consulting podiatrist (or managing authority that administers the service) for correspondence with other persons related to care of the
patient.
• Filing system and space.
• One trolley (preferably stainless steel) with easily cleaned surface
on balanced castors and with two shelves or trays equipped with
medicaments and dressings as specified by the podiatrist.
13
• The podiatrist will also require access to a minimum of one (1)
power point, a wash basin with hot and cold water and disposable
(paper) dressing towels, appropriate rubbish disposal for general
and infectious waste and “sharps” and access to patient medical
records for recording treatments.
• For transporting equipment, a lightweight, compact carry case that
is easily cleaned, to carry the minimum of medicaments, dressings,
felt, etc.
• Sterilised sets of instruments, the number of sets equal to the number of patients to be treated. Sets of instruments are to be sterilised
individually, prior to the home visit. Packaging should be in such
a way as to maintain sterility of the instruments whilst transporting equipment to/from the patient’s home. A separate container for
return of used instruments to the sterilising area.
The following special procedures pertain to home visits:
Hand Washing
Refer to the “Infection Prevention and Control Guidelines for Podiatrists
2012” for recommendations on hand washing.
Waste Disposal
General waste - disposed of in the patient’s garbage bin.
Contaminated waste - to be returned to the place of employment for appropriate disposal as per the Infection Prevention and Control Guidelines.
Sharps - placed in a designated sharps container carried into the patient’s
home. Small containers made for their easy portability in such situations
are available. Ensure that the container can be closed during transportation
and reopened again for use.
Soiled Linen
Soiled linen should be segregated according to the Infection Prevention
and Control Guidelines or alternatively the patient’s own linen can be utilised.
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Health Education
Foot health education may be required for other health professionals, for
members of the public or special interest groups such as diabetes or arthritis support groups.
In order to provide this service, the podiatrist will require access to audio
visual materials (e.g. DVDs, posters, pamphlets, models), library facilities
for researching lecture topics, and projection equipment.
Most Member Associations have available to their members a range of audio visual aids and equipment for loan.
The Australasian Podiatry Council produces other resource materials for
use in promotional activities which are available to members electronically.
2.2 Clinical Records
The preparation and maintenance of high quality patient notes is an essential part of a podiatrist’s duties. It is imperative that the clinical facility has
a system for the recording of such information. The system should allow
appropriate access, processing and storage of patient records and ensure
confidentiality requirements are met.
TIP: High quality patient notes help practitioners to justify/defend their actions if they are ever challenged for negligence or are subject to a complaint
received by the Podiatry Registration Board of Australia. Conversely,
poor quality notes, or a total lack of notes undermine a good defence, and
can be grounds for disciplinary action against the podiatrist in itself.
2.2.1
Confidentiality & Privacy
As patient records contain information which is highly personal and sensitive in nature, it is important that the practitioner and clinical facility
respects the right of individual privacy and ensures steps are in place to
facilitate appropriate use, access and storage of records. There is further information found at http://www.privacy.gov.au/materials/types/infosheets/
view/6583 including 10 National Privacy Principals.
15
All handling of clinical records must comply with Federal and State / Territory Privacy Laws. Please go to the Office of the Australian Information
Commissioner web site http://www.oaic.gov.au (search for “health”) for
details on Federal laws and links to state laws.
The laws detail requirements related to the collection, storage, use, access
and disclosure of patient information in the context of health service providers. The National Privacy Principles provided aim to promote good
privacy practice in the health care setting.
The rights of the patient regarding access to their medical records are also
covered under this legislation. Generally patients have the right to access
any information about them which is held by the practice; however certain
limitations apply where it is in the patient’s best interest to limit access (eg.
A psychological condition may be affected). Please go to http://www.oaic.
gov.au (search for “health”) for more information.
While patients have access to their own health record, practitioners should
be cautious about releasing records to third parties. While there are provisions to pass on information to other health providers for the continued
treatment of the patient, and where the patient would have a reasonable
expectation that this would occur (e.g. a report back to a referring doctor),
practitioners should be cautious in releasing information. The law does
not require a release of information to any party other than the patient. If
practitioners are unsure of whether a “reasonable expectation” exists, they
should check with the patient. If the patient refuses to grant permission
then the information should not be released, as practitioners are required
to maintain confidentiality under the privacy legislation.
2.2.2
Report Writing
The patient’s record constitutes an ongoing account of the service provided
to an individual, offering a record of treatment given, progress made and
a history for future consultation as required. For podiatry guidelines on
clinical records (set by the PBA) see http://www.podiatryboard.gov.au/
Policies-Codes-Guidelines.aspx. Increasingly, statistical information is acquired from the patient record, occasionally the record may be used for
teaching and research purposes and there is always the potential that a patient’s record will be required as evidence in court. It is important therefore
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that patient records meet a minimu m standard, having regard for their
purpose.
• Reports should be accurate, brief, complete and include reference
to any patient refusal of treatment or action contrary to advice.
• Reports should be legibly written and include the signature of the
attending practitioner. In multiple practitioner clinics and surgeries
it is recommended that the practitioner’s name is also printed as
some signatures are difficult to identify.
• Reports should be objectively written, based upon facts.
• Entries should be made at the time of consultation and should be
recorded in blue or black ink.
• All correspondence and any other reports concerning the patient
(e.g. pathology or radiology reports, detailed assessments, orthotic
prescriptions), should be filed in the clinical record.
Any telephone conversations with the patient and any consultation with
any third party should be recorded in the clinical record. Abbreviations
should not be used in clinical reports unless they are accepted by the clinical facility and included in that facility’s ‘List of Common Abbreviations’
which is documented to include the facility’s accepted interpretation of
each abbreviation.
• Any errors made whilst writing an entry in a patient’s manual record should be dealt with by drawing a line through the incorrect
entry and initialling it before continuing. Correction fluid may not
be used.
• No entry concerning a patient’s treatment should be made in a patient’s record on behalf of another practitioner.
• In a multi-disciplinary facility, the reports of all health personnel
involved in caring for the patient should be part of an ongoing,
integrated, holistic record.
References
Australian Council on Healthcare Standards Ltd. (1996) The ACHS accreditation guide. Standards for Australian health care facilities. 13th Ed.
17
Australian Community Health Association. (1993) Community Health
Accreditation and Standards Program (CHASP). 3rd Ed.
The Office of the Privacy Commissioner, Privacy Law Website: http://www.
privacy.gov.au/law
MacFarlane P. (1995) Health Law. The Federation Press
Staunton PJ, Whyburn B. (1993) Nursing and the Law. W.B.Saunders/Bailliere Tindall
2.2.3
Documentation Format
An ordered approach to documentation of patient related information will
assist with maintenance of record standards, (particularly where more than
one podiatrist is practising from the one location) and help to ensure that
all relevant information is captured. It will also provide a basis for quality
improvement and research projects.
An example Assessment and Care Plan format is included for your guidance.
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Podiatry Assessment & Care Plan
19
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Appendix – the Footwear Assessment Form
General shoe style/covering
• barefoot
• socks only
• stockings only
• backless slipper
• mule
• high heel
• courtshoe
• boot
• slipper
• sandal
• moccasin
• athletic shoe
• walking shoe
• Oxford shoe
• ugg boot
• thong
• surgical/bespoke footwear
Heel height
• 0–2.5 cm
• 2.6–5.0 cm
• >5.0 cm
Fixation
• none
• laces
• straps/buckles
• Velcro™
• zips
Heel counter stiffness
• minimal
• <45°
• >45°
Longitudinal sole rigidity
• minimal
• <45°
• >45°
Sole flexion point
• at level of MTPJs
• before MTPJs
Tread pattern
• textured
• smooth (i.e. no pattern)
• partly worn
• fully worn
Sole hardness
• soft
• firm
• hard
Reference
Menz HB, Sherrington C, The Footwear Assessment Form: a reliable clinical tool to assess footwear characteristics of relevance to postural stability
in older adults - Clinical Rehabilitation 2000, 1999.
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2.3 Workplace Health and Safety
A safe working environment in accordance with all Workplace Health and
Safety regulations is an important responsibility to uphold by all podiatry
clinic owners, managers and podiatry practitioners. The wellbeing of each
person in the workplace is vital and thus the process of managing, controlling or eliminating risks and establishing safe systems of work, as required
under Workplace Health and Safety legislation, is important for the following reasons:
• Your personal health and safety, as well as the health and safety of
everyone working in, and entering, the clinic. A work related injury or disease can result in unexpected costs, the absence of a staff
member and unnecessary emotional and psychological stress.
• The penalties for failing to comply with Workplace Health and
Safety laws are high and include criminal sanctions such as imprisonment.
There are potential hazards in podiatry clinics and therefore the risk of
harm or injury to persons who work in these environments and persons
who visit these areas must be recognised. Due to the nature of duties, safety standards should in particular address the risk of physical injury and of
cross-infection. The fundamental steps involved in developing a safety system for all practices are: identify hazards, assess risks and control risks.
It is important to be aware of anything that could go wrong, the effect that
this would have on people, equipment and the clinic and how to prevent
such an occurrence. Adequate time during consultations and between patients must be allowed to ensure adherence to safety standards. Podiatry
practised in sub-standard conditions brings a risk of infections to the patient and possible injury to the podiatrist.
While general principles and information is provided, state / territory
workplace health and safety requirements vary. It is your responsibility to
find out the requirements which apply to you.
2.3.1
Your Business and the Law
Workplace health and safety is everyone’s responsibility
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Whether your clinic is big or small, whether it is based at one location or
many, whether you are an owner operator or an employer, you are legally
required to make sure that the working environment is safe and without
risks to health. You must also ensure that no one else, like your patients,
visitors or neighbours are put at risk because of your work activities.
2.3.2
Workplace Health and Safety (WH&S)
legislation
Workplace health and safety in Australia is legislated by separate Acts in
each State/Territory. Safe Work Australia is the national organisation that
establishes policy on workplace health and safety. Links to state health and
safety bodies may be found at http://safeworkaustralia.gov.au.
State legislation specifies duties for the following parties:
• Employers
• Persons in control of workplaces
• Employees
• Self-employed persons
• Manufacturers and suppliers of plant and substances
• Persons erecting or installing plant in a workplace
As an employer, you have a legal responsibility called a ‘duty of care’ to
protect the health, safety and welfare of people in your workplace. This
includes people who work for you casually, part-time, full-time, permanently, as volunteers or as outworkers, plus members of the public while
they are in your workplace.
Employees also have a duty of care. They should follow instructions relating to health and safety, and avoid putting other people at risk.
The Acts cover other matters such as how to deal with WH&S issues and
how the law will be enforced, the roles of inspectors, notices, penalties,
etc.
Inspectors have the power to enter workplace premises and, where appropriate, issue Improvement or Prohibition Notices requiring that hazards be
23
remedied within a specified period or that a work activity be suspended
until the hazard is removed. Failure to comply with such a notice is an offence. It is also an offence to obstruct, hinder or deceive inspectors in the
lawful course of their duties.
2.3.3
Regulations
The general duties in the Acts are supported by more detailed requirements set out in regulations for issues such as:
• Manual handling
• Hazardous substances
• Noise
• Plant
• Confined spaces
Fact sheets and links to the regulations may be located on the website of
your state worksafe / workcover authority.
2.3.4
Guidance Material
Codes of Practice, National Standards and Australian Standards provide
practical guidance on how to achieve the standard of health and safety required by the Acts and regulations. A Code of Practice should be followed
unless there is another way to get an equal or better outcome.
2.3.5
Workplace Health and Safety laws
require employers to:
• Provide a safe workplace and safe systems of work.
• Maintain equipment, tools and machinery in a safe condition.
• Provide safe and hygienic facilities, including toilets, eating areas
and first aid.
• Provide information, instruction, training and supervision to all
workers.
• Establish a process for consultation with workers.
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• Monitor and record work-related injuries and illnesses.
• Notify any workplace death or serious injury, or any incident that
could have caused death or serious injury.
http://www.business.gov.au provides a good resource for business owners,
managers and employees on WH&S.
2.3.6
Steps to Developing a Workplace
Health and Safety Program
A workplace health and safety (WH&S) program is a planned set of activities needed to make your work and workplace safe. It ensures that hazards
in your workplace are managed in a systematic way.
An WH&S program helps to protect your clinic, employees, patients, and
your personal liability as an employer, owner, manager or supervisor. It
will enable you to comply with workplace health and safety legislation and
reduce costs associated with work-related injury and disease.
Every business should take these simple steps to improve the way they
manage health and safety in the workplace. In a small business, this is best
achieved if each step is incorporated into the day-to-day operations of the
business, to reduce duplication of effort.
http://www.business.gov.au recommends the Victorian Government Workplace Health and Safety Guide as a starting point. It can be located at http://
www.business.vic.gov.au (search “WH&S). The steps to getting started
are:
Step 1 – Know your responsibilities
Find out the legal workplace health and safety requirements that apply to
your business. Then write a health and safety policy to demonstrate your
commitment to a safe workplace.
Step 2 – Involve your workers
Talk to your staff and set up ways for them to be involved and contribute to
decisions that may affect health and safety in the workplace.
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Step 3 – Identify hazards
Find all the things that could cause harm to people in your workplace.
Step 4 – Assess the risks
Determine how serious these hazards are.
Step 5 – Manage the risks
Don’t wait for someone to be injured or fall ill. Fix the health and safety
problems by finding ways to remove the hazards or ways to keep people
safe from them.
Step 6 – Inform, train and supervise
Inform staff about hazards in their job and workplace as well as the requirements for health and safety in your clinic. Safe work procedures can
be used as a training tool. Ensure new workers are properly supervised.
Step 7 – Put safety into purchasing
Consider health and safety risks before hiring contractors or other services
and before buying equipment or materials. Incorporating health and safety
at the purchasing stage is more cost-effective and is likely to reduce time
required for training and supervision.
Step 8 – Manage injuries
Plan to respond appropriately and reduce the impact of an incident/injury
if it occurs.
Step 9 - Keep records
Keep records of your safety activities so that you can monitor and review
the health and safety performance of your business.
Step 10 – Monitor, review and improve
Review the steps you have taken to manage health and safety in your
workplace. Adjust your program to address any business or legislative
changes.
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2.3.7
Hazards in Podiatry Clinics Ergonomics and Podiatry Equipment
Manual tasks involving repetitive procedures, forceful exertions and holding constrained or awkward postures for a long time can result in musculoskeletal injuries.
Common problems
• Lower back pain – caused by standing for long periods of time,
adopting awkward positions, sitting on chairs or stools without a
back rest or leg support.
• Neck and shoulder pain (tendonitis) – caused by prolonged static
postures, bending the head forward or to the side, holding arms
away from the body or above shoulder height.
• Wrist and hand problems (carpal tunnel syndrome) – caused by
gripping, repetitive movements, e.g. scalpelling, grinding and polishing.
• The following factors should be considered to help you decide how
to reduce the risk of musculoskeletal injury:
Clinic layout and furniture
• Provide enough space to allow free movement around work areas
and furniture.
• Arrange equipment and materials on workbenches within easy
reach.
• Store heavier and frequently used items at waist level to eliminate the need for lifting from below mid-thigh or above shoulder
height.
• Adjust podiatry chairs to position the patient so that you do not
have to bend or twist your back.
• Operator chairs should be height adjustable with good lumbar support, and have a five-point base on castors.
• Design workstations so that staff can do most of their work in an
upright position with shoulders lowered and upper arms close to
the body. The working height and objects used in the task should be
roughly level with the elbows, whether the work is done sitting or
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standing. People vary in stature and may require different working
heights. So it is best to use adjustable workstations that can be set
to suit the height of each person.
Work organisation
• Vary tasks as much as possible to use different muscles and allow
tired muscles to recover.
• Alternate between sitting and standing.
• Tools and equipment.
• Select tools and equipment where the shape and orientation of
handles allows a comfortable grip and avoids awkward wrist positions.
• Use well balanced, lightweight tools and instruments to reduce
hand and arm fatigue. Use larger diameter grips on instruments
such as files or curettes to reduce finger pinching.
• Maintain all cutting and grinding tools (burs, discs) so that they do
not require extra effort to use.
• Lifting techniques - the following principles should be followed
when lifting:
• Plan the lift - assess the load, determine where it will be placed and
how it will be handled.
• Adopt a comfortable, balanced posture with feet slightly apart.
• Face the load squarely and securely grip the item with both hands.
• Position the load close to the body.
• Lift gradually and smoothly, without jerking.
• Avoid twisting the back - turn the feet, not the hips or shoulders.
• Team lifting principles:
• Organise a team of adequate numbers of persons who are of similar
height and capacity, and trained in manual handling techniques.
• Appoint a person to coordinate the lift.
• Plan and rehearse the lift with the team.
• Use the safest, most comfortable lifting technique.
• Team lifting should only be used when mechanical lifting equipment is unpractical.
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Podiatrist’s Chair
Correct posture must be maintained during treatment. This includes feet
flat on the floor, hips flexed at 90% (or slightly extended) to upper body
and a straight back with the lower lumbar curve maintained. A chair that is
too low increases flexion at the hip and promotes poor back posture.
The following features are considered essential on a podiatrist chair:
• Hydraulic height control
Variable height control to accommodate different seating heights.
The height of the podiatrist’s chair should remain static throughout
treatment and the patient chair adjusted to enable access to different parts of the foot. A sufficient height range on the patient chair
is therefore vital. The podiatrist’s chair height should only be adjusted on those rare occasions when the patient chair height is not
adequate. Consider seating that is designed to be more ergonomic
for your professional needs: http://bambach.com.au/.
• Swivel seat / castors
The podiatrist needs to be able to move from side to side around
the feet and turn to the trolley to collect materials, without twisting
the upper body. (A combination of twisting and reaching has been
implicated as the cause of many back problems.) A five castor base
increases manoeuvrability and non-carpeted floor surface ensures
this.
• Adjustable lumbar bar / back rest
The lumbar bar / back rest supports the lumbar spine and helps
maintain correct back posture. It must be adjustable to cater for different staff. If the patient chair can be raised high enough, it is not
unreasonable for the podiatrist to work standing up. This tends to
limit the amount of lumbar spinal rotation which is a causative factor in many spinal injuries.
• Patient’s Chair
A height adjustable hydraulic chair is vital in any clinic. It enables
easy patient access and treatment of all aspects of the foot whilst
maintaining correct posture of the podiatrist.
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High chairs with steps are to be avoided as they immediately prohibit access to people with mobility problems such as the very frail
and patients with hip replacements. Such chairs should only be
employed on a temporary basis or in areas that receive a minimal
service and have fairly mobile patients.
A moveable arm rest improves access from the side of the chair
instead of climbing over the leg rests. Provide assistance where necessary to assist the safe transfer of patients into and out of the chair.
The material on the chair should be easily cleaned, vinyl is great.
Also refer to the infection control guidelines for cleaning material
as a cloth is not suitable.
An adjustable back rest enables the chair to be converted to a plinth
for biomechanical examinations and also multi-purpose use by other health professionals. An adjustable back rest is also essential to
accommodate patients who cannot flex their hips greatly after hip
surgery.
• Electric hydraulic control
Foot control enables quick height adjustments whilst podiatrist remains seated. Manual height-adjusted chairs force the podiatrist to
change their chair height during treatment and so correct back posture is not always maintained. These chairs may be appropriate for
occasional use only, ie, no more frequent than once a week.
• Height range
Podiatrists will differ in the chair height they comfortably work at,
but most will work in a range of 70-95 cm. Taller podiatrists will of
course require a higher range. Patient chairs should therefore rise
to a minimum heel height of 90 cm (i.e. the patient’s feet can be
raised to that level for comfortable working position).
• Portability
It is often advantageous for the chair to be on castors for easy movement into a corner or another room, and for floor cleaning(though
most good patient chairs do not have castors.) During the use of the
chair the wheels can be locked into place.
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• Trolley/Cabinet
The trolley / cabinet should be on castors to keep materials and
instruments within easy reach of the podiatrist or moved out of
the way for better access to the feet. (This prevents excessive reaching and twisting of the upper body.) The trolley should be at desk
height (approximately 74 cm) for easy access. Ideally the trolley
should contain a lockable cupboard or drawer in which to permanently store materials. However, a trolley consisting of shelves is
considered adequate.
Reducing the Risk of Incidents
• Educate your staff and colleagues about the risk of injury when using podiatry chairs. Maintaining a safe environment is everyone’s
responsibility.
• It’s not uncommon for clients to behave in a way you didn’t expect.
Don’t assume they will act safely.
• Ensure the chair is positioned at the lowest setting before a client
enters the room.
• If you leave the room while the client is undressing, instruct them
not to sit on the treatment chair or the podiatrist’s stool until you
return. Make a conventional chair available as needed.
• Supervise the client getting on and off the chair. Instruct them not
to attempt to reach out or get off the chair without your help.
• Adjust the base of the chair to ensure it sits level on the floor. Keep
any wheels locked at all times. Avoid moving the chair unnecessarily to prevent leaving the wheels unlocked.
• Consider how a client’s size and weight may impact the stability of
the chair, particularly when the chair is raised.
• Do not allow children to play on or under the chair.
• Reduce clutter in and around the treatment area. Keep equipment
or other objects away from the chair’s foot switch to avoid accidently activating the pedal.
• Perform regular housekeeping to remove hazards that may cause
injury.
• Consider the benefits of using signage to further alert clients to the
dangers of not following safety instructions.
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2.3.8
Safety equipment/PPE
protective equipment)
(personal
The following should be available for the podiatrist’s use to prevent injury
and infection in the clinic and workroom (see the Infection Prevention and
Control Guidelines for Podiatrists at http://www.apodc.com.au/):
• Eye protection
• High filtration mask
• Sterile and non-sterile gloves
• Gown / Apron
Podiatrists practising in institutional facilities including hospitals and
nursing homes should be aware of the dangers associated with lifting and
transferring of patients on-site. Training in local transfer techniques is advised as is the use of assistance of staff members. If treatment of patients at
the bedside is unavoidable, the number treated in any given session should
be limited and the podiatrist should avoid potentially injurious postures
and take frequent breaks.
2.3.9
Hazardous Substances
Podiatrists use a wide range of materials. Many of these products may
contain chemicals that are classified as hazardous substances. Exposure to
these chemicals can increase the risk of various health problems.
Hazardous substances can enter the body through the skin, by inhalation
or by swallowing. Acute he alth effects, such as eye and throat irritation,
may occur almost immediately after exposure. Chronic health effects, such
as allergic contact dermatitis or cancer, take some time to develop.
The likelihood of a hazardous substance causing health effects depends on
a number of factors, including:
• The toxicity of the substance
• The amount of substance that workers are exposed to
• The duration of exposure
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• The frequency of exposure
• The route of entry into the body, e.g. skin absorption, inhalation or
ingestion
You can determine whether a product is hazardous to health by reading its
label and the material safety data sheet (MSDS).
2.3.10
Hazardous substances laws
• Most jurisdictions have introduced hazardous substances regulations under workplace health and safety laws. These regulations
apply to all workplaces where hazardous substances are used or
produced. To ensure that workers are not exposed to health and
safety risks, the regulations require employers to:
• Obtain information about the chemicals used in the workplace.
• Find out what the risks are (conduct a risk assessment).
• Control the risks by eliminating or reducing exposure to the substance.
• Provide training in the safe use of these substances.
• Conduct air monitoring (if required).
• Arrange health surveillance (if required).
• Keep records, such as a register of hazardous substances, current
MSDS, risk assessment results.
The following table lists some of the hazardous substances used in podiatry clinics and their potential risks:
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Product
Hazardous
Substance
Wart treatment/ Liquefied phenail surgery
nol
Trichloroacetic
(Monocholacetic) acid
Histofreezer Dimethyl
Cryosurgical
ether Propane
system
Isobutene
Plaster of paris Calcium sulphate
Risks
Methylated
Ethyl alcohol
spirits (cleaning
solvent)
Highly flammable, harmful to eyes
and respiratory system
Disinfectants
Adhesives
Medicament
Grinding
stones/wheels
Gases
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Causes burns to skin and eyes
Corrosive – causes burns to skin, vapours irritating to eyes and respiratory system
Flammable, causes freezing on contact with skin and eyes, inhalation of
vapour causes headaches, dizziness
Dust harmful – may aggravate respiratory conditions
Quarternary
Irritating to eyes and skin
ammonium
compounds
Gluteraldehyde Toxic, irritating to eyes, respiratory
system and skin – headaches, nausea, asthma, allergic contact dermatitis
Solvents
Highly flammable, harmful to skin,
eyes and respiratory system
Potassium hy- Caustic
droxide
Aluminium
Inhalation of dust and fumes harmoxide Silicon
ful
carbide Zinc
oxide
Propane BuHighly flammable, asphyxiant
tane
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2.3.11
Where to Get Information
Labels
• Ensure that containers of chemicals and other substances in your
workplace have labels attached. A label must be in English and display the product name, risk and safety phrases, dangerous goods
symbols (identifying dangerous properties e.g. flammable, toxic,
corrosive) and directions for use.
• Ensure that the contents of a container can be easily identified and
used correctly.
• Always store chemicals in original containers.
• If a chemical is transferred from one container to another, and the
substance is not entirely used immediately, you must ensure that
the second container is properly labelled and will not react with the
chemical. Do not pour chemicals into food or beverage containers.
• If the contents of a container are unknown, it should be labelled:
“CAUTION: DO NOT USE – UNKNOWN SUBSTANCE”.
• Store all unknown substances in isolation until the contents can be
identified and properly labelled. If the contents cannot be identified, they should be disposed of in accordance with local Waste
Management requirements.
Material Safety Data Sheets (MSDS)
MSDS are a major source of information about a chemical product and is
additional to the information provided on a label. It contains information
about chemical ingredients, potential health effects, precautions for use,
safe handling and storage, first aid and emergency procedures.
The value in having an MSDS is that this information can be incorporated
into your work practices. You are required to keep a register containing a
list of all hazardous substances used in your workplace and a copy of the
current MSDS for each substance.
The supplier of the product must provide an MSDS for each hazardous
substance with the first order and also upon your request. Manufactur35
ers and importers of hazardous substances are responsible for preparing
MSDS. An MSDS should not be more than five years old.
An MSDS should alert you by providing enough information to identify
where a chemical may release another hazardous substance during normal use. MSDS should be available where chemicals are stored, mixed or
used.
Self-employed persons should note that they cannot ensure their own
health and safety unless they are familiar with MSDS information for the
substances they use.
Risks associated with a chemical can affect the way it is used and stored.
Therefore, it is important to know what chemicals are used, the potential
risk of using the chemical and ways to reduce the risk. This is why a Risk
Assessment must be done and why all materials used in the podiatry clinic
must have MSDS.
2.3.12
How to do a Risk Assessment for
Hazardous Substances
Divide your work into tasks
Look at each work process and divide it into separate tasks. Include processes such as cleaning the clinic.
Identify all substances used and released in the process
Make a list of all the products and materials that you use in each task, e.g.
(example) adhesive, disinfectant, plaster. Check processes that release airborne contaminants such as dusts, fumes, vapours or mists.
Find out which substances are hazardous
Check the label and MSDS to find out whether the product contains a hazardous substance or not. If you are unsure whether a substance is hazardous, contact your supplier.
Obtain information about the hazards
Read the label and MSDS for each hazardous substance to find out how it
should be used and stored safely.
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Inspect and evaluate exposure
The work process should be analysed to find out how each substance is
being used:
• Are workers being exposed to the hazardous substance?
• How often are they exposed? For how long? How much are they
exposed to?
• What is the route of exposure? (e.g. skin or eye contact, inhalation,
ingestion).
• Are safe operating procedures in place (e.g. lids replaced on containers immediately after use)? If so, are they being followed?
• Are control measures in place (e.g. fume/dust extraction system)? If
so, how effective are they?
In some instances it may be necessary to have the level of hazardous substances in the air monitored.
Evaluate the risk
Information from the previous steps should enable you to establish whether the risk for adverse health effects is high, medium or low, depending
on:
• The nature and severity of each hazardous substance
• The degree of exposure to persons in the workplace
• Whether existing control measures adequately reduce exposure
Decide what to do to control the risk
In most cases, controlling the risk will simply involve following the precautions described in the MSDS. Ensure that your staff are trained in using
chemicals safely and have access to the MSDS. You will also need to set a
date for reviewing the work processes to check that exposure levels remain
acceptable and that staff are monitored for adverse health effects.
2.3.13
Controlling Exposure
Eliminate exposure to hazardous substances
• Remove hazardous substances from the clinic (if possible).
• Substitute with a less hazardous substance.
• Use a disinfectant that does not contain harmful gluteraldehyde.
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• Isolate the substance from the operator.
• Use and store adhesives in a fume cabinet.
2.3.14
Engineering Solutions
Modify the process to reduce exposure:
• Trimming insoles with scissors instead of grinding reduces exposure to dust.
• Use dust extraction systems with grinders and drills.
Administrative controls – safe work practices
• Store chemicals away from energy sources, such as fuse boxes, heat
and intense light sources.
• Never mix chemicals that should not be mixed together.
• Clean up any spills immediately with an absorbent material (e.g.
cotton wool, paper towel) – follow the instructions on the MSDS.
• Chemical spills – consider PPE and neutralizers (caustic or solvent).
• Keep lids on containers when they are not in use.
• Purchase chemicals in ready-to-use packages instead of transferring from large containers.
• Do not eat, drink or smoke in areas where chemicals are used or
stored. Always wash hands before eating, drinking or smoking.
• Ensure chemicals are disposed safely. The disposal of waste materials, especially hazardous substances, via the sewerage system
impacts on local freshwater and marine ecosystems.
2.3.15
Personal Protective Equipment
• Provide gloves, aprons, respiratory and eye protection to reduce
the risk of exposure. In all cases, protective equipment must be appropriately selected, individually adapted and users trained in its
correct use and maintenance.
• Barrier creams and protective tape should be applied on exposed
skin areas if bothered by skin irritation.
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• A face shield or safety glasses should be worn where there is a slight
chance of chemical or dust entering the eye. Wear safety glasses
over contact lenses or replace contact lenses with prescription safety glasses with side protection.
2.3.16 Airborne Contaminants
Fumes and Vapours
–
Dust,
Fumes, vapours and fine dust particles in the air can enter your lungs. If
too much dust reaches the lungs, it can overwhelm the lungs’ own defence
system, causing damage to the lung tissue. Some types of dusts, such as silica, cause permanent scarring in the lungs, known as fibrosis. Other types
of dusts can trigger asthma attacks.
Even the larger dust particles that do not reach the lungs can cause health
problems. Dust in the nose and in the tubes leading to the lungs can irritate
them, causing rhinitis or bronchitis.
Factors that generate dust in podiatry clinics are: grinding materials and
burring nails. Liquids such as solvents release harmful vapours. Aerosol
sprays release fine mist and heating materials such as thermoplastics/EVA
generates fumes that can also be inhaled.
Controlling Exposure
If there is airborne exposure to hazardous substances, you must control
exposure so that the relevant national exposure standard for that substance
is not exceeded. Work involving hazardous substances should occur in a
well-ventilated area.
Natural ventilation generally does not provide sufficient airflow to be suitable for use as a method for controlling exposure to airborne contaminants
in the podiatry clinic.
Air conditioning dilutes the contaminated air rather than removing it and
circulates airborne contaminant around the room. Unless there is uniform
airflow, it is likely that pockets of air will remain contaminated for long
periods.
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Local exhaust ventilation is a more effective way of removing airborne contaminants at the source, before they can be breathed in. When installing
dust/fume extraction units, care must be taken in the design of the system
to ensure that it draws contaminated air away from, rather than past a person’s nose and mouth (breathing zone).
The breathing zone is a hemisphere of 300mm radius extending in front of
a person’s face:
• Replace filter bags in dust extraction units regularly.
• Dusty work processes should be isolated where possible.
• Good housekeeping procedures are essential. Do not use compressed air to remove dust from surfaces such as bench tops. This
releases contaminants back into the air. Clean surfaces by vacuuming or using wet cloths, mops or rinse items under water.
• Appropriate respirators should be worn. Note that dust masks do
not provide protection against chemical vapours.
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Air Quality Checklist
• Do strong odours linger for more than 10 minutes?
• Can strong odours be detected at a distance form the source (ie. the
other side of the room)?
• Can you still smell odours when you open the laboratory in the
morning?
• Do the walls ever “sweat” with moisture or the windows become
foggy?
• Do you ever have to open windows or doors because odours become too strong?
• Do visitors/patients complain of offensive odours?
• Is there a build up of dust around the clinic?
• Do workers complain of health effects such as headaches, sore eyes
or respiratory problems?
If you answered yes to one or more of these questions, the ventilation in
your clinic may need improvement.
2.3.17
Provide Information and Training
Your staff must know how to use hazardous substances safely. Training
should cover:
• Reading and understanding labels and MSDS
• Where the MSDS are kept
• The health effects associated with the use of hazardous substances
• Safe handling and storage procedures
• Use of personal protective equipment
• Clean up of spills, first aid and emergency procedures
Ensure that you update training when there is a change in: materials used,
in work practices or control measures.
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2.3.18
Biological Hazards – Infection
Control
Please refer to the Infection Prevention and Control Guidelines for Podiatrists 2012.
2.3.19
Mechanical Safety
There are various hazards which may be encountered when operating
equipment in the podiatry clinic, for example:
EQUIPMENT
Grinder/belt sander
Heat guns/autoclaves
Podiatry chairs
HAZARD
Noise, dust, entanglement, vibration, electrical
hazard
Burns, electrical hazard
Falls coming onto, or off the chair
• Purchase equipment with built-in safety features.
• Check that all control/knobs can be operated easily.
• Ensure that all tools and equipment are in good working order by
conducting regular maintenance checks.
• Follow manufacturer’s instructions and use tools and equipment
only for the purposes for which they were designed.
• Choose a suitable location to operate the equipment, providing
sufficient space around the equipment for it to be safely used and
maintained.
• Ensure that machinery is only operated by staff trained in its use.
• Where possible, provide guarding if equipment has moving parts.
Hinged, clear screens should be used on grinders and belt sanders.
• Ensure that equipment is securely anchored to the floor or bench
and will not move advertently during operation.
• Grinding belts, discs and burs should be used at or below the maximum speed recommended by the manufacturer. Replace when
they become worn or blunt. Know the characteristics of grinding
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and cutting tools and use only on materials for which they were
designed.
• Provide suitable gloves and/or tongs to remove hot items from ovens.
• Eye protection and dust masks should be worn during grinding
and polishing.
2.3.20
Electrical Safety
Electricity is an invisible hazard and therefore it is easy to become complacent about electrical risks. The two major causes of electrical accidents are:
• Lack of maintenance of electrical equipment
• Unsafe work practices
The following control measures are necessary to ensure that risk of injury
or death from electric shock for all people at the workplace is reduced as
far as is reasonably practicable.
Electrical equipment must be either:
• Inspected, tested and tagged (some states require annual inspections), or
• Connected to a residual current device (RCD) or safety switch
Visual inspection
Conduct regular (monthly intervals at least) visual inspections of electrical
equipment to check that:
• Equipment (including accessories, connecting lead and plug) has
no obvious external damage or inadequate temporary repairs.
• Inner cores of electrical leads are not exposed and outer coverings
are not cut, frayed, worn or otherwise damaged.
• Sockets are not cracked or broken.
• The connection of the lead to the appliance is secure.
• Control switches/knobs are undamaged and secure.
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Testing and tagging
Electrical equipment needs to be regularly inspected, tested and tagged
by a qualified electrical worker. A durable, non-reusable, non-metallic tag
must be attached to the equipment’s flexible supply cord to indicate that
the equipment has been tested within the time prescribed in the table over
page.
Safe work practices
• Ensure that workers are trained in the use of the equipment and
that manufacturer’s instructions are followed.
• Keep electrical equipment away from wet or damp areas, unless
waterproof electrical equipment is used.
• Ensure flexible leads are fully unwound and kept away from heat,
chemicals, sharp edges and traffic areas to prevent insulation damage.
• When adjusting or cleaning equipment, always switch off the power and pull out the plug – not by the cord.
• Do not touch equipment with wet hands and do not use a wet cloth
to clean sockets.
• Do not operate too many appliances from one socket – install additional power points to avoid overloading problems.
• Use power boards with overload switches instead of double adaptors.
• Maintain a list of all electrical equipment and record the date of
inspection and testing, as well as details of any repairs and maintenance carried out.
• Faulty equipment should be withdrawn immediately from service
and have a label attached warning against further use. Arrangements should be made, as soon as possible, for such equipment to
be disposed, destroyed, or repaired by an authorised repair agent.
Residual current device (RCD)
Electrical equipment can be connected to an RCD, which may be either
portable or installed at the switchboard. An RCD must be tested immedi44
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ately after connection and at least every three months (push-button test). A
competent person must also test the device for operation every two years.
The use of an RCD can enhance safety but does not remove the need to
observe safe work practices and conduct regular maintenance.
Australian Standard 3760: 2001 provides frequency of inspection and testing recommendations.
2.3.21
Gas Cylinders
Many podiatry clinics use gases from portable cylinders in which the gas is
contained at high pressure, eg. cryotherapy systems, liquid nitrogen. The
hazards associated with the use of gas cylinders relate to the accidental
escape of the gas, whether in liquid or vapour form, increasing the risk of
fire, explosion, asphyxiation, corrosion, cold burns or frostbite. There are
many smaller systems in use also.
Dangerous Goods classification for gases is:
Class 2.1
Class 2.2
Class 2.3
Class 5.1
Flammable
Non Flammable
Toxic
Oxidising
Obtain Material Safety Data Sheets for the gases that you are using. Check
the requirements of Dangerous Goods legislation in your State/Territory.
Avoid the indoor use and storage of gas cylinders wherever possible. Where
it is impracticable to provide an outdoor storage and reticulation system,
the keeping of cylinders is subject to the following precautions:
• Use cylinders only if they are properly labelled.
• Check the test date for older cylinders – cylinders should be tested
every 10 years.
• Protect the cylinder against falling, damage and excessive temperature rise.
45
• Cylinders should be stored securely on a level, dry surface to prevent corrosion.
• Store cylinders away from sources of heat and ignition, combustible or waste material.
• Cylinder valves must be kept closed when not in use.
• Store cylinders upright, ensuring that the pressure-relief device is
in communication with the vapour space.
• The storage area must be adequately ventilated.
• Do not store cylinders in locations that may jeopardise escape from
a building in the event of fire.
• Where a cylinder is designed to incorporate a detachable valve cap,
the cap should be kept in place when the cylinder is not in use.
• Whenever possible use a cylinder trolley for transporting large cylinders.
• Never let oil or grease contact your cylinder or fittings, especially
oxygen equipment.
• Regularly check hoses, connections, valves and pressure regulators
for faults and leaks. Test for leaks using soapy water.
• Where cylinders are used or located indoors, the total capacity
should not exceed two 9kg cylinders, which includes cylinders in
use, spare cylinders not in use and empty cylinders awaiting removal.
References:
Australian Standards
AS 4332: 1995 – The storage and handling of gases in cylinders
AS/NZS 1596: 2002 – The storage and handling of LP Gas
2.3.22
Fire Safety
Prevent fires by following safe work practices:
• Don’t allow rubbish to accumulate.
• Use Australian Standards approved safety cans for carrying or
pouring flammable liquids.
• Store and use flammable liquids in a well ventilated area away from
ignition sources.
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• Avoid storing large quantities of flammable substances.
• Ensure electrical leads and appliances are in good working order.
• Never overload circuits.
• Prevent leaks and spills of flammable gases and liquids.
Be well prepared in the event of a fire:
• Ensure all exits are marked and kept clear of obstacles.
• Install smoke alarms and sprinkler systems.
• Ensure that you have appropriate fire extinguishers. Each building and premises with in it needs a fire evacuation plan placed in a
public place, with exit points and an evacuation route/ safe meeting
point marked. There needs to be a person allocated to monitor the
fire extinguisher maintenance at least 6 monthly and that training
is done for all users of the premises annually.
Location of Portable Fire Extinguishers:
Each extinguisher should be located in a conspicuous and readily accessible position. Where practicable, extinguishers should be located along
normal paths of travel and near exists.
For non-domestic installations, extinguishers in and around buildings
shall:
a.
have their locations clearly identified with an appropriate sign.
https://www.fire.qld.gov.au/planning/.
b.
be mounted at the appropriate height and the extinguisher, or extinguisher location sign, shall be clearly visible from a distance up
to 15m in all directions of approach.
Type of Fire Extinguisher:
There is no one type of fire extinguisher that will universally cover all
classes of fires. Therefore careful consideration must be given to all factors
likely to cause fires in order to select the most suitable fire extinguisher, or
combination of fire extinguishers.
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The following lists the various types of fire classifications:
• Class A - Fire involving carbonaceous solids, such as wood, cloth,
paper, rubber and many plastics
• Class B - Fires involving flammable and combustible liquids
• Class C - Fires involving combustible gases
• Class D - Electrical Hazards
Electrical Hazards
Where a fire is due to an electrical hazard can be expected, the extinguisher must be electrically non-conductive, in addition to having the relevant
classification. The marking of [E] on the fire extinguisher indicates that it is
suitable for use on fires involving live electrical equipment.
NOTE: Extinguishers produced between 1976 and 1981 were marked [C] to
indicate electrical non-conductivity.
Gas Hazards
A floor plan displayed near the entrance to the clinic should also indicate
the location of gas cylinders. Different gases should be stored separately.
Factors which affect the selection of fire extinguishers include:
a.
Choice of an appropriate extinguisher for the type of fire most likely to occur.
b.
Size and mass of the fire extinguisher and the ability of the user to
carry and operate it.
c.
Effects of environmental conditions on the fire extinguisher and its
support fixture.
d.
Possibility of adverse reactions, contamination and other effects of
an extinguisher on products or equipment.
e.
Possibility of winds or draughts affecting the distribution of the extinguisher.
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Maintenance: Maintenance should be carried out every six (6) months in
accordance with ’Australian Standards 1851.1”.
WHAT TO DO WHEN A FIRE STARTS
• If there is no danger, assist any person/s in immediate danger.
• Close the door.
• Call the Fire Brigade on triple zero, 000.
• Attack fire if SAFE to do so.
• Evacuate to assembly area.
• Remain at assembly area and ensure everybody is accounted for.
Never place a used extinguisher back on its hook or bracket.
2.3.23
Noise and Vibration
Noise
Various processes and equipment in podiatry clinics emit noise. Besides
the risk of hearing loss, exposure to high or continuous levels of noise can
also result in fatigue and distraction. Noise is a problem if it is difficult to
hear a normal voice within a distance of one metre.
The current noise exposure standard sets a limit of 85 dB(A) for exposure
to an 8 hour equivalent continuous sound pressure level. For impulsive
noise, the existing peak noise standard is 140 dB. Three elements which
need to be considered in controlling noise are:
Noise source  Noise path  Noise receiver
1.
Control noise at the source:
• New equipment usually has lower noise levels than older versions.
• Regularly lubricating and servicing equipment will also reduce the
noise level.
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2.
Isolate the noise:
• Place noisy equipment, such as a belt sander, in another room or
enclose the unit in a soundproof box.
• Rearrange the layout of the workplace to separate noisy work activities from quieter activities.
3.
Protect the worker:
If exposure is still excessive after all possible control measures have
been taken, individual protection in the form of earmuffs or earplugs should be used.
Vibration
Podiatrists are exposed to hand vibration when holding a work piece
against a moving tool, such as a grinding wheel or when using a hand drill
to burr nails.
The most common condition caused by prolonged exposure to high levels
of local vibration is “vibration white finger” or Raynaud’s disease. Initial
symptoms are slight tingling and numbness. Later the tips of fingers have
attacks of whiteness and are painful; with continued exposure to vibration the fingers turn permanently blue-black, sometimes with the advent
of skin necrosis.
Precautions
The most dangerous frequencies appear to be between 40 Hz and 120 Hz.
Disabilities from hand vibration are significantly increased when the operator’s hands are cold.
Reduce vibration by:
• Using insulating covers on hand tools.
• Replacing old equipment with new equipment that has less vibration.
• Regularly servicing machinery.
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• Mounting machinery on a heavy base.
• Care should be taken when using an ultrasonic cleaner. Fingers
should never be placed into the unit while it is operating.
2.3.24
Work Environment
Construction of Premises
It is recognised that not all existing clinic premises are designed to meet
current standards, however if businesses renovate, relocate or if you are
opening a new businesses - these standards should be met.
Planning for new construction or major renovation requires early and continuous consultation between architects, engineers, government authorities and trade persons all of whom are familiar with the requirements of
the podiatry industry, to ensure compliance with workplace health and
safety legislation. Consult other clinics to ascertain what problems, if any,
they encountered.
Workplace health and safety and infection control issues must be considered at all stages of the design and construction of new premises. Access
and egress, the texture of flooring, height and positioning of sinks/basins,
benches and switches must all be taken into account during the design
phase as they may be difficult and or expensive to rectify after completion
of the works. Work practices during and after construction of the premise
or facility must incorporate workplace health and safety principles.
Additional Resources
• Building Code of Australia
• The Australian Commission on Quality and Safety in Health Care
Standards (2011), and
• Relevant Australian Standards such as AS 4187 - 2003 Cleaning,
disinfecting and sterilising reusable medical and surgical appliances and equipment, and maintenance of associated environments in
health care facilities
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Floor Surfaces
Uneven or slippery floors hinder smooth movement, make floor surfaces
unpredictable and increase the likelihood of slips, trips and falls. The presence of steps, changes of floor coverings, etc can also increase the risk of
injury.
Measures to reduce the risk of injury from inadequate floor surfaces include:
• Using non-slip surfaces. This does not have to be expensive. However, the use of carpet in the clinic area is not recommended as it
contravenes infection control standards.
• Wearing shoes with low heels, non-slip soles and which enclose
and support the whole foot.
• Spillage of water, oil, chemicals and other substances is common on
floors and should be removed as soon as possible.
Lighting
Poor lighting can adversely affect safety and can contribute to:
• Accidents and injuries
• tired, sore eyes
• headaches
• blurred vision
Common lighting problems include too much or too little light. Glare and
shadows can force the worker to use awkward body positions to see work.
Poor lighting conditions can increase the risk of injury. For example, going
from areas of bright light to shadow can temporarily impair vision and
increase the risk of tripping. A good lighting system eliminates shadows,
and highlights potential hazards.
Natural or artificial light needs to be at appropriate levels for the task.
Some activities will require lamps to provide adequate light on the work
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area. Effective lighting includes:
• Illuminating the complete work area using daylight type fluorescent tubes.
• Light intensity of 3000 lux to see very fine detail.
• Prismatic covers over the fluorescent tubes will eliminate harsh
shadows or glare.
• replacing bulbs or tubes as they age and lose light emitting capacity.
• Keeping light covers and windows c lean.
• Providing blinds, curtains or window tinting to control glare.
Air Quality
Air quality is influenced by:
• Temperature – in an air-conditioned workplace, the ideal temperature range is between 19-23°C in winter and 22-24°C in summer.
• Humidity – relative humidity levels should ideally be between 40%
and 60%.
• Air movement – too little airflow may create stuffy indoor environments whereas too much air movement causes draughts. An airflow rate of between 0.1 and 0.2 metres per second is ideal.
• Air contaminants – exposure to hazardous dust, fumes and vapours may cause a range of health effects such as headaches, eye
irritation and respiratory conditions. Regulations vary from state to
state re: smoking in the workplace: see http://www.ashaust.org.au/
SF%2703/law.htm, generally there is a 4 m exclusion zone around
entrances to the workplace.
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Common causes of air problems
Air-conditioning systems
Examples
• Design
• Inadequate cooling capacity
• Operation
• Not turned on before occupants arrive
• Maintenance
Building material
• New
• Filters not changed
• Damaged
Work activities
• Grinding, polishing
• Mould on water-damaged carpet
• Using chemicals
• Chemical vapours, odours
• Using ovens
• Heat producing
People
• Smoking
• Paint, fabric, carpet - releasing pollutants
• Dust
• Body odour
• Perfumes
Outdoor air
• Entering through air- • Exhaust fumes, dust, pollens
conditioning systems
and through open
windows/doors
Air-conditioning systems can provide a comfortable indoor environment
in terms of air temperature, humidity and air-movement. If an air-conditioning system is installed, it should operate whenever people are in the
workplace. Air -conditioning systems need to have air filters cleaned and
monitored at least every 3 months. Systems which operate by automatic
timer should have an override facility if people are required to use the
building out of normal work hours. The following factors need to be considered in assessing the thermal environment:
• Effect of solar heat (sun shining through window) and heat sources
inside the laboratory (furnaces)
• Clothing worn by workers, including protective clothing
• Nature of the work being performed
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• Individual perceptions of thermal comfort
• Ways to control thermal comfort
• If an air-conditioning system is installed, adjust temperature and
humidity.
• Avoid locating workstations directly in front of or below air-conditioning vents to prevent staff being affected by draughts. Install
deflectors on air vents to direct airflow away from people.
• Shield windows using reflective glass, blinds or awnings.
• Relocate workstations away from heat sources.
2.3.25
First Aid
In addition to being a legal requirement, workplace first aid:
• Saves lives/reduces the severity of injuries.
• Reduces pain and anxiety.
• Reduces the cost of injuries.
• Contributes to a safer workplace.
To determine adequate first aid provisions, list the types of injury and illness that could occur in your workplace and their potential causes. Consider the size and layout of the workplace as well as the number of staff.
Also include first aid requirements for patients and visitors – be aware of
any medical conditions and special needs.
All podiatrists are required to hold a current CPR Certificate which must
be renewed according to the course providers’ certification on the term of
currency.
Requirements for First Aid Kits
Contents – will depend on your workplace hazards and the types of injury/
illness likely to occur. Quantity of items may depend on the size of the
clinic. Basic First Aid kits should include the following:
• Adhesive plastic dressing strips, sterile, pkt of 50 Dressing, non adherent sterile 7.5cmx7.5cm Gloves, disposable single
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• Safety pins, packet
• Gauze bandages 50 mm, 100 mm
• Swabs, packet of 10, pre-packed, antiseptic Triangular bandages
• Antiseptic 50ml Savlon or equivalent
• Scissors, blunt, short nosed, min. length 12.5 cm
• Eye pads, sterile
• Resuscitation masks/bags
• Rescue Blanket
• Adhesive dressing tape 2.5 cm x 5 m
• Sterile eyewash solution, 10ml single use
• Ampoule
• Kidney dish
• Wound dressing No. 14
• Splinter forceps, stainless steel
• Number of kits – at least one first aid kit should be provided for each
workplace. If necessary, consider locating a “central” first aid kit in the
laboratory and a smaller kit in the clinic.
• Location of kits – close to areas where there is a likely risk of injury/
illness occurring. They should be clearly visible and easily accessible.
First aid kits should be provided for persons working in remote areas
or in vehicles where access to medical and emergency services may be
limited.
• Signs – the following symbol should be displayed on the outside of the
first aid kit:
First Aid Symbol – white cross on green background
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• Information – a list of contents should be provided with the kit. Names
of trained first aiders should also be displayed with important telephone numbers, including 000.
• Management – the trained first aider should be responsible for assessing kit requirements, checking and restocking contents and ensuring
kits are accessible and not locked whenever staff are at work.
2.3.26 First Aid Awareness
All staff should be given information about:
• The type of first aid facilities in the workplace
• The location of first aid kits
• The names and work phone numbers of person/s responsible for
rendering first aid
• The procedures to be followed when first aid is required
2.3.27 Recording of Injuries
First aid record systems should be integrated with other incident and accident reporting systems, in particular with the Register of Injuries required
by workers compensation laws. The first aid report form should be completed by the trained first aider and include information on:
• Name of injured person
• Date and time
• Description of symptoms
• Treatment provided
• Any referral arrangements (e.g. ambulance, hospital, medical service)
Remember to keep personal information about the health of an employee
or patient confidential.
Any patient injury should be reported to your professional indemnity insurer to ensure future claims arising from the injury are covered.
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2.3.28
Domiciliary
The podiatrist should ensure at all times when carrying equipment into the
patient’s home that:
• Correct back posture is maintained whilst lifting.
• Not too many items are attempted to be carried inside at once (multiple trips are better than overloading one trip).
• Only equipment that is necessary should be taken into the home.
It is advisable that the podiatrist does not treat in any one position for
a prolonged period, particularly if unnatural such as sitting on the floor.
Regular breaks to stretch the back are recommended and treatment positions should be altered often.
Allow enough time to pack/unpack the car, arrange furniture at the home
of the patient to provide the best possible treatment setting, conduct the
treatment, pack equipment, write up the patient history and make a follow
up appointment. Be realistic about the number of patients it is possible to
treat in a day (on average, one per hour- depending on travel time).
1.
ACT workcover. Please go to web address: http://www.worksafe.
act.gov.au/health_safety
2.
ACT WorkCover Small Business Health and Safety Toolkit, 2000
3.
ACT Dept. of Health, Housing and Community Care Infection Control Guidelines for Office Practices and other Community Based Facilities, September 2001
4.
NSW Draft Health Infection Control Guidelines for Dental Health
Care Settings, Oct. 2001.
5.
ACT WorkCover First Aid in the Workplace Code of Practice, April
1994 (State based legislation - http://www.business.gov.au/BusinessTopics/Occupationalhealthandsafety/Pages/ActsandCodesofPracticeinyourstateorterritory.aspx)
6.
Chubb Fire
7.
Brady Australian Pty Ltd. Catalogue
8.
Building Code of Australia
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9.
The Australian Council on Health Care Standards (ACHS) EQUIP
Guide
10.
Australian Standards :
• AS/NZS 3760: 2003 - In-service safety inspection and testing of electrical equipment
• AS 4332: 1995 – The storage and handling of gases in cylinders
• AS/NZS 1596: 2002 – The storage and handling of LP Gas
• AS/NZS 1716:2003/Amdt 1:2005 - Respiratory protective devices
2.4 Clinical Coding
2.4.1
Background
Currently two formats for the description of clinical interventions and professional activity have accepted national usage. The Minimum Data Set is
commonly used in the public sector and includes methods for describing
clinical activity for which the patient may not actually be present and important professional duties which are not specifically attributable to individual patients. It is the only acceptable format for data processing used
by the national Centre for Classification in Health, supported by the Case
Payment section of the Casemix branch of the Commonwealth Department
of Health. This Centre is responsible for developing national consistency in
classification for morbidity and mortality for Australian healthcare services.
The codes are listed for inclusion in the MBS - Extended Procedure Classification in the ICD - 10CM (International Coding of Disease - 10th Clinical
Modification). Although these codes were developed for use in the acute
hospital sector, a standardised form of data collection nationally enhances
comparability and improves information and decision making processes
in health planning and service evaluation. As the National Casemix project
moves from acute care into the rehabilitative and ambulatory settings these
codes will become more important to podiatrists practising in the public
health sector, where recognition of service provision which is not directly
therapeutic and costs of expensive items such as orthoses and wound care
must be taken into account when determining funding formulae.
The Podiatrists Procedural Terminology describes direct interventions
and is generally used in the private sector. It provides an accepted format
for health funds and government departments including Department
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of Veterans’ Affairs and Workcover to identify services provided more
accurately and provides a common reference system for negotiation with
appropriate bodies.
2.4.2
Minimum Data Set
National Reference Standards Project
The Allied Health Minimum Data Set was developed with Federal Government funding and support and was auspiced by the National Allied
Health Casemix Committee. It provides a framework for data collection
which ensures consistency in the collection format and accuracy if data is
to be collected and compared from more than one site. It also provides a
useful basis for any costing projects or funding formulae.
Generic Minimum Data Set
Definitions
Clinical Care: Activities which provide a service to an individual, group or
community to influence health status.
Clinical Services Management Support: activities essential to clinical care.
Teaching and Training: Activities which relate to the imparting of knowledge, skills and clinical competency.
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Research: Research activities undertaken to advance the delivery of care to
an individual, group or community.
Clinical Care is partitioned into activities which can be attributed to an individual patient (IPA) and clinical care activities which cannot be reasonably
attributed to an individual patient (NIPA). Ten or more minutes of time
is considered a reasonable amount at which activity should be attributed
to an individual Unique Identifying Number (or person / client / patient.)
Large groups, for example, with whom a practitioner might spend 15 minutes in health promotion or education, could be recorded under Clinical
Care but as Not Individual Patient Attributable.
Patient Attributable Podiatry Intervention Codes have been developed for
use when recording Discipline Specific Activity. If the data collection site
format allows for recording only one intervention and several occur during one consultation (e.g. callous reduction, biomechanical assessment and
impression casting), it is advisable to re-enter the UR number and record
interventions separately.
Note that travel can be considered as an activity appearing in any of the
splits of Clinical Care or as a Clinical Services Management activity.
2.4.3
Podiatrists’ Procedural Terminology
Introduction
The Podiatrists’ Procedural Terminology is a recommended schedule of
services that has been adopted by the Australasian Podiatry Council in July
1997 for use by individual practices when rendering podiatric services in
private practice.
Definitions
New Patient:
A patient new to the podiatrist.
Established Patient:
A patient known to the podiatrist with records on file.
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General Services and Consultations:
Includes - history taking, assessment, diagnosis and treatment plan preparation and clinical interventions performed. This also considers administrative time and costs in preparing new patient/client files. Other independent services or interventions may be itemised separately at the discretion
of the practitioner.
Brief Service:
Should be used in the case of short, uncomplicated consultations and includes cutting of non-pathological toenails in the absence of any associated
local or systemic pathology.
Home-Based, Domiciliary:
The items are listed separately due to the additional cost incurred in transport and preparation of equipment and materials.
Extended Care:
Includes all hospital (public and private), nursing home, hostel and any
other institution visits, where more than one patient is seen during the attendance. Fee scheduling takes into account the additional costs incurred
in preparation of equipment and materials and complexity of care issues.
Diagnostic Services:
It is presumed that a certain amount of assessment is performed with all
general consultations. These codes are available for the scheduling of significant and comprehensive diagnostic examination, necessary for the development of a treatment plan and implementation of associated therapy.
Orthomechanical Services:
Each code is representative of an intervention performed on or provided
for one foot. In the event that both feet are treated or a pair are provided,
the client/patient will be billed twice, indicating left and right, on the account or receipt rendered.
There are two codes for custom-made orthoses moulded to a positive cast
of the client/patient’s foot - one for devices which have no plaster modification (F265) and a second for devices moulded to a cast with modifications
based on biomechanical measurement (F221).
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Fees billed for some codes involving supply of a full foot orthoses or shoe
insoles are likely to vary depending on the nature of materials utilised and
complexity of additions such as soft-tissue supplementary padding (F201,
F221, F263, F265, F271, F341, F331).
Physical Therapy:
Practitioners are advised to select the code that is most closely associated
with the therapy provided. The codes may be used as an alternative to the
General services codes, where an established client/patient presents for an
isolated physical therapy, or where a physical therapy intervention is provided in addition to a General service.
Podiatric Surgery:
The listed surgical procedures include the operation per se, all sterile packs
and other requisite materials and equipment, local anaesthesia and normal, uncomplicated, post-operative follow-up.
General Podiatric Services and Consultations:
CLINIC
The billing guide is a comprehensive list of F codes and descriptions of all
the services provided by podiatrists. It is used for private health insurance
billing and rebates. The billing guide can be obtained through both your
member association and the Australasian Podiatry Council.
2.5 Quality Improvement
2.5.1
What is Quality Assurance
Quality Assurance (Q.A.) is a planned and systematic approach to monitoring and assessing a service, which identifies opportunities for improvement and ensures that action is taken to make and maintain these improvements. Total Quality Management (T.Q.M.) refers to the philosophy which
complements quality assurance. Prevention of problems, risk management, continuous improvement, team work and satisfying customers are
the major themes.
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2.5.2
Why should ‘Q.A.’ be included in my
clinical program?
Essentially Q.A. serves to demonstrate the quality of services and care provided in a health care facility, providing factual information on which to
base decisions to plan and improve on service delivery. With increasing
demand to provide high quality healthcare at a cost the community can afford, public institutions in particular need a formal process whereby they
can objectively evaluate clinical programs and examine the effects of cost
containment to assist with future planning. As Q.A. also offers information
such as levels of patient satisfaction and offers public assurance through
process and documentation, its inclusion in private clinics is just as valid
and important.
2.5.3
Where do I start?
A quality assurance activity is usually generated as a result of monitoring
the objectives and functions of a service (e.g. reviewing outcomes of orthotic therapy), through identification of a problem (e.g. reduction in the number of referrals from a particular medical practice) or to answer a question
(e.g. is this facility’s Infection Control protocol up to date and adhered to?).
Many practitioners practice an informal Q.A. process in their day-to-day
clinical practice as they alter treatment methods based on the outcomes of
previous interventions with prior patient contacts.
The quality assurance process tends to be “cyclic” in nature. The changes
made as a result of assessment and evaluation and their effects on service
delivery must still be monitored. Thus quality assurance becomes an integrated part of the facility’s ongoing service provision.
2.5.4
Implementation,
The
Improvement Cycle
Quality
Monitoring Activities
This is a systematic, ongoing process to collect information on the objectives and core tasks of the service. Periodic monitoring may be commenced
to identify particular activities (e.g. following a change in work practice).
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tion review and performance indicators.
Assessment
This is the planning and problem solving aspect of the activity and includes:
1.
Determine the aim of the project.
2.
Identify and document clear objectives for the activity.
3.
Study method - determine the most appropriate ways of collecting
the required information.
4.
Set study parameters (including time frame, sample size and characteristics).
5.
Determine and develop instruments and tools (including questionnaires).
6.
Collect the data (ensuring validity and reliability).
7.
Collate and analyse the data - the analysis may identify a strength
or weakness.
8.
Action plans may be developed at this point.
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Action
The required action will result from the planning and problem solving process generated by the analysis of collated data. Action may not always be
necessary, particularly if no problem or weakness is identified.
Follow Up
If action has been taken it is necessary to ensure that the desired changes
have resulted or the identified problem has been resolved. Thus monitoring activities remains important and further assessment may be required
at a later date.
2.5.5
Clinical Indicators
A clinical indicator is defined as “a measure of the clinical management
and outcome of care”. The end product is actual numbers of patients who
fulfil or don’t fulfil a criterion or “indicator” of care. In order to effectively
evaluate clinical programs, appropriate indicators must be developed. The
three requirements of any indicator are:
1.
That data be available.
2.
That the indicator is relevant to the particular clinical practice.
3.
That the measure is achievable.
With improved methods for data collection, there is increasing prevalence
of nationally accepted clinical indicators which can be compared across
health care facilities to provide a “benchmark” for acceptable standards of
care, where a standard defines the acceptable level of achievement in that
area. This further offers the capacity to review associated processes and
contrast with other facilities in order to meet or even exceed benchmark
level.
Criteria for indicator selection are:
• The information can be captured (Source).
• Access to the information is possible (Confidentiality).
• Collection of the information is relatively easy (Method).
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• The information is available when required (Timeliness).
• The information reflects reality (Accuracy).
• Monitoring is achievable (Implementation).
• The indicator is meaningful to staff (Useful).
Examples of indicators include infection rates, response times (e.g. to referrals) and waiting lists.
References
http://www.racgp.org.au/your-practice/business/tools/support/indicators/
Australian Council on Healthcare Standards Ltd. (1996) The ACHS accreditation guide. Standards for Australian health care facilities. 13th Ed.
Australian Community Health Association. (1993) Community Health Accreditation and Standards Program (CHASP). 3rd Ed.
Australian Council on Healthcare Standards (1993) Clinical Indicators - A
User’s Manual: Hospital-Wide Medical Indicators. Vers. 2
Koch M.W., Fairly T.M.. (1993) Integrated Quality Management Mosby
Mason E.J. (1994) How to write meaningful standards of care 3rd ed Delmar publishers
2.6 Infection Control
A copy of the NHMRC guidelines must be kept on site (electronic or hard
copy) by law.
The ‘National Infection Control Guidelines for Podiatrists,’ have been written to reflect the principles behind successful infection control. It serves as
an essential tool for all podiatrists in the implementation of infection control strategies. Infection control should be practised in accordance with this
document, Communicable Diseases Network Australia guidelines, Australia and New Zealand Standards and State / Territory legislation, regulations and guidelines.
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All podiatrists are advised to obtain copies for reference. The ‘National Infection Control Guidelines for Podiatrists’ can be downloaded by members
from the APodC CPD Online site http://www.cpd.apodc.com.au/.
Summary of Infection Control as per NHMRC guidelines:
Healthcare-associated infections (HAIs) can occur in any healthcare setting. While the specific risks may differ, the basic principles of infection
prevention and control apply regardless of the setting.
In order to prevent HAIs, it is important to understand how infections occur in healthcare settings and then institute ways to prevent them. Risk
management is integral to this approach.
If effectively implemented, the two-tiered approach of standard and transmission-based precautions recommended in these guidelines provides
high-level protection to patients, healthcare workers and other people in
healthcare settings.
Infection prevention and control is integral to clinical care and the way in
which it is provided. It is not an additional set of practices.
Involving patients and their carers is essential to successful clinical care.
This includes ensuring that patients’ rights are respected at all times, that
patients and carers are involved in decision-making about care, and that
they are sufficiently informed to be able to participate in reducing the risk
of transmission of infectious agents.
The information presented in this part is relevant to everybody employed
by a healthcare facility, including management, healthcare workers and
support service staff.
Identifying and analysing risks associated with health care is an integral
part of successful infection prevention and control.
Adopting a risk-management approach at all levels of the facility is necessary. This task requires the full support of the facility’s management as
well as cooperation between management, healthcare workers and support staff.
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Differing types and levels of risk exist in different healthcare settings. In
developing local policies and procedures, each healthcare facility should
conduct its own risk assessment (i.e. how to avoid, identify, analyse, evaluate and treat risks in that setting), and also refer to discipline-specific guidance where relevant.
A patient-centred health system is known to be associated with safer and
higher quality care.
A two-way approach that encourages patient participation is essential to
successful infection prevention and control.
The use of standard precautions is the primary strategy for minimising the
transmission of healthcare-associated infections.
Transmission-based precautions are used in addition to standard precautions, where the suspected or confirmed presence of infectious agents represents an increased risk of transmission.
The application of transmission-based precautions is particularly important in containing multi-resistant organisms (MROs) and in outbreak management.
Medical and dental procedures increase the risk of transmission of infectious agents. Effective work practices to minimise risk of transmission of
infection related to procedures require consideration of the specific situation, as well as appropriate use of standard and transmission-based precautions.
The information presented in this part is particularly relevant to healthcare
workers and support staff. It outlines effective work practices that minimise the risk of transmission of infectious agents.
It is essential that standard precautions are applied at all times. This is
because:
• People may be placed at risk of infection from others who carry
infectious agents.
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• People may be infectious before signs or symptoms of disease are
recognised or detected, or before laboratory tests are confirmed in
time to contribute to care.
• People may be at risk from infectious agents present in the surrounding environment including environmental surfaces or from
equipment.
• There may be an increased risk of transmission associated with specific procedures and practices.
Standard precautions consist of:
• Hand hygiene, before and after every episode of patient contact
• The use of personal protective equipment
• The safe use and disposal of sharps
• Routine environmental cleaning
• Reprocessing of reusable medical equipment and instruments
• Respiratory hygiene and cough etiquette
• Aseptic non-touch technique
• Waste management
• Appropriate handling of linen
Standard precautions should be used in the handling of: blood (including
dried blood); all other body substances, secretions and excretions (excluding sweat), regardless of whether they contain visible blood; non-intact
skin; and mucous membranes.
Transmission-based precautions are applied in addition to standard precautions.
The aim of instituting early transmission-based precautions is to reduce
further transmission opportunities that may arise due to the specific route
of transmission of a particular pathogen.
While it is not possible to prospectively identify all patients needing transmission-based precautions, in certain settings, recognising an increased
risk warrants their use while confirmatory tests are pending.
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The full document – “Australian Guidelines for the Prevention and Control
of Infection in Healthcare” NHMRC can be downloaded at http://www.
nhmrc.gov.au/_files_nhmrc/publications/attachments/cd33_infection_control_healthcare.pdf. The above is a summary only from the publication.
Australian Standards AS 4815 (2006) Office-based health care facilities—
Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of the associated environment
Diabetes Assessment Guidelines
These guidelines have been prepared by the Australasian Podiatry Council
in conjunction with Diabetes Australia. They provide a guide to baseline
foot assessment for all people with diabetes and include a recommendation that all people with diabetes have an annual assessment by a podiatrist. This has been updated in 2011 - http://www.diabetesaustralia.com.
au/For-Health-Professionals/Diabetes-National-Guidelines/#DiabetesManagement-in-General-Practice.
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Module 3 - Extended Care
3.1 Domiciliary Care
A clinic or surgery is usually the most appropriate venue in which to conduct podiatric treatment. It is beneficial both for the podiatrist and the patient if the clinic is adequately equipped, a wide range of treatment options
will be available to the patient, under the safest possible circumstances,
with a minimised risk of cross-infection.
Providing services in the home may limit the treatment options available
to the patient and might perpetuate a patient’s dependence and social isolation if this is an issue. The risk of work-related injury to the podiatrist
may also be increased outside the clinic environment.
Transport is often an area that is overlooked when establishing a service.
Bearing in mind the greater utilisation of podiatry services by the elderly,
this could be a major oversight when considering access to the service.
There are a number of options that patients can explore if they require in
rooms treatment:
• Friends or relatives.
• DVA patients over 80 years are eligible for ‘Booked car with driver’.
See
http://www.dva.gov.au/BENEFITSANDSERVICES/TRANSPORT/Pages/book%20car.aspx.
• Taxi vouchers – sometimes available to health card benefit holders
with application approved by general practitioner.
• Home Care services - some patients may require personal assistance in and out of vehicles.
• Transport could be provided by a home carer at a nominal fee to
the patient.
• Red Cross services - some areas offer free transport with the Red
Cross supplying the vehicle and voluntary drivers. Civil Ambulance
may be available where specialist medical services are required and
regular transport cannot be used. This is charged to the hospital or
centre providing the service.
Specific issues requiring protocols or special attention include:
• Infection control standards are more likely to be breached and protocols covering hygiene, waste disposal and instrument sterilisation in particular should be developed and maintained.
• Clinical records must still be kept and the practitioner should take
into account the need to maintain confidentiality at all times when
devising a method for documenting clinical care.
• Consideration should be given to personal safety and security when
conducting house calls.
• It is advisable to implement basic security measures such as carrying a mobile telephone and personal alarm and informing a third
party of your planned whereabouts. Visit the homes of elderly and
disabled persons with caution. If there is limited support at home it
is unlikely that usual maintenance is occurring. Take particular care
with electrical appliances.
3.2 Nursing Homes, Hostels and Day
Therapy Centres
Aged Care facilities attract federal funding for provision of services, the
details of which are further described in Section 5 of this Module. Some
residents will automatically be eligible for podiatry treatment, whilst others may seek a visiting service on a user-pays basis. A special rate may be
negotiated in view of the nature of treatment required and the volume of
work. Some patients may be eligible under the Medicare multi-disciplinary care program. See: http://www.health.gov.au/internet/main/publishing.nsf/content/health-medicare-health_pro-gp-pdf-allied-cnt.htm.
Special consideration should be given to ergonomics. Treating patients in
their bed is probably the most potentially injurious work position, so wherever possible, have the patients brought to the podiatrist in a wheelchair
and either treat in a hydraulic chair if one is available, or from the wheelchair, utilising a foot stool. Never attempt to transfer or lift a patient yourself, always wait for third party assistance. If a bed bound patient requires
the assistance of a third party to enable access to that patient’s feet, do not
proceed with intervention unless you have that assistance.
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It may not be practical to bring the requisite number of instrument sets,
however most facilities have a small steriliser on site which must be utilised if the number of patients to be treated exceeds the number of sterile
instruments. Check with the facility manager if this is a type B or Type S
autoclave and complies with AS 4815. Infection control protocol must not
be breached.
An assistant assigned to assist with instrument processing, transporting
patients and other duties as required will improve the efficiency with
which podiatry duties are conducted. Refer to the podiatry assistants policy for further information on this matter, http://www.podiatryboard.gov.
au/Policies-Codes-Guidelines.aspx.
Clinical records must still be kept and it is advisable to record interventions in the residents’ central clinical history, particularly where follow-up
by nursing staff (for example, assistance with a splint or instructions regarding dressings) has been recommended.
Due to their clinical background and limited mobility, many residents will
only require routine foot hygiene. It is not uncommon for the attending
podiatrists to provide on-site training for other staff in basic foot hygiene
procedures to improve service efficiency and improve early identification
of persons requiring podiatric intervention. Refer to the Podiatry Assistants Policy for further information on this matter.
3.3 Foot Health in Residential Aged Care
The risk of foot abnormality increases with age, including quantifiable peripheral nerve and vascular disease, which is coupled with an inability to
adequately care for feet and increasingly inappropriate footwear choices.
The need for podiatric care increases as a result, with estimates of up to
85% requiring intervention for both ambulatory and institutionalised older
persons. In addition, Guidelines for the Management of Type II Diabetes (
2011) advocate regular foot assessment, along with regular podiatry intervention, for the estimated 10% of people over the age of 65 with Type II diabetes. The immediate benefits for the ambulant resident receiving podiatry
care are improved mobility and independence, with reduced likelihood of
hospitalisation or institutionalisation.
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It is important that foot care services offered to residents of Aged Care facilities meet both legislative and standards requirements to ensure safety
and quality of care provided.
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Module 4 - Ethics and Legal
Issues
4.1 Code of Conduct - Ethical Principles
A key objective of the Australasian Podiatry Council and its Member Associations is to uphold the standards of the profession, eliciting public confidence in the profession and safeguarding the interests of each member.
Podiatrists must be familiar with and adhere to the Podiatry Code of Conduct for Registered Health Professionals available from the Podiatry Board
of Australia http://www.podiatryboard.gov.au/.
The code of conduct should be read in conjunction with the relevant registration act and regulations. A code of ethics may also be available through
your member association.
References
Beauchamp TL, Childress JF. (1989) Principles of Biomedical Ethics (2nd
Edition). New York: Oxford University Press
Mitchell KR, Lovatt TJ. (1991) Bioethics for Medical and Health Professionals. Social Science Press
4.2 Documentation, Confidentiality
Each patient should have an individual health record containing all the
health information held by the practice about the patient.
The Podiatry Board has specific Guidelines for practitioners on clinical records: http://www.podiatryboard.gov.au/Policies-Codes-Guidelines.aspx
The Board will refer to these Guidelines as evidence of what constitutes
appropriate professional conduct or practice for podiatrists.
Should a patient’s clinical record be required as evidence in court, the
health care facility or individual practitioner will typically be served with
a subpoena requiring them to produce the relevant records.
As patient records contain information which is highly personal and sometimes sensitive in nature, it is important that the clinical facility respects
the right of individual privacy and ensures steps are in place to facilitate
appropriate use, access and storage of records.
• No information concerning a patient should be released to another person without the consent of the patient, where possible, in
writing. Particular care should be taken to ensure that the consent
specifies the information required and that the part of the medical
report released contains only this information. Where appropriate,
consent should be obtained from a legal guardian.
• All health records should be stored in areas to which only authorised staff are permitted access and appropriate security arrangements made. All staff should be informed of their responsibility to
maintain patient confidentiality.
• Due to the sensitive nature of health records, a health professional
should always be involved in the handling of requests for health
information to ensure that only information relevant to the request
is released.
• Health records are the property of the health care facility. They
should not be removed from the facility except as a result of a court
subpoena.
4.2.1
Guidelines on Privacy in the Health
Sector - Australia
Organisations that hold information about people are under an obligation
to handle the information in accordance with the National Privacy Principles (NPPs). The NPPs aim to ensure that personal information is handled
responsibly, and that individuals have some control over the way information about them is handled.
The Federal Government has enacted a new privacy regime to replace the
NPPs, which will come into force on 12 March 2014.
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In brief, the principles currently guiding the minimum standards for ensuring patient privacy is protected are as follows:
• NPP1 - Collection of information
You should only collect information necessary for assessing and
treating the patient. The collection of personal information must be
fair, lawful and not intrusive. It should be collected with your patient’s consent and preferably directly from the patient. You should
make clear the reason for collecting the information if this is not
obvious, and inform the patient that are allowed to request access
to the information. Consent should also be obtained if you intend to
disclose the information to other health providers.
• NPP2 - Use and disclosure
Where information has been collected with your patient’s consent,
you may use or disclose it to assist in assessing, diagnosing or treating a particular or suspected health condition. If you intend to use
the information for other purposes - for example, statistical or research use - you must obtain the patient’s consent.
There are some instances in which you may disclose information
about your patient without their consent, but these situations are
limited, and doing so will require extreme caution. It would be advisable to seek legal advice in these circumstances.
• NPP3 - Data Quality
You must take reasonable steps to ensure the information you hold
about your patients is accurate, complete and up-to-date.
• NPP4 - Data Security
You must take reasonable steps to protect patient information from
misuse, loss or unauthorised access. This includes ensuring that
staff members have varying and appropriate levels of access to patient information, depending upon their role within your practice.
You must also destroy or permanently remove identification from
data no longer required.
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• NPP5 - Openness
You must develop a policy document outlining your informationhandling practices and provide this to anyone who requests it.
• NPP6 - Access and Correction
The Act gives people a general right of access to personal information held about them by private organisations, which in a podiatry
practice includes clinical records. There are some exceptions to this
general right of access, such as if release would have an unreasonable impact on other individuals, however before refusing access it
is advisable that the practitioner seek legal advice.
The patient will not have to provide a reason for obtaining their
records and will not be required to put the request in writing. You
should confirm the identity of the person seeking access to a particular clinical record. It is expected that access to the record must
be provided within 30 days of the request. You may not charge patients for lodging requests for access, but they may be charged for
administrative costs associated with providing access, so long as
this does not prevent an individual from accessing their records.
• NPP7 - Identifiers
You must not adopt, use or disclose an identifier issued by a Federal government agency eg. Medicare numbers.
• NPP8 - Anonymity
Patients have the right to be treated anonymously where this is
practical and lawful; eg. in using telephone counselling services.
• NPP9 - Transborder data flows
This relates to the transfer of patient information overseas, without first obtaining consent. Generally in these circumstances you
would be required to ensure that the country to which the information is transferred can afford at least the same level of protection of
privacy as can Australia.
• NPP10 - Sensitive Information
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You must not collect sensitive information unless the patient has
consented to this collection or it is required by law or in other
specific circumstances, such as where it concerns public health
and safety or to lessen or prevent a serious and imminent threat
to life or health. Sensitive information is defined as information or
an opinion about an individual’s racial or ethnic origin; political,
philosophical or religious beliefs and associations; membership of
a professional or trade association, sexual preferences; or criminal
record.
Full details and a range of information sheets can be downloaded at www.
oaic.gov.au
4.3 Negligence
‘The cardinal principle of liability is that the party complained of should
owe to the party complaining a duty to take care and that the party complaining should be able to prove that he has suffered damage as a consequence of a breach of that duty’ - Donoghue v. Stevenson (1932) AC 562
In order to be found negligent, a number of principles are required to be
established. First it must be shown that the defendant owed the plaintiff a
duty of care. Podiatrists, as health practitioners, owe a duty to their patients
to act with reasonable care. This duty extends not only to podiatric treatment, but also to the counselling of patients and keeping them informed of
their clinical options and their consequences.
After establishing that a duty of care is owed by the defendant to the plaintiff, it needs to be shown that the defendant breached their duty of care.
A defendant practitioner breaches their duty of care in providing professional services if their act or omission is not in accordance with professional practice as widely accepted by other practitioners as competent professional practice.
Thirdly, the harm suffered by the plaintiff needs to have resulted from the
defendant’s breach of their duty of care to the plaintiff. The harm could be a
direct occurrence, such as when a procedure is negligently performed and
injures the patient, or more indirect, such as where a practitioner neglects
to warn of a material risk of a procedure, that ultimately materialises.
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An action in negligence can be defended by establishing, typically with
expert opinion, that the treatment and/or advice accorded with competent
practice. Alternatively, that any breach was not the cause of the injury, loss
or damage which may have occurred. Another common defence is that
the patient gave informed consent to the treatment and accepted the risk
of the injury that materialised. Often it can be alleged that the patient was
contributorily negligent in whole or part and that this was the cause of any
loss, injury or damage.
All podiatrists must carry Professional Indemnity Insurance as a registration requirement. It is also advised that members and/or their employees
carry Public Liability Insurance. The APodC cannot recommend a level of
cover however policies generally range between $5mil and $20mil for each
of Public Liability and Professional Indemnity.
(Refer to Module 7 : Insurance Programs and Policies.)
4.4 Informed Consent
It is unlawful to give any treatment to a patient without the patient’s informed consent, or the consent of a person entitled to give such consent on
behalf of the patient.
Consent can be given verbally, in writing, or be implied in the circumstances. In some circumstances written consent is preferable, because it provides
documentary evidence that consent was given, however it is important to
be mindful that consent in writing, whilst preferable, does not guarantee
that the consent given was valid.
Consent is considered valid if:
• It is given freely and voluntarily.
• It covers the proposed treatment.
• It is informed and relevant to the act being performed.
• The person giving consent has the legal capacity to give such a consent.
The right to withhold consent to treatment is a fundamental common-law
right of all patients of full legal capacity.
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Any practitioner / patient consultation or interaction should consist of the
following to ensure adequate informed consent:
1.
A diagnosis (or possible differential diagnosis) has been reached
and explained to the patient.
2.
A treatment plan has been developed and the patient is informed
as to the nature of the intended treatment and alternative courses
of action.
3.
The potential risks of the various treatment options have been discussed with the patient, including those risks that are unlikely but
may be of concern to the particular patient.
4.
The expected outcomes of the treatment options have been discussed with the patient.
In the case that a patient decides not to proceed with treatment, the patient
should be informed of the consequences and risks of not proceeding with
the treatment.
4.5 Strategies to Minimise Risk
The Guild SAFETY tool (issued by Guild) is a useful tool to help manage
workplace risk.
S – Stop & Think – What are the risks in this situation?
A – Analyse & Evaluate – What are the consequences should the
risk occur? How likely is it?
F – Follow the right practice – What do you need to STOP doing,
START doing and KEEP doing to manage the risk effectively?
E
– Evaluate your actions – Learn from what did and didn’t
work.
T – Teamwork & communication – Don’t act in isolation – work
together to achieve results.
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Y – You are responsible – You are accountable for your actions and
the services you provide.
There are also a couple of other things to consider:
• Thorough and meticulous clinical record keeping - ensures that a
full and detailed account of patient encounters is available in the
event of problems arising. (See Module 2.2: Clinical Records).
• Communication - good communication skills entail both verbalising your intentions and expected outcomes of proposed treatment
plans and listening to patients’ needs. Giving patients a quote for
services as part of a treatment plan is a good management plan.
• Maintain and update skills and knowledge - familiarity with current standards and practice, continuing education in the form of
reading, special interest groups, post-graduate programs and conference attendance.
Legal Proceedings
A patient’s clinical record will be relied upon by both parties in civil and
criminal proceedings. Examples of the ways in which the records are used
include:
• As evidence to support an allegation of negligence by the practitioner, in that a certain treatment was wrongly given or there was a
failure to give a particular treatment, usually in civil proceedings.
• As supporting evidence of matters that may be in dispute in civil
proceedings, e.g. that a particular injury occurred.
• In criminal proceedings, as evidence that an injury occurred and
the nature and extent of injury.
For further information a copy of “Guildwatch - Risk Management for Podiatrists” may be found online.
References
MacFarlane P. (1995) Health Law. The Federation Press
Staunton PJ, Whyburn B. (1993) Nursing and the Law
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Module 5 - Third Party
Arrangements
5.1 Medicare
As a result of sustained and effective lobbying at a national level by the
Australasian Podiatry Council, Medicare rebates for podiatry were introduced in July 2004. This has brought with it positive recognition of the
podiatry profession, our role as primary health care providers and created
a new pathway for patients to access our care.
The flip side of this increased access to patients, is the paperwork and procedural headache. Following changes introduced by Medicare Australia
the following guide has been prepared by the APodC to help you and your
support staff navigate and understand the system.
5.1.1
Why should I bother?
Being part of Medicare gives you greater opportunities to value add to
your existing patients’ experience and increase their overall satisfaction.
It also removes significant barriers for potential patients seeking your services, including concerns they may have regarding costs.
More referrals and subsidised costs can initially introduce more people to
your clinic. Once these new people have discovered the value and range of
your care, they are likely to become long term fee paying patients, who in
turn can refer even more people to your clinic, steadily increasing profits.
In saying this it is also beneficial to not rely solely on medical referrals to
grow your business.
5.1.2
Overview of the Allied Health
Initiative
The Medicare scheme commenced on 1st July 2004 and allows patients under a GP Management Plan (GPMP) for which Team Care Arrangements
(TCA) have been established to gain access to Medicare rebates for up to 5
visits per calendar year to an Allied health provider.
That’s a total of 5 allied health visits per patient, not 5 visits per provider.
Medicare only provides a rebate back on the cost of the consultation. See
http://www9.health.gov.au/mbs/search.cfm?q=10962&sopt=S for more information.
5.1.3
Who qualifies?
Patients with chronic conditions or complex care needs, who are managed
under a GPMP and TCA by their GP, qualify for rebates. The Chronic Disease Management (CDM) items apply to treatment of people with asthma,
cancer, arthritis, diabetes, heart disease, mental illness and other chronic
medical conditions that would benefit from a team care arrangement.
(Also refer to http://www.medicareaustralia.gov.au/provider/incentives/
allied-health.jsp for further information on chronic disease management
under Medicare).
Please note that patients admitted to a hospital or day hospital facility do
not qualify for Medicare.
5.1.4
What do I need to get started?
If you are registered with Medicare (i.e. if Medicare has issued you a provider number), you are already registered for this scheme. If not, contact
the Medicare Provider Enquiry line on 132 150 or the Medicare Australia
web site www.medicareaustralia.gov.au for details on how to register and
gain access to forms.
If you want to claim directly from Medicare Australia then the two forms
you will need along with a Medicare card Imprinter
• Assignment of benefit form (DB1N-AHa)
• Bulk bill voucher (Allied health provider) (DB2-AHa)
The imprinter, envelopes and forms, including a guide on how to complete
them, are available from Medicare Australia website. Pre - addressed envelopes to Medicare (ENVa) are also available. Some EFTPOS machines or
practice management software have integrated systems to claim medicare
bulk billing/easyclaim services.
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5.1.5
What does the GP have to do?
The GP needs to complete, and most importantly lodge for payment with
Medicare Australia a GPMP and TCA item. Part of this plan will involve a
referral to you and the other team members to participate. The invitation
and acceptance can be returned signed by any podiatrist in the practice.
Although it’s not compulsory GP’s are encouraged to send you a copy of
the plan , if they don’t you can always ask the patient to bring their copy in
for you to take a copy.
For a patient to be considered to be currently managed under an EPC plan
then the GP has to have claimed both MBS item numbers 721 and 723 together within the last two years.
5.1.6
How do the referrals work?
Once the GP has finished and lodged the care plan they will refer the patient using the Medicare referral form, an example can be viewed at: http://
www.medicareaustralia.gov.au/provider/incentives/allied-health.jsp . This
MUST be complete or Medicare may seek to recover fees paid under the
referral.
A normal GP referral letter is not sufficient and will be rejected by Medicare Australia.
The referral remains valid for the stated number of services NOT a 12 month
period. If the services are not used during the calendar year in which the
patient was referred, the unused services may be used in the next calendar
year. However, they will be counted as part of the five services for allied
health services available to the patient during that calendar year (that is,
the maximum number of rebates a patient can access in a calendar year is
five regardless of how many were accessed the previous year).
NOTE: It is not necessary to have a new CDM plan prepared every 12 months
just to access a new set of allied health referrals. Patients continue to be eligible for
rebates for eligible allied health services while they are being managed under an
EPC plan, as long as the need for the eligible services continues to be recommended
in their plan.
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5.1.7
What if I’m not sure the correct paper
work is in place?
Medicare Australia can be contacted on 13 21 50 and you can ask them if
you are able to bill an MBS item No 10962. It’s important to ask about this
particular item number, not just if they have a care plan in place or not, because they could have already used their allocated visits somewhere else.
An important change to note is that you do not require the patient present
to obtain this information over the phone.
5.1.8
What are my responsibilities?
Once you have provided a consultation to the patient of at least 20 minutes
duration, a report needs to be sent to the GP. Podiatrists providing multiple
services to the same patient under one referral are only be required to provide a written report back to the GP after the first and last service only, or
more often if clinically necessary. This report can be produced quickly and
inexpensively by using the Doctor Report form available from the APodC
.
The service can be provided by any podiatrist, including locums, in your
practice not just the provider on the referral form.
5.1.9
How much can I charge?
The Medicare Benefits Schedule (MBS) item number is 10962. The scheduled fee can be located by searching the MBS Online at http://www9.health.
gov.au/mbs/search.cfm . The rebate amount is the highest amount you can
bill Medicare Australia directly.
The Medicare Easyclaim allows practitioners to charge full fee, the patient
pays full fee to the podiatrist practice, then , if the patients bank account
details are lodged with Medicare, the rebate is paid directly to the patients
account.
The rebate is only payable for patient consultations; not for care planning,
paperwork, splints, or appliances. It is important to note that once a claim
is made to Medicare there is no private health insurance rebate available to
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the patient for that particular consultation. Therefore it is necessary for the
patient to decide if they are better off continuing to claim on any private
health insurance they may have instead of Medicare. This is likely to be
influenced by any anticipated out of pocket charges.
It is also important to note that any Medicare gap amount payable qualifies
towards the patient’s Medicare Safety Net.
5.1.10
How do I get paid?
There are two methods of receiving payment for your services. You can
either invoice the patient and let them make the claim themselves or bill
Medicare directly.
If the patient pays in full on the day, the patient takes the receipt to Medicare and receives a refund for the rebate amount, or they can utilise the
Easyclaim system.
If the patient doesn’t pay on the day, you issue an invoice to the patient and
they lodge the account with Medicare, and then await a cheque made out
to the provider. This along with any gap amount payable by the patient can
then be forwarded to you to settle the account.
5.1.11 What needs to be included on / with
your account / receipt?
• Name and practice address or name and registration/provider
number of the podiatrist who actually rendered the service
• Name of the patient
• Date of service
• Amount charged, total amount paid, and any amount outstanding
in respect of the service
• MBS item number and/or description of the service: 10962: Allied
Health Services, Podiatry. (Note that this is the only eligible item
number. “F” item numbers such as F012 do not apply.)
• Name and practice address or name and provider / registration
number of the Podiatrist and of the referring GP along with the
referral date (the date the GP signed the EPC referral)
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There may be additional information that practitioners are required to include.
5.1.12 What paperwork should I keep?
• Copies of both the referral and the account need to be kept by the
podiatrist for auditing purposes for a period of 7 years, or 7 years
from when they turn 18 years old.
5.1.12.1 Billing
billing)
Medicare
directly
(bulk
5.1.13 What do I send to Medicare?
A completed direct payment claim form (DB2-AH)
A completed assignment of benefit form (DB1N-AH). The practitioner
needs to get a PKI key , security code sent separately and log on to the
HPOS logon section of medicare web site to find out if they have been paid
by medicare. Files are available as pdf or excel. Pdf files are easier to read
and print. Then if the payment doesn’t go through they need to contact the
client and ask for payment for services rendered.
Forms may be found at http://www.medicareaustralia.gov.au/provider/
pubs/medicare-forms/#N1013B.
Medicare isn’t paying by cheque, it is electronic only.
5.1.14 So should I bill the patient or
Medicare?
With the various implementation problems it’s easier and less risky to make
the patient pay up front and for them to make the claim from Medicare
themselves. But there are benefits in billing Medicare directly in the form
of patient and GP satisfaction in the program and in your own practice.
Some practices have reported that by advertising to GPs they are
not only participating in the scheme, but also billing Medicare directly; their practice has experienced an increase in both Medicare
and general referrals from those GPs.
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Direct billing allows you to assist in any problems patients may
have with claiming from Medicare. This will assist to manage the
relationship between you, the patient and the GP.
5.1.15 After all, is it really that difficult?
For many years, podiatrists have grappled with Medicare and the Department of Veterans Affairs with all the associated paperwork and procedures.
As with any government funded initiative, the latest Medicare initiative
comes with rights and responsibilities for eligible practitioners. On the upside, podiatrists are now recognised along with other mainstream allied
health practitioners and the public has an avenue to access quality footcare
services. Podiatry is one of the most utilised services under the enhanced
primary care program. As Medicare and the Department of Human Services may be subject to fraud, they also need to ensure stringent process
and audit reporting.
Access and use by consumers, along with feedback from GPs and allied
health practitioners will inform the ongoing review process which is operating through the advisory committee chaired by the Department of Health
& Ageing and on which the Australasian Podiatry Council is a respected
member. Many of the changes stem from recommendations made by that
committee and data on the uptake and utilisation is being closely monitored.
5.1.16 Where can I get more information?
Medicare
http://www.medicareaustralia.gov.au/
Australasian Podiatry Council
www.apodc.com.au
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5.2 Podiatry and X-Ray Referrals
5.2.1
Procedural and Ethical Considerations
- Introduction
The purpose of this module is to provide the podiatrist with clinical and
procedural details pertaining to the referral of patients for diagnostic radiology.
Podiatrists in all states of Australia are permitted to refer directly to radiologists for the purpose of diagnostic radiography of the foot, ankle and
leg, and for other imaging techniques such as ultrasound, CT scanning and
MRI.
Patients (in Australia) who are referred to a radiologist by a podiatrist for
approved radiological services, that is, specified plain diagnostic x-ray examinations, will receive a full Medicare rebate for these services. CT scans,
ultrasound, and MRIs where referred by a podiatrist will not be rebated.
5.2.2
Ethical Considerations in Diagnostic
Radiology
A basic principle of patient protection in diagnostic radiology is that an
x-ray examination should not be performed unless the benefits accruing to
the patient outweigh any radiation risks.
Judgement of whether benefits outweigh risks can be determined in cases
where the potential radiation injury is the result of acute excessive doses
where the effects can be observed in the short term. However, the estimates
of risks of delayed injury, such as carcinogenesis, resulting from chronic
exposure at the low radiation dose levels typical of most diagnostic radiology are derived from epidemiological studies and can be expressed only
on a statistical basis.
The simpler question of whether the x-ray examination is reasonably necessary to ensure an adequate diagnosis and for the ongoing medical care of
the patient concerned should always be examined. In many cases, x-ray examinations may routinely be requested to exclude the possibility of unex92
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pected causes or conditions. Implicitly the diagnosis provided by podiatric
radiography determines subsequent patient management. If subsequent
patient management is expected to be unaffected by the result of an x-ray
examination, then the need for the examination may be questioned as being excessive, unnecessary or otherwise not reasonably required for the
patient’s wellbeing.
Radiological evidence has demonstrated that certain tissues such as the red
marrow, gonads, breast (female), lungs, thyroid and bone surfaces may be
particularly sensitive to radiation. The total effect of a given dose depends
significantly also on the extent of irradiation of other tissues. An expression of the total effect delivered in a diagnostic x-ray examination is the ‘Effective Dose, E,’ which is the sum of the dose to the above specified organs
and other organs, weighted according to their relative radio sensitivities.
For podiatric radiography the Effective Dose will be lower than for most
diagnostic x-ray examinations because only the bone surfaces amongst the
specified organs are included in the methodology, and no other organs of
significant radio-sensitivity.
The Effective Dose would increase considerably if in any podiatric procedure the x-ray beam was directed towards the lower abdominal region.
The longer life expectancy of children results in a greater potential for the
manifestation of possible deleterious effects of radiation. Children may also
be more radio-sensitive. Therefore particular attention should be given to
minimising x-ray examinations in children and questioning whether the
examination is essential or otherwise necessary for the child’s wellbeing
and subsequent patient management.
Therefore, while the radiation risk for lower limb x-ray examination is low,
consideration must always be given to the necessity of the procedure to be
performed in order to make a clinical diagnosis and subsequent patient
management plan.
Furthermore, the overall cost to the public and to the patient should also be
considered prior to referral.
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5.2.3
Medicare Benefit Arrangements
The Australian Medicare Program provides access to medical and hospital services for all Australian residents and certain categories of visitors to
Australia. Legislation covering the major elements of the Program is contained in the Health Insurance Act 1973 (Cth).
5.2.4
Diagnostic Imaging Services
Approved Podiatry Referrals.
-
Under the Health Insurance Regulations 1975 (Cth), a podiatrist may request the following plain x-ray items:
• From Group 13 -Diagnostic Radiology
• Subgroup 1 - Radiographic Examination of Extremities and Report
• Item 57521 Foot or ankle or leg or knee or femur
• Item 57527 Foot and ankle or ankle and leg or leg and knee or knee
and femur
• Item 55832 – 55842 Ultrasound of lower leg, foot and ankle
Currently these are the only radiological examinations which attract a
Medicare rebate when referred by a podiatrist.
(“Plain radiography” means an x-ray examination during which:
a) The x-ray tube and film remain stationary.
b) And no contrast medium is introduced into the patient.)
5.2.5
Provider Numbers
A Medicare provider number must be obtained in order for a practitioner to refer a patient to specialist services, diagnostic imaging services or
pathology. It is also required to allow patients to seek Medicare benefits
for the service requested and provided. Without a provider number any
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patient for whom you have requested radiological examination will not be
able to seek a Medicare rebate.
The podiatrist must apply in writing to Medicare for an initial Medicare
provider/registration number for Allied Health Professionals. A separate
provider/registration number must be obtained for each site/clinic at which
the podiatrist practices.
Details of your name, registration and addresses of practice sites will be required. Health Insurance Regulations provide that, for Medicare purposes,
a valid account/receipt must contain the practitioner’s name and either:
• The address of the place from which the service was provided.
• Or the provider number for the place from which the service was
provided.
Medicare provider number information is released in accordance with
the secrecy provision of the Health Insurance Act 1973 (Cth) (Section 130),
to authorised external organisations including private health insurance
funds, the Department of Veterans’ Affairs, and the Department of Health
and Family Services.
5.2.6
Provider Number for Locums
If a podiatrist is providing a locum service at a practice for more than two
weeks or will return to that practice on a regular basis for short periods,
then a provider number for that practice must be obtained.
If, however, the locum period is less than two weeks then the locum can
use their existing provider number from an alternate address. A provider
must never use another provider’s number.
5.2.7
Use of Incorrect Provider Numbers
and Closure of Practice Locations
Use of an incorrect Medicare provider number may be considered a breach
of the Health Insurance Regulations.
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5.2.8
Patient Eligibility for Medicare
An “eligible person” means a person who legally resides in Australia and
whose stay in Australia is not subject to any limitation as to time, but does
not include a foreign diplomat or family (except where eligibility is expressly granted to such persons by the terms of a reciprocal health care
agreement).
A person in Australia is covered by a reciprocal healthcare agreement,
which covers services of immediate necessity. Current reciprocal health
care agreements are in place with New Zealand, United Kingdom, Netherlands, Sweden, Finland, Italy and Malta.
Medicare benefits are generally not payable to other visitors of Australia or
temporary residents, although the Minister has the power to extend eligibility to such persons in exceptional circumstance. People visiting Australia specifically for medical or hospital treatment are not eligible for Medicare benefits.
All “eligible persons” must enrol with Medicare in Australia before benefits can be paid. Medicare cards are renewed occasionally, the number
claimed for service must match the patients current card. Some referrals
are out of date with medicare numbers, but are updated with the last digit
being higher.
5.2.9
Workers’ Compensation or Third
Party Insurance
Medicare benefits are payable for medical expenses for professional services that are wholly covered by workers’ compensation or damages under
a Commonwealth or State or Territory law. The exception is where a person has entered into a reimbursement arrangements with a compensation
insurer.
5.2.10 Podiatrist Referral for Radiological
Examination
A standard format of referral is not required for podiatrists, however the
request must be in writing and must including the following:
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• Name and either practice address or provider number of referring
practitioner
• Date of referral
• Period of referral (where other than for 12 months)
For podiatrists the referral will in most cases be valid for a period of 12
months, unless otherwise stated that it be for a period more or less than 12
months (e.g. 3, 6 or 18 months or valid indefinitely).
While there is no standard format of the written request, the legislation
provides that the request should contain sufficient information about the
patient’s condition that the referring practitioner considers necessary in
terms that is generally understood by the profession, to clearly identify the
item of service requested. Responsibility for the adequacy of requesting
details rests with the referring practitioner.
The podiatrist needs to be mindful of the clinical relevance of the request
and determine if the service is necessary for the adequate professional care
of the patient.
The written request requirement does not apply where:
• The person who received the diagnostic imaging service or someone acting on that person’s behalf claimed that a medical practitioner, dentist, chiropractor, physiotherapist or podiatrist had made
a written request for such a service but that the request had been
lost.
• The provider of the diagnostic imaging service or that practitioner’s
agent or employee obtained confirmation from the requesting practitioner.
• A podiatrist should not request a radiographic examination on behalf of another practitioner.
5.2.11 Billing and Rebate
For medical and related expenses (i.e. not hospital treatment), the basic
aim of the Medicare program is to provide benefits equal to 85% of the
Medicare Benefits Schedule fee for any one service where the Schedule fee
is charged.
97
Some radiologists have a policy of bulk billing, while others will charge the
patient who then claims the benefits portion through Medicare.
References
Medicare Benefits Schedule Book, May 2013.
5.3 Department of Veterans’ Affairs
The Department of Veterans’ Affairs (DVA) health care program provides
access for entitled persons to services which assist in coping with disabilities and improving health and well-being. Access to podiatry services will
generally occur via the person’s Local Medical practitioner (GP).
5.3.1
To provide podiatry services to the
veteran community you must:
Be a registered podiatrist who has a valid Medicare provider number for
the location of treatment.
Further information on the conditions of service provision may be located
at: http://www.dva.gov.au/service_providers/Pages/factsheets.aspx.
5.3.2
To provide footwear prescription
services to the veteran community
you must:
Be a registered DVA provider and footwear prescriber.
There are stipulations surrounding referral requirements and which veterans are eligible to receive treatment under the scheme. Restrictions also
may apply in some situations. It is essential that podiatrists understand
these requirements prior to managing patients under the scheme.
For further information contact your state association for current contact
personnel and telephone numbers or go to the Department of Veterans’
Affairs podiatry website at http://www.dva.gov.au/service_providers/dental_allied/podiatry/Pages/index.aspx
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5.4 Transport
Authorities
5.4.1
and
Work
Accident
Transport Accident and Workcover
What do you need to do as a health care provider?
As with all patients, it is important that a thorough history and examination takes place prior to any treatment being undertaken. In this case, it is
even more important to have (in the patient’s own words) a total recounting of the injury which occurred.
Use a separate form, to be completed by the patient so that details regarding their accident can be covered very specifically. This is particularly
important since the likelihood of needing to write an insurance report is
higher in these cases. It is recommended that you ask the patient to provide
the following details, in addition to the information that a patient would
normally be asked to provide:
• Name of employer and who the incident was reported to
• Description of accident (Including date and time)
• Description of symptoms arising from the accident
• Details of any treatment provided
It is also important that on the first visit you clarify both your position and
that of the patient. That is, the patient is responsible for informing their
employer/or compensable body of an injury and ensure that the appropriate forms have been completed. The exact requirements differ between
the states and territories, however generally a worker must inform their
employer that an injury occurred as soon as possible. The employer then
has a set time to accept or deny the claim.
Although there is work being undertaken to harmonise laws, Transport
and Workplace Accident Authorities are state / territory based bodies. Each
has specific requirements and procedures around the provision of health
services and payment to their claimants. Generally health care providers
need to register as a service provider before offering treatment. Amounts
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reimbursed for podiatry services will vary. Podiatrists need to become familiar with the requirements in their state / territory by contacting their
local authority, prior to treating patients under these schemes.
5.4.2
Australian
Websites
Workcover
Authority
Workcover Authority of NSW - http://www.workcover.nsw.gov.au
Workcover SA - http://www.workcover.com/
Worksafe Victoria - http://www.worksafe.vic.gov.au/
Worksafe ACT - http://www.worksafe.act.gov.au/health_safety
WorkCover Queensland - http://www.workcoverqld.com.au/
WorkCover Tasmania - http://www.workcover.tas.gov.au/
NT WorkSafe- http://www.worksafe.nt.gov.au/home.aspx
WorkCover WA - http://www.workcover.wa.gov.au/
5.4.3
Australian
Transport
Authority Websites
Accident
Victoria - Transport Accident Commission - http://www.tac.vic.gov.au/
New South Wales - Motor Accidents Authority - http://www.maa.nsw.gov.
au/
South Australia – Motor Accident Commission - http://www.mac.sa.gov.
au/
Queensland - Motor Accident Insurance Commission - http://www.maic.
qld.gov.au/
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Western Australia - Insurance Commission of Western Australia - http://
www.icwa.wa.gov.au/
Tasmania - Motor Accidents Insurance Board - http://www.maib.tas.gov.
au/
Australian Capital Territory – overseen by NRMA Insurance Ltd - http://
www.nrma.com.au/
Northern Territory - Territory Insurance Office - http://www.tiofi.com.au/
5.5 Private Health Funds
Private health funds will provide a rebate to patients for podiatry services
under ancillary, which varies depending on the fund and the level and type
of health insurance cover the patient holds. This information should be
sourced from each health fund prior to offering services under a private
health fund scheme.
In order to be able to claim a rebate for podiatry services provided, practitioners must first register as a service provider and obtain a provider number from Medicare. Some health funds require a separate form for recognition of a new provider. This provider number must be printed on receipts,
in order for patients to claim against their health insurance policy. This
applies to associates and locums.
A provider number is required for each practice location and for each
individual practitioner. Most private health funds will use the provider
number/s allocated by Medicare Australia when the podiatrist applies to
participate in the allied health initiative. In addition to eligibility to request
Medicare rebates for plain film x-rays.
Some health insurance funds require a copy of a letter from Medicare Australia confirming the practitioner’s provider number/s to enlist them as a
service provider for that fund. The procedure of each health fund needs to
be confirmed at the time of registering.
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In the case of a locum who has no fixed place of work, they must work under a provider number issued to their primary location (eg. home office).
A locum must establish a new provider number when they work for more
than 4 weeks in the one establishment.
Practitioners must only claim for treatment provided under their own provider number. They should not allow any other practitioner to use their
provider number. Some insurance companies insist on a patient signature
on an invoice (re: fraud allegations) to confirm that the service was provided.
5.5.1
HICAPS
HICAPS is an electronic, real time, claims and payments system, which can
be used in private podiatry practice to automatically process patients podiatry health insurance claims (for participating health insurance funds).
To utilise this system you need to contact HICAPS initially and lodge an
application form. Once the application has been processed and accepted
HICAPS provide installation and training in around four weeks of the application being accepted.
The HICAPS terminal installed in the practice works through a swipe card
system whereby after providing treatment, patients can access their health
fund entitlement on the spot. The terminal will calculate and deduct the
insurance rebate amount and patients then are able to pay the gap to you
directly. HICAPS settles the amount owing to you from the health insurance rebate the following day thereby reducing delays in you accessing
payment. The HICAPS terminal can also operate as an EFTPOS or credit
card facility. Currently mobile EFTPOS machines are not able to process
HICAPS transactions as they are not address linked required by provider
number identification.
Charges apply for the HICAPS services. You can contact HICAPS for further information and application details on free call number 1800 80 57 80
or go to their website at http://www.hicaps.com.au/
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Module 6 - Before You Start
in Practice
The below is for information only and should not be taken
instead of appropriate advice. Please consult your
accountant and / or legal advisor for independent advice.
6.1 Are you Ready?
The purpose of this Module is to help you assess whether you would be
successful in running your own practice. You may find that some of the
questions are hard-hitting, but if answered honestly they will indicate your
chance of success or failure.
Having the skills is only part of the answer - being able to make tough decisions that affect one’s own life and the lives of other employees is critical.
Ongoing self-assessment and being able to change with the ever-changing
market is another important aspect. It is also vital to be able to monitor the
financial welfare of your practice and make decisions, disregarding one’s
personal ego, which for all of us is sometimes very difficult to do.
Practice Ownership - Advantages and Disadvantages
Advantages
* Personal satisfaction
* Independence of decision making
* Financial reward
* Sense of achievement
* Social recognition
* Opportunity for leadership
Disadvantages
* Financial insecurity
* Long/irregular hours
* You are on your own
* Risk of failure
* Pressure on family life
* Isolation/frustration
It’s important to understand that running a business requires a practitioner
to ostensibly change professions. While some skills are transferrable, many
new skills will be required if the business is to be a success. The most important skill required is to be able to identify the limits of your knowledge
and skills and to be able to seek (and follow) advice from others who are
experienced and qualified while you develop your skills. In the same way
a podiatry assistant might watch a podiatrist and be able to emulate the interventions with some success, many people fall into the trap of assuming
business administration can be easily learned by seeing others in practice.
Our advice is that once you have decided to become a business owner,
start educating yourself in the professional field of business administration. Start reading, seek opportunities to manage a practice under supervision and consider formal education in the field.
6.1.1
Personal Characteristics- Are You
Suitable?
How Do You Rate?
Ability to handle risk and stress
Ability to handle professional isolation
Business/accounting/legal experience
Knowledge of the industry/experience
Drive and energy
Commitment to the long term
Leadership ability (Can you motivate staff?
Could you appraise a staff member?)
Level of determination and the ability to
solve problems
Ability to set clear and attainable goals
Ability to take moderate, calculated risks
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Rating ( tick one)
Adequate
Inadequate
□
□
□
□
□
□
□
□
□
□
(may need to improve)
□
□
□
□
□
□
□
□
□
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How Do You Rate?
Perseverance (when necessary)
Willingness to seek and take advice
Willingness to take personal responsibility
Negotiating skills
Ability to communicate
Preparation for financial difficulty
Overall chances of success
Rating ( tick one)
Adequate
Inadequate
□
□
□
□
□
□
□
(may need to improve)
□
□
□
□
□
□
□
A predominance of ticks in the adequate column would suggest you are
ready to set up on your own! On the other hand a predominance of ticks
in the inadequate column may suggest that this is not the best course of
action.
6.1.2
Can you Afford to Start?
When going into business it is essential that your finances are in order. Begin by being thoroughly aware of your personal assets and liabilities.
To some extent, your personal worth will determine whether you can afford to finance a lease or a loan on the purchases you make, i.e. a practice,
new car, equipment, etc. A statement of personal worth is required by a
potential financier and also helps you define your financial position. You
m ay need to consider BAS payments which will be made quarterly. Doing a cash-flow budget is just as important as a balance sheet when starting out. Also consider how to save for BAS which will be payable at least
quarterly.
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Your Personal Worth
Liabilities
Housing loan(s)
Investment loan(s)
Personal loan(s)
Hire purchase contract(s)
Store account(s)
$
$
$
$
$
Any other monies owing $
Total
$
Assets
Cash/bank deposits
Shares/investments
House
Car (s)
Insurance/superannuation
Other
Total
(Less) Liabilities
Your Net Worth
$
$
$
$
$
$
$
$
$
You need sufficient assets to provide equity and/or to support your loan
application. The lender will expect you to bear the risk.
Your Personal Needs
This is the sum of all the expenses you have and includes all bills (monthly,
quarterly and yearly), plus your regular living expenses. These expenses
should be calculated on a monthly basis and will include: house, car and
loan repayments, insurance premiums, phone and power, rates, and taxes.
Your living expenses include food, clothes, entertainment, education, sport,
transport, etc. By totalling all of your living expenses you have an amount
that represents the net (after tax) monthly income you require.
Regular Monthly
House Payments
Car Payments
Credit Cards
Insurance Premiums
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$
$
$
$
Other Monthly
Food
Health
Clothes
Entertainment
$
$
$
$
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Regular Monthly
Phone, electricity
Rates, taxes
Other
$
$
$
Other Monthly
Transport
Education
Other
Total Monthly Bills
$
$
$
$
(Plus) Total monthly ex- $
penses (Equals) Monthly income needed
The new practice, especially during the start-up period, will make a heavy
demand on your funds. As it would be unwise to expect that you could
withdraw your regular income from the business for some time, you should
plan for funds to provide for your personal needs.
Summary
If you are satisfied that you are ready and able to start, you will need to
consider:
• Whether to buy an existing practice or set up a new practice.
• What business structure you want to adopt.
• What finance you will need.
6.2 Buying a Practice or Establishing a
Practice
• Prior to signing anything have you sought advice from your solicitor, re: contracts, structures, and any limitations in the lease, etc?
• Have you sought the opinions of potential patients or suppliers?
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Choice
Some Advantages
Starting a • Choose your
practice
pace
Possible Disadvantages
own • High risk and uncertainty
• No immediate income
• Can be less competi- • Lenders may be apprehentive
sive
• Don’t have to buy
goodwill
Buying a • Higher likelihood of • May inherit existing probpractice
success
lems
• Finance may be easier • Exit of past owner may efto obtain
fect business
• Stock and suppliers • Location may be inadeare established
quate
• Operational ability is • Premises may be inadea known Factor
quate
• May obtain valuable • Landlord may be difficult
employees
• Need to pay goodwill
• Danger goodwill is overvalued
6.3 The Goodwill Component
When buying or selling a podiatry practice, just as with any other business,
the value of “goodwill” is incorporated in the purchase price. The purchase
price is based on the value of tangible assets - fittings, fixtures, building,
equipment, stock, etc. - and an estimated value for intangibles including
the likely future cash flow, or “goodwill”.
Goodwill may be defined as
“The amount the purchaser is prepared to pay for future cash flow over and above
the present value of the plant, equipment, furniture and fittings and other assets”.
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Therefore goodwill, that intangible asset being the difference between the
net asset value and the asking price, could be said to represent the capacity
of the practice to earn future profits.
Some people feel that goodwill is worth around 25% of the annual turnover of the practice, averaged over the last three years. However, the figure can be higher or lower for a variety of reasons, e.g. the supply of new
patients versus repeat consultations for existing patients, or whether the
practice is in a significant growth curve in a growing community; alternatively, whether the current principal has a network of personal contacts,
e.g. via church or clubs.
There are several approaches to valuing goodwill however a practice is
ultimately only worth what a willing buyer is prepared to pay. A valuing
your practice fact sheet is included with this manual. There are several
methods of valuing a practice, some based on potential future earnings
rather than good will.
Goodwill and Capital Gains Tax
Goodwill is a premium the purchaser is prepared to pay in excess of the
net asset of the practice in order to acquire the practice as a going concern.
As a result, goodwill is classed as a capital asset for the purpose of capital
gains tax, and this means that the disposal of goodwill after 19 September
1985, may give rise to a capital gains tax liability. Generally, no such liability will be payable where the practice was established before this date.
However, you must check this with your accountant.
6.4 Planning Permits
The responsible authority in your area - in most cases, your local municipal
council - will be able to provide you with information as to the zoning of
the premises from which you intend to carry on your podiatry practice,
and if there is the need for a planning permit. If it is necessary to obtain
a planning permit in order to conduct business from those premises, the
statutory planning office of your local council will be able to provide you
with a permit application form and information about the procedure for
obtaining a planning permit.
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Should you be in a position to require a planning permit in order to conduct a home occupation, that permit must be obtained prior to the commencement of business from your residential premises.
Where premises are used to conduct business in breach of an existing planning permit or used without planning approval, the user of the premises
may be served with an infringement notice under the relevant State or Territory planning legislation. Should the user of the premises fail to comply
with such a notice, he/she is liable to prosecution by the planning authority.
Should your application for a planning permit be refused by the local
council, you will be served with a notice of refusal to grant a permit. The
grounds of refusal will be listed on the notice. You may be advised by your
local council before this notice is given if the local council anticipates that
the permit will be refused, allowing you time to amend your application
or address council’s concerns. If your application is refused, the notice will
provide information on how apply for a review of your application in your
State or Territory should you wish to lodge an appeal.
If, at the application stage, you have reason to believe that granting of your
permit may not be a simple routine matter, you may be wise to retain the
services of a professional town planner to submit your application on your
behalf. Should your permit application reach appeals stage, you will probably need to consult your solicitor as well.
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Module 7 - B u s i n e s s
Structures
The below is for information only and should not be taken
instead of appropriate advice. Please consult your
accountant and / or legal advisor for independent advice.
7.1 Introduction
There are four commonly used business structures you can choose from:
• Sole trader
• Partnership
• Company
• Trust
You should decide carefully on the structure best suited to your circumstances, and the way you want to operate your business, weighing up the
advantages against the disadvantages in each case.
The business structure of your practice has, amongst other things, implications for your tax position and your personal liability for debts. The form of
business structure you choose deserves close consideration and you should
seek advice from your accountant, financial advisor and solicitor.
In this section of the Manual, considerable attention is given to issues relating to the operation of partnerships as this form of business structure is
often inadequately understood by private practitioners.
7.2 Sole Trader
This form of business structure is characterised by the fact that the individual practitioner owns and operates the business in their own name
(although they may trade under a registered business name different from
their own name) and, while they may have employees, trades, controls and
manages all aspects of the business.
As a result of this the individual proprietor is personally liable for any
debts of the business (practice). The individual’s liability is unlimited and
personal assets are exposed. Debts and losses cannot be shared.
In relation to taxation, the individual proprietor must report the business
(practice) income earned (after expenses) on their personal income tax return, along with any other income. The net business (practice) income is
assessed for primary income tax. The individual proprietor is liable to pay
tax at the individual marginal rate and is entitled to the tax-free threshold
if an Australian resident.
The individual proprietor is responsible for their own superannuation arrangements and may be able to claim a deduction for personal superannuation contributions made. The individual proprietor is also responsible
to make superannuation contributions for any eligible employees.
The benefit of this structure is its simplicity, ease of operation and lack of
expense to establish. All that is required, generally, is a separate business
bank account and perhaps a separate trading name. A sole trader receives
the full benefit of profits made by the business.
If an individual wishes to trade under his/her own name, i.e John Smith,
then nothing need be done except print the business stationery. But if the
business is to trade under any name other than that of the owner, ie. Smith
Podiatric Clinic, then in Australia it must be registered with the Australian
Securities and Investment Commission (ASIC) National Business Name
Register.
Registration will be granted for a chosen business name, provided it is not
already registered. The individual will have to pay a registration fee.
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7.3 Partnerships
• When does a partnership exist?
• Characteristics of a partnership
• Liability of partners
• The Partnership Contract
• Dissolving a Partnership
• Financial Aspects of Partnerships
A partnership is the relationship or association between two or more people carrying on a business with a common view to a profit. The partners of
a partnership may be individuals or companies. Every partnership agreement, whether it is in writing or verbal, implies a term of the utmost good
faith, that is, each partner must act with absolute good faith in all dealings
relating to the partnership.
A partnership, like a sole trader situation, is reasonably simple to establish
and inexpensive. Where a business of the partnership is to trade under a
business name rather than the names of the partners involved the partnership must register a business name with ASIC.
Legislation of each state and territory sets out well established legal principles governing partnerships in Australia (“Partnership Acts”).
Tax considerations
Although a partnership is not a separate legal entity, for taxation purposes
an annual partnership income tax return must be lodged on behalf of the
business to show the total income earned and deductions claimed by the
business. The taxable income of a partnership flows out to the partners according to each partner’s share in the partnership. Each partner must pay
tax, at that partner’s marginal tax rate, on their share of the partnership
income earned. Therefore, it is important that the partnership accounts
properly record income and losses so that each partner can calculate their
individual tax liability.
The liability of the partners in a partnership is known as joint and several.
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This means that each partner is jointly and severally liable for all of the
debts and liabilities of the partnership; that is, each partner is fully responsible (100%) for all of the partnership’s debts regardless of the proportionate share of the partnership.
Furthermore, a partner’s personal assets are potentially available to creditors of the partnership to satisfy the partnership debts.
Each partner can be held liable for the debts of the partnership with no
limit even though they did not directly incur or were not a party to the
incident causing the debt.
In this respect, the partnership structure can expose a partner to a greater
risk of personal liability than a sole trader because as a partner you are not
only liable for your own acts, but also the acts of your partners in the conduct of the partnership business.
Many partners will decide to incorporate their partnership into a company
structure for this reason alone.
When does a partnership exist?
The Partnership Acts set out important rules in relation to the creation,
operation and termination of partnerships.
It doesn’t really matter whether the partners call themselves partners or
not. In some cases, a partnership can exist even where the parties say that
they are not in partnership.
In determining whether a partnership does or does not exist, regard will be
had to the following:
• The joint intention of the parties in connection with a business.
• How the parties jointly participate in the sharing of the income of
a business.
• Whether the parties are each other’s agents.
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Characteristics of a Partnership
The four main characteristics of a partnership are:
a.
Identification of the Individual Partners
Our legal system recognises the partners themselves as people who
carry on a business in common. It does not identify the partnership
as an entity separate from its operators.
It is advised that all parties who are contemplating a partnership
consult with a lawyer.
b.
Unlimited Personal Liability of the Partners.
Even though the partners may agree amongst themselves that the
liability of any one of them is to be limited, the liability of each partner to the creditors of the business is unlimited.
c.
Non-Transferability of Partners’ Interest
A partner cannot transfer their interest in the partnership to a person who is not already a partner, unless the other existing partners
agree.
A partnership agreement can allow for the manner in which a partner’s interest may be sold or transferred to the other partners or to
a person who is not a partner.
d.
The Right of Each Partner to Take Part in the Management
Subject to any express or implied special agreement between the
partners of a partnership, each partner may take part in the management of the partnership business and no change may be made in
the nature of that business without the consent of all the partners.
Liability of Partners
Much more thought should be devoted by people contemplating entering
a partnership as to the liability imposed on them by a partnership situation. This issue is discussed in detail below.
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a.
Contractual Liability to Third Parties
The Partnership Acts impose joint liability on each partner for the
partnership’s debts and obligations which have been incurred while
the partner is a partner.
The estate of a deceased partner is also severally liable in the course
of administration for debts of the partnership incurred before the
partner’s death that remain unpaid but subject primarily to the prior payment of the deceased partner’s individual debts.
b.
Liability for Wrongs to Third Parties
Partners are liable jointly and severally in the event that any wrongful act or omission of a partner committed in the ordinary course
of business or with the authority of their co-partners, causes loss or
injury to any person not being a partner in the partnership.
Innocent partners are also responsible for the misrepresentation of
the other partners or employees in matters connected with the ordinary business of the partnership, and they are also liable for damages caused by the negligence of a partner in the ordinary conduct
of the partnership business.
c.
Liability of New Partners
Unless a new partner specifically agrees to incur liability for debts
or obligations incurred before their admission to partnership, they
are not liable for those pre-admission debts or obligations.
d.
Liability of an Outgoing Partner
A retiring partner is not excluded from liability of debts incurred
while they were a partner unless there is a specific agreement between themselves, the remaining partners and the people to whom
the debts are owed.
e.
Securing the Liability
Partnership property is generally not exposed to action by a creditor unless the creditor has judgment against the partnership. The
Court may, on application by the judgment creditor, make an Order charging that partner’s interest in the partnership property and
profits with payment of the amount of the judgment debt. If a part-
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ner permits the sale of partnership property, the other partners may
choose to dissolve the partnership.
f.
Liability to Account
Partners must render true accounts of the partnership and full information of all things affecting the partnership to any partner or
their legal representative.
Every partner must account to the partnership for any benefit derived by the partner without the consent of the other partners from
any transaction concerning the partnership or from any use by the
partner of the partnership property, name or business connection.
If a partner, without the consent of the other partners, carries on
any business of the same nature as, and competing with, the partnership business, they must account for and pay over to the partnership all profits made by them in that other business. This does
not apply where the partner uses information acquired in the business to venture into non-competing areas of business.
The Partnership Contract
The rights, responsibilities, obligations and general relationships of the
partnership are governed by agreement between the partners.
Partners should therefore give full consideration to all aspects of the business relationship they intend on entering into. The Partnership Acts impose
few restrictions or terms on the partners and the provisions of the Partnership Acts can, for the most part, be overridden by agreement between the
partners.
It is recommended that partners should commit to agreement in writing
before commencing business to avoid disputes in the future by outlining
the terms of the partnership and the partners’ ongoing relations in connection with the partnership, although such formalities are not required by
law. It is highly advisable to have a written agreement drawn which covers
all material matters that relate to the partnership . It is suggested that the
following matters be taken into account (though this is by no means an
exhaustive list):
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• Names and addresses of the partners
• Length of partnership
• Place / address of business
• Initial contribution to capital
• Provision for increase to capital
• Return on capital
• Loans by partners
• Goodwill
• Outgoings (including partners’ salaries)
• Shares in net profit
• Details of the partnership’s bankers
• Details of the partnership’s accountants, tax agents, legal representatives
• Drawings
• Duties of partners
• Private obligations of partners
• Prohibitions
• Accounts
• Holidays
• Life policies and insurance (eg. sickness, life Assurance)
• Retirement
• Winding up of the partnership
• Disposal of goodwill on winding up
• Notice of dissolution
• Effects of death, bankruptcy or retirement
• Expulsion
• Mediation
A partnership agreement should be prepared by a Solicitor who will provide an estimate of the likely cost upon inquiry. Standard forms of partnership agreements are available for sale to the public, but a personalised
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partnership agreement prepared by a Solicitor is more suitable in accommodating individual requirements.
Dissolving a Partnership
The Partnership Acts provide that, subject to any agreement between the
partners, the following situations will lead to the dissolution of a partnership :
a.
At the expiration of fixed term specified in the agreement.
b.
If entered into for a specific venture, on the conclusion of that venture.
c.
If there is no period specified in the agreement, on any partners giving notice of their intention to dissolve the partnership.
d.
On the death or bankruptcy of any partner, unless otherwise agreed
by the partners.
e.
Where a partner charges their share of the partnership property
for private purposes. This is not automatic and depends on other
partners exercising their option.
f.
Where the business of the partnership is unlawful.
g.
In a dual partnership situation, where a partner sells out to the
other.
Alternatively, upon application, a Court may order the winding up of a
partnership where it is “just and equitable” to do so.
A common and advisable practice, on the dissolution of a partnership, is
for one or all of the former partners to advertise the dissolution in appropriate publications (government gazette, daily newspapers). This can be
of benefit where problems arise in relation to liabilities to third parties for
ongoing debts.
Financial Aspects of Partnerships
One area deserving of thorough planning is the defining of a partner’s financial interest in the partnership from the outset.
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Obtaining advice from an accountant can prevent problems before they
arise, promote harmony and reduce the possibility of disagreement and
misunderstanding between the partners.
The types of matters that may require consideration and clarification are:
• Valuation of goodwill (both initially and ongoing)
• Capital
• Division of profits
• Provision for retirement or death
• Provision for purchase of deceased partner’s share
A properly planned partnership can be a satisfying, profitable and enduring form of business relationship.
7.4 Company
The third option, a company, is characterised by the fact that a company
is, as a general proposition, an independent legal entity, separate from its
shareholders in both liability and taxation concerns.
A proprietary or private company, must have at least one director, but does
not need to have a secretary. The director and secretary (if any), must ordinarily reside in Australia.
A proprietary or private company does not permit the trading of its shares
in public.
All company officeholders, being a director or secretary, must follow the
requirements set out in the Corporations Act 2001 (Cth) (“Corporations
Act”). It is important that company officeholders know what their legal
obligations (http://www.asic.gov.au/asic/asic.nsf/byheadline/Company+of
ficeholders?openDocument) are, for example:
• Ensuring company details are kept up to date.
• Maintaining various registers and records.
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• Paying the appropriate lodgement and annual review (http://www.
asic.gov.au/asic/asic.nsf/byheadline/ASIC+fees?openDocument)
fees to avoid late fees and non-compliance action.
The company officeholders remain ultimately responsible for the company’s compliance with the Corporations Act.
Before you apply to register a company you must decide how the company
will be internally governed (http://www.asic.gov.au/asic/asic.nsf/byheadline/Constitution+and+Replaceable+Rules?opendocument). You’ll need to
decide if its internal governance operates under:
• Replaceable rules (these are rules for internal management set out
in the Corporations Act)
• Its own constitution, or
• A combination of both
Your solicitor can assist you with this.
Your proprietary company cannot be governed by replaceable rules if you
will be its only director and shareholder; special rules apply instead.
Under a company structure the liability of the company’s shareholders is
limited; the shareholders are not, as a general rule, personally liable for
the company’s debts and other obligations. This corporate veilis somewhat
eroded by statute based law which can impose liability on directors and
other senior management. For example, under the Corporations Act directors may be held personally liable for debts incurred by their company if
the company continues to trade while insolvent, and a range of statutes
including in relation to occupational health and safety, the environment
and tax can impose personal liability on directors in some circumstances.
To set up a company, you will need legal advice and some understanding
of the obligations imposed on company directors. These requirements can
prove onerous and difficult to fulfill for some people. The Corporations Act
is complex and it is often hard for the owners of small businesses to grasp
the full implication of their responsibilities as directors.
Those who form a company to limit personal liability often find the protection offered has been circumvented by lenders or lessors demanding per121
sonal guarantees from directors in addition to other security offered. Yet,
at a certain point of business growth, incorporation may become necessary
to protect the personal interests of the private practitioner.
It is recommended that you utilise the advice of a qualified accountant
when considering the best business structure for you.
How to Form a Company
ASIC is Australia’s corporate, markets and financial services regulator.
ASIC is the national authority responsible for administering the Australian
Securities and Investment Commission Act 2001 (Cth) and carries out most
of its work under the Corporations Act regulating corporations, securities
and futures markets.
All applications to register companies are processed by ASIC.
Before deciding to register a company, it is best to seek the advice of your
accountant or financial adviser.
Companies and Taxation
A company, as stated earlier, is a legal entity separate and distinct from its
shareholders for taxation purposes. This generally means that the company
will be assessed separately on its taxable income at the company tax rate.
However, special rulings of the ATO apply to companies operated by professional practitioners. Personal Services Income rules restrict the professional from retaining profits in the company and provides that all profits
must be paid to the professional in the form of a salary or superannuation
benefits. This restricts the professional benefiting from the retaining profits
of the company being taxed at the company tax rate which is generally
lower than the highest personal marginal rate of tax. (Search “Personal Services Income” at www.ato.gov.au).
Where at least as many non-principal practitioners (non-owners) as principal practitioners (owners) operate through the practice company then
there may be some opportunity for the company to retain profits and pay
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tax at the company rate. The owner must still be paid a salary commensurate with the income they have generated within the company although
residual profits can be retained in the company and taxed at the company
rate. The retained profits, generally, will build up in the company or eventually be paid out to the shareholders as franked dividends.
The Australian Taxation Office does not prohibit the incorporation of professional practices. The main effect of incorporation seems to be to reduce
the professional’s income by the amount of an appropriate superannuation
cover. There may also be other taxation advantages for the podiatrist.
It is recommended to seek the professional advice of your accountant or
financial adviser on this taxation issue.
7.5 Trust
A trust is a relationship where a trustee (an individual person or persons
or a company) carries on business for the benefit of other people (the beneficiaries). For example, a trustee may carry on a business for the benefit of
a particular family and distribute the yearly profit to them.
A trust provides asset protection and, especially where there is a corporate
trustee, limits liability in relation to the business. Trusts are also very flexible for taxation purposes. A discretionary trust provides flexibility in the
distribution of income and capital gains among beneficiaries.
A trust is a complex legal structure, which should be set up by a solicitor
or an accountant.
There are two commonly used types of trusts:
1.
A discretionary trust, where the trustee decides how income and
capital will be distributed among beneficiaries.
2.
A unit trust where the interests in the trust are divided into units,
similar to shares, and distribution from the trust is determined according to the number of units held by the unit holder.
A third type of trust is a hybrid trust, which is a combination of a discretionary trust and a unit trust.
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A trust may be used to establish a service entity arrangement where the
trustee of a trust, usually a company, provides a range of management or
administrative services to the practice, e.g. provision of rooms, administration staff, accounting services, etc.
The Australian Taxation Office accepts the use of a service entity “where
the service arrangement is a commercially realistic one, it is accepted for
income tax purposes” (emphasis added). It is only where the arrangement
is commercially realistic that it will be allowed.
It is recommended that any practitioner considering a service entity should
read and consider the Australian Taxation Office rulings and guidelines on
service entity arrangements.
Further, the utility of a service entity in a specific business depends on the
cost / benefit analysis as applied to the specific circumstances. A careful
analysis of the business should be undertaken by your accountant or financial advisor to determine whether a service entity is appropriate.
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Module 8 - F i n a n c i a l
Management and Fees
The below is for information only and should not be taken
instead of appropriate advice. Please consult your
accountant and / or legal advisor for independent advice.
8.1 Financial Requirements
Will you have sufficient capital, loan funds and revenue to cover all costs
and expenditure? It is vitally important you are able to meet all of your
obligations as they fall due.
You need to determine the costs involved in starting and operating a practice. Some of these can be:
Capital Costs
Startup Costs
Growth Costs
Operating Costs
building and renovations
equipment
goodwill
motor vehicles
cost of stock (takeover and / or purchases)
deposits, bonds and connections
licenses and fees
promotional costs
ability to fund/finance business growth (a mix of extra capital and debt is needed)
wages / bonuses (staff and your own)
rents / leases and other occupancy costs
administration / accountancy
telephone / fax etc.
marketing
Sources of Outside Accountants
Help / Advice
Accredited Business Agents
Solicitors
Consultants
Professional Associations Employer Associations
Government
The Government Small Business Agency in your
State Teaching Institutions
Other Practice Owners
Financing Costs
interest and loan / lease repayments bank and legal
fees debtors etc.
8.1.1
Business Equity
Owners’ equity is an important consideration for borrowing money to start
a business because the lender will expect you to contribute part of the total
amount required.
Other considerations include:• The degree of risk of the practice
• ability of the practice to repay
• Financial history and record of the people wanting to borrow
You need to determine what the cost of servicing / repaying the required
level of borrowing will be. To calculate whether your practice will be viable
or not you need to establish an initial target figure. This helps determine
the amount of gross fees required to break even.
8.2 Banking and Bank Loans
8.2.1
Personal loans
If you are a recent graduate the most accessible finance for you will probably be a personal loan from a Bank. These loans can be used for any worthwhile purpose, such as purchasing a car, or travelling overseas. Personal
loans are usually less than $20,000, and are often unsecured.
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Personal loans always have a fixed interest rate and the interest amount is
added to the principal at the outset and repaid over the term of the loan
(generally up to 7 years).
When you buy goods with a personal loan ownership of the goods rests
with you.
8.2.2
Overdrafts
An overdraft is a loan with no fixed repayment arrangement. The limit is
decided beforehand and recorded on the borrower’s cheque account. The
interest rate is always variable and is linked to a published index or benchmark rate and quoted as a margin above or below that rate.
Overdrafts are usually used as a short term working capital facility to meet
the timing difference between payments being made from your account
and the receipt of income. Overdrafts are not usually provided to refinance
existing debt and should in the normal course fluctuate fully from debit to
credit.
Overdrafts can be unsecured or secured depending on the nature of the
borrower and the amount of the limit.
8.2.3
Fully Drawn Advance
A fully drawn advance is a loan account with a set original amount (like a
personal loan), a fixed term and prearranged repayments. A fully drawn
advance is most often utilised for significant purchases and is often secured
by: a mortgage over property, and/or a guarantee from another party.
The amount which can be borrowed through a fully drawn advance is limited only by the available security and the demonstrated ability to repay
the money.
Fully drawn advances are often used by medical professionals to purchase
existing practices.
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8.2.4
What banks and finance companies
consider
When lending money, bankers look for three things in the borrower:• Character (willingness to repay money)
• Capacity (ability to repay money)
• Collateral (what to do if the borrower can’t repay - security1)
Character is a constant, whilst (to a degree) capacity and collateral can be
balanced against each other. That is to say, a lender must be satisfied that a
borrower intends to repay the money but will allow some leeway for partly
secured or unsecured loans where there is strong evidence of an ability to
repay the loan.
The sort of things bankers will look for to satisfy themselves that you can
repay the money is stability of past employment (if applicable), past history with borrowed money and credit cards, and most importantly, the
income you are likely to make from your practice.
For these reasons it is important to look beyond interest rates when choosing a bank, carefully evaluate all bank fees as well as their service for private practice / small business. For the same reason that you don’t buy a car
based on its price alone, you need to look beyond interest rates and special
“packages” when choosing your bank.
8.2.5
Bank Accounts
Records.
and
appropriate
When you graduate and begin work, either for yourself or for another podiatrist, you will be confronted with the Australian taxation system.
1
Security is a generic term which describes assets over which a lender takes a legal charge.
This charge gives the lender the right, in specific circumstances, to exercise its control over the asset
and sell it to recover its money. Only if there is money left over at the end of this process does the
borrower get a share of the sale proceeds. Banks take security to limit the downside risk to their
investors.
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To ease stress at the end of the financial year it is always best to prepare in
advance. The most important thing to do is to ensure that your records are
complete and easy to interpret. The way you structure your bank accounts
at the outset is fundamental to this requirement.
Make sure your personal expenses and banking are kept separate from
business banking
8.3 The Business Plan – An Overview
8.3.1
Why a Business Plan?
Studies show that businesses which develop and use business plans have a
higher rate of success than those which do not. Banks often require a business plan when considering a loan application.
Checklist of items you should include in a Business Plan
1.
The Practice
A description of the practice, reasons for being in the practice.
2.
An Opportunities Statement
Identify trends and outlooks for the practice and its overall performance.
3.
A Strategic Audit
Statement of practice “mission”, directions for growth, identifiable
advantages over competitors.
4.
Objectives
Identify and establish performance measures and targets.
5.
Business Strategies
Identify marketing, personnel and financial matters.
6.
Action Plans
Identify plans for “making it happen” - the who, when and how of
being in business.
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7.
The Total Plan
Make provisions for learning from the operations and experiences.
Does your Business Plan support a loan application?
8.3.2
Special Packages for Professionals
Most banks and some building societies offer “special packages” to professionals. These usually involve discounted home loans, small unsecured
facilities, and a Gold Card - Credit Card facility. Be very wary of these, usually any package is just a way for banks (and building societies) to “buy” a
low risk business.
At the end of the day it is pretty hard to make a dollar from one bank look
any different from a dollar from another bank, therefore the products offered by all banks and building societies are sometimes fairly similar. The
impressive sounding names such as “Mortgage Power”, “The Negotiator”,
and “Advantage Saver”, are put there to make the products seem different.
Either you are borrowing money or you are investing it. Also, you can rest
assured that all banks, like any other business, are out to make a profit,
and any discounts and special rates will probably be picked up somewhere
else.
8.4 Other Financing Options
8.4.1
When is it Better to Finance than
Buy?
Financing can be particularly suitable for a fast-growing, profitable practice which needs to conserve funds for expansion. In such circumstances, a
practice might find that leasing is a more tax effective form of finance than
the traditional bank options. Whether this would actually be the case could
involve some quite complex calculations. You should therefore ask your
accountant, a lease broker or some other professional adviser for specific
advice on this. You may want to consider the cost of the item and utilise a
depreciation schedule for larger items over $1000.
Note:
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• Virtually any equipment that produces income for you can be financed. The parameters are broad, but the test is that the goods
must be used in the course of your business and financiers generally prefer to finance new equipment.
• As a lease is a debt requiring periodic repayments, a lending institution will look at your overall ability to service future borrowings.
A regular and consistent track record of repayment with a lease or
hire purchase contract will provide you with an excellent credit rating, which will be very beneficial with future borrowings.
• It is sometimes possible to change over to new goods if equipment
becomes unworkable or obsolete during the term of a lease. A new
lease agreement will be arranged in keeping with the altered values
resulting from such a change-over and the possible scrapping of the
obsolete goods.
A finance lease
• The financier retains ownership of the goods financed.
• The client is “renting” the goods over a long term.
• The client obtains a tax deduction for the payments (according to
business use).
• The term and residual are defined according to Tax Offices’ rulings
and the wishes of the client.
• The goods must be wholly or mainly for business use.
• Government stamp duty may be applicable.
• Penalties are applied for early termination of the loan.
• Rates are fixed for the term of the loan.
Commercial hire purchase
• The client retains ownership of the goods (the financier retains a
mortgage).
• The essence is that you are paying off the loan to obtain full ownership if required.
• The interest payable on the loan is tax deductable (according to
business use).
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• Depreciation of the goods is also deductable.
• Payments and terms are structured along similar lines to leasing.
• There are no penalties attached to paying the loan off early.
• Hire Purchase is generally considered to be a more flexible method
of financing.
• Both Leasing and Commercial Hire Purchase (CHP) offer much
lower interest rates than personal.
• Rates are fixed for the term of the loan.
8.4.2
Finance and Taxation
What taxation arrangements apply to leasing?
The full amount of rental paid is tax deductible when the goods are used
wholly for business purposes. Leasing, is of most benefit to a profitable
practice that requires tax deductions.
Does that differ from hire purchase?
In these transactions, the interest charges paid to the financiers are tax deductible as is the depreciation of the plant and equipment as distinct from
the whole of the payment with leasing.
What happens to the equipment when the lease ends?
You will generally have four options:
• To arrange to re-lease for a further period.
• To trade-in the goods at a figure sufficient to clear the residual value
and take up a further lease, or purchase other goods.
• To offer to purchase the goods.
• To hand the goods back to the lessor (this is not recommended).
How is the residual value of goods determined?
At the time the lease plan is drawn up, the lessor and lessee will negotiate a
residual value for the goods. This residual value will be based on a number
of factors, including the depreciation rate permitted by the Taxation Office,
the make and model of the goods, how they will be used and previous
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ful in estimating the residual value of goods subject to rapid technological
change such as computers and electronically controlled machinery.
Sources of leasing finance
You would be wise to compare the lending rates charged by a variety of
finance companies and banks every time you are considering a new financing commitment. Competition between lessors is strong and it would be
inadvisable to consider yourself bound up to the one bank, or to the one
type of finance, for a lifetime.
What does a lease broker do?
A lease broker acts as an intermediary between you and the lending institutions. They can offer you advice on the types of finance that are available,
discuss the taxation implications and negotiate a competitive package between you and the lender.
You should ask your accountant to evaluate a proposed leasing plan to
determine whether this offers you worthwhile tax benefits.
8.4.3
Leasing
Advantages
Disadvantages
and
Advantages
The use of 100 percent financing allows you to conserve capital for more
profitable use elsewhere, such as stock, debtors and other investments.
Generally security is not required, however it may be required when you
are establishing yourself.
The total lease rental is tax deductible, provided the arrangements meet
Taxation Office requirements and the leased goods are used solely for business use.
Leasing charges are fixed for the term of the loan and are therefore not affected by subsequent changes in interest rates.
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You are not committed to go on using the leased goods at the end of the
lease period; you can buy or lease more modern equipment or undertake a
further lease on the goods you have been using.
The amount of finance provided is fixed, unlike an overdraft, and your
rental payments may be structured to suit your seasonal cash flow variations.
Disadvantages
Because leasing is 100 percent financing, lessees can become over-committed on high monthly or quarterly charges.
At the end of the lease period technically you have no more equity than at
the start of the leasing agreement. But the residual that remains is generally the market value of the items leased, and this figure becomes the agreed
figure between you and the financier to purchase the items if required.
A penalty may be applied if you wish to pay the loan off early.
8.5 Financial Records
Financial records must be kept to conform to either: company or income
tax legislation, or both.
It is important that you keep accurate records of costs and outgoings which
may be attributed to your business activity, both in order to account properly for the costs which relate to your business, and also in order to keep
adequate records for taxation purposes.
While financial records must be kept to meet legislative requirements, they
also provide information vital to you in the day to day operations of the
business. Records are also vital for the preparation of your end of year financial statements and income tax returns. These records are important in
complying with the substantiation requirements of the income tax act.
In addition to these financial statements, regular periodic reports should
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be prepared and used intelligently to alert you to how your business is
progressing.
Your records should include information on revenue, profitability, cash
flow, and statements comparing actual expenditure with pre-determined
budgets.
8.5.1
Basic Bookkeeping Records
The following represents the basic bookkeeping records that should be
maintained by business proprietors:
• Bank statements
• Sales invoices
• Sales journal
• Receipt books
• Cheque butts/books
• Bank pay-in books
• Cash book
• Petty cash book
• Orders
• Creditors invoices
8.5.2
Bank Accounts
• Have a separate cheque account for your business.
• Bank all income intact and make all possible payments by EFT.
• Request bank statements on a weekly basis, file carefully and reconcile promptly with the cash book. It’s possible to have electronic
downloads into compatible book-keeping systems.
8.5.3
Cheque Butts
• Fill them out clearly including the name of the payee, the date, the
nature of the expenditure.
• File completed cheque books carefully.
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8.5.4
Deposit Books
• Loans, capital introduced, proceeds of the sale of assets.
8.5.5
Payments Made in Cash
• Maintain remittance advices and other documents relating to nontrading income in a special file/folder.
• Keep copies of invoices aside in readiness to give to your accountant.
• Keep hire purchase agreements and lease agreements in readiness
to give to your accountant.
• Where funds are obtained for the business from a bank or finance
company, keep the bank letter or loan agreement in readiness to
give to your accountant on request.
• Value stock at cost unless the market value of the item has fallen
below cost. If this is the case, value the item at market value and
mark “market value” on the stock sheet.
8.5.6
Accounting Systems
While it is possible to start a business using manual bookkeeping, we recommend a computerised accounting system such as MYOB or Quickbooks.
Check with your accountant before purchasing a system to ensure they can
accept a file from the system. A system that can expand to include employee information in the future is a good idea. This reduces your ongoing
accounting costs. You should also check with the supplier of your practice
management system to ensure you can transfer billing information into the
system regularly and easily.
8.5.7
Help from Accountants
It is important that small businesses seek the services of an accountant before starting a business and thereafter on a regular basis during the operation of that business. In this way the risk of making costly errors is avoided
as the accountant is in the best position to provide a wide range of necessary advice. At the same time the accountant can provide guidance on a
simple and effective record keeping procedure, enabling the progress of
the business to be periodically measured.
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The following lists the range of services offered by accountants in public
practice. Some of the functions may not be handled by an accountant. The
list can be used as a basis for determining the precise area in which an
accountant can be of help. In some cases the accountant does the work
directly. In other cases he or she can provide valuable advice or act as a
source of referral.
8.6 Australian Taxation Office
8.6.1
Goods & Services Tax (GST)
Apart from medical services, “other health services” are GST-free if they
are:
• Listed in the table in section 38-10 of A New Tax System: Goods and
Services Tax Act 1999; “recognised professional” and
• Generally accepted in the relevant health profession as being necessary for the appropriate treatment of the recipient of the supply.
Most (but not all) podiatry professional services and goods supplied are
GST-free. Products not supplied at the time of appointment and orthotic
devices being re-made incur GST.
Further information regarding GST may be obtained by:
• Phoning the ATO on 13 24 78.
• Downloading information from the website at www.ato.gov.au.
• Obtaining A Fax From Tax on 13 28 60.
• Phone the Telephone Typewriter Service (TTY) if you have a hearing or speech impairment; or Write to the A.T.O. at PO Box 9935 in
your capital city.
8.6.2
Australian Taxation Commissioner’s
Schedule – Podiatrists’ Assets
In 2002/2003 the Australian Taxation Office conducted an effective life review of podiatrists’ assets.
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Table A of Taxation Ruling TR 2006/5. The following assets are listed under
that sub-heading:
TABLE A
ASSET
LIFE
(YEARS)
REDATE OF APVIEWED PLICATION
HEALTH CARE AND SOCIAL ASSISTANCE
(84010 to 87900)
Medical assets:
Benchtop sterilisers
5
*
1 July 2003
Benchtop
ultrasonic 7
*
1 July 2003
cleaners
Clinical furniture
10
*
1 July 2003
X-Ray viewers10
10
*
1 July 2003
Secondly, the following schedule of Podiatrists’ assets is included in Table A
of Taxation Ruling TR 2006/5 under the sub-heading “Podiatry Services”.
TABLE A
ASSET
LIFE
(YEARS)
REDATE OF APVIEWED PLICATION
PODIATRY SERVICES
(85399)
Podiatrists’ assets:
Computerised orthoses manufacturing assets:
Contact pin digitiser
Carving mill
Doppler vascularscopes
Electric nail drills:
Dust extraction drills
Portable dust extraction
drills
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7
7
5
*
*
*
1 July 2003
1 July 2003
1 July 2003
7
5
*
*
1 July 2003
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Water and alcohol based
spray drills
Examination/magnifying
lamps
Footrests
Gait analysis assets:
Computerised system (incorporating in-shoe pressure analysis or platform
based pressure mats, integrated hardware and
integrated software)
Non-computerised:
Treadmills
Video cameras
Video monitors and video recorders
Orthotic benchtop grinders
Patient chairs
Podiatric instruments
4
*
1 July 2003
10
*
1 July 2003
10
*
1 July 2003
4
1 July 2003
10
5
7
*
*
*
1 July 2003
1 July 2003
1 July 2003
6
*
1 July 2003
12
3
*
*
1 July 2003
1 July 2003 1
July 2003
Vacuum Presses
3
Vascular neurological assessment assets:
Monofilaments
2
Tuning forks
10
*
*
*
1 July 2003
1 July 2003
8.7 Budgeting and Financial Control
8.7.1
Controls through the budget
The mere preparation of a budget may prove to be of considerable value
to the average practice, but its value lies in the: planning aspects and in its
utilisation for coordination and control during the period. Budget control
involves constant checking and evaluation of actual results against budget
goals, resulting in corrective action where indicated.
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Budget estimates are the best forecasts available before the financial year
starts. Certainly, be flexible in your thinking at the time of preparation, but
once fixed it should be the control point against which actual figures are
compared. Be realistic in setting the estimates, so that you can see the factors which are the underlying basis for the figures established, and then direct your attention to the actual problem areas. Thus control of the practice
is obtained from setting the budgets.
A budget is your best estimate before the financial year starts of what the
business will achieve during that year, and should highlight the opportunities and difficulties which may occur. In this context, it is for a period
of twelve months, but it can be extended to three or four years, thereby
encompassing a business plan.
The budget is segmented into various categories such as fee income, overheads, and final net profit. In turn, one must look at the cash budget to
ascertain the change in cash requirements including capital expenditure,
and working capital, such as stock requirements.
The budget is a prediction of the time periods ahead, and also includes
financial benchmarks, to which the business should aim to adhere to.
8.7.2
How is a Budget Drawn Up?
The current economic climate is displayed by a number of factors, such as:
inflation, interest rates, the strength of the dollar, growth or real increases,
an unemployment. Population changes may also have an effect.
It is best to start with the sales budget, overheads and net profit. The following stage is the cash budget and includes capital expenditure, working
capital, such as trade debtors and stocks, taxation and dividends or drawings.
8.7.3
Operating budget
This covers the forecast income and expenditure accounts, and is used on a
regular basis, say monthly, for comparison with actual results.
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It includes the following steps;
• Fee income
• Overheads
• Administration
• Financial
• Net profit, with taxation as an appropriation of net profit.
8.7.4
Budgets
You should be aware of the actual and forecasted fee income for the current
year, perhaps divided into groups or categories, say on a monthly basis. If
a 3% growth plus inflation of 5% is predicted, there is the starting point for
the following year. At that point, you should look at the outside factors,
e.g. other practices and their profitability, profit margins and so on. The
answers to these questions will assist in predicting the fees forecast.
New business will have to rely entirely on information from outside, such
as experience and market research.
8.7.5
Overhead and other expenses
Overheads and other expenses should be compared to previous periods/
years. You may be looking at a down-turn in profit in one particular year
with the thought that profits in the following year will make up for the
down-turn.
Overheads may be defined as expenses which are necessarily incurred in
rendering a service but which cannot conveniently be attributed to individual units of production or service. In any consideration of: costing, pricing
and profit, it is often essential that overheads be taken into account in their
entirety. Too often business proprietors are heard to say that there are very
few overheads in their business.
Examples include rent, lighting and heating, motor vehicle expenses, salaries, rates, telephone, postage, staff salaries, conferences, equipment maintenance, accounting, and depreciation.
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8.7.6
Other Budgeting Strategies
There are three areas which can be looked at in conjunction with your financial advisor:
• Cash flow statement
• Working capital
• Projected balance sheet
The cash flow highlights the surplus or deficiency of funds over a twelve
month period, broken down into months. It can be done by a forecast of
future cash receipts and cash payments and must include additional items
such as:
• Leasing charges
• Capital expenditure
• Mortgage payments
• Bank and other interest
• Taxation including fringe benefits taxation
It will tell us if the business requires more cash, either permanently or short
term. This is one of the crucial elements of the budget, perhaps even more
so than the operating budget.
The effect of working capital on the business highlights those items which
may tend to be overlooked, such as stocks, debtors and creditors. Again it
should be available on a quarterly or monthly basis.
A projected balance sheet assists with any lending programmes.
8.8 Operating as a Locum
The following is a checklist when operating as a locum.
1.
Register with the appropriate locum and associate services.
2.
A locum may organize their bookings privately or through an agency.
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3.
Advertise your availability and always have a way of being easily
contacted.
4.
Ensure you have Professional Indemnity insurance, podiatry registration and the practice is covered for Public Liability. It is wise to
have good income protection insurance.
5.
Medicare issues provider numbers which in turn are recognised
by private health funds. A provider number is specific to a location
and a practitioner, hence locums will need to register for multiple
provider numbers based on their bookings. Ref to Medicare MBS
Schedule – G.2.3 Locum Tenens. Forms are available from http://
www.medicareaustralia.gov.au/provider/pubs/medicare-forms/
provider-number.jsp.
6.
Ensure that the clinic has stock in place for your arrival that includes your preferred glove size and type, preferred dressings and
any other specific requirements that you consider important to your
proficient consultation ability.
7.
When negotiating a locum fee, consider the relevant award, e.g.
Federal Allied Professions award, as a basis plus appropriate oncosts.
8.
Be confident negotiating a travel fee if the practice is a considerable
distance from your home. Transport costs and time spent on the
road is time that could have been billable.
9.
Good to advise your MA of your availability as a locum as they
get many member enquiries and may even keep a “locum list” as a
member service.
10.
Locums should ensure a good working knowledge by observing
the practitioner for a minimum of 2-3 hours prior to take over. You
may want to consider ethics in practice: re not taking patient records or contacting patients. Also ethics of locum - don’t change
care plan unless absolutely necessary.
11.
Keep evidence of expenses and revenue are required, possibly a
combination of accounting software and hard copy filling.
12.
Record these incomes and expenditures in the accounting system
throughout the year.
13.
Keep a record of all leases, any mortgages for your home and costs
of equipment which you may have bought (for a depreciation
schedule).
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14.
Ensure you have enough training to cope with new record keeping
methods, especially if on an unfamiliar computer software system.
15.
Decide whether you need to consider an incorporated structure or
merely operate as a sole practitioner if you are a contractor or are
operating your own practice. You therefore need to review the costeffectiveness of incorporation as well as other issues such as capital
gains tax, protection of assets and the limitations on re-arranging
your structure at a later date. There are also some additional advantages regarding superannuation deductions within an incorporated
entity. Expert advice in this area is strongly recommended.
16.
Separate business and private cheque accounts are advisable for
ease of recording details for your accountant. The operation of separate accounts should assist in the management of your funds and
may assist in the event of a tax audit.
17.
In recent years the taxation office has amended their rules in relation to substantiation of business expenses. They have introduced
stringent rules and guidelines that need to be adhered to in relation
to the maintaining of records to verify business expenditure. Consider whether to use an ABN as a contractor and requirements of a
contractor.
18.
Business expenses should be verified with a receipt (with limited
exceptions). Other documents that help verify business expenditure
including travel diary records and motor vehicle log books should
also be kept. Allow about 4-6 weeks for allocation of a provider
number, particularly at peak times such as end/beginning of year.
19.
Locums must also have a provider number (do not use another providers’ number). Have an ABN number if your income requires it
and be knowledgeable of GST in your invoicing and completing
BAS statements.
20.
As a locum contractor, the employer is not required to pay you the
superannuation guarantee, so consider this in your pricing and take
care of your own superannuation needs.
21.
One grey area is Workcover premiums. We advise anyone employing you as a contractor to include fees in their Workcover premium
calculations to be on the safe side.
22.
Ensure you have someone to contact in case of emergency, especially if consulting without reception assistance.
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8.9 Insurance Programs and Policies
8.9.1
Range of Programs
The Australasian Podiatry Council has negotiated competitive rates on insurance through Guild Insurance. The package has been tailored to suit the
needs of podiatrists and is available to members of the Australian Podiatry
Association.
The insurance and financial services offered to podiatrists by Guild include:
•
Professional Indemnity Insurance
Provides cover for health professionals if you are found to be negligent in the discharge of your professional duties.
•
Public Liability Insurance
Provides cover if a patient or member of the public is injured as a
result of an accident caused by you.
•
Product Liability Insurance
Provides cover for goods sold or supplied to you in your business.
However, this does not provide you with cover in any role as a
commercial manufacturer.
•
Business Insurance
Provides cover for contents, loss or damage, fire, theft, etc.
Guild also offers the following :
•
•
•
Income protection (accident and emergency cover,sickness)
Financial planning
Superannuation
NB: the above comments are subject to the terms and conditions of the current Policy.
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For further information on insurance and the services offered by Guild
they can be contacted directly on 1800 810 213 or go to their web site at
www.guildifs.com.au.
Please refer to the Guild Services for Podiatrists Brochure (Located at the
back of this module).
8.10Calculating your fees
8.10.1 Overview
Adjusting your fees periodically should be an integral part of your business planning. If your fees reflect your current expenses and earnings, you
have indisputable evidence when tendering for contracts, seeking loans
etc. Health funds don’t pluck their rebates or fees out of the air. Typically
they look at the average fees charged for a service over a period and come
up with a figure on the lower side of the bell curve. Therefore if you don’t
adjust your fees in line with expenses periodically you are inadvertently
holding down the averages.
Commit yourself to regular fee reviews rather than waiting until escalating
costs leave no alternative. Playing catch up is never a good idea.
“By adjusting your fees at regular intervals in step with rising costs and
the ongoing need to enhance your clinical capabilities, you reaffirm that
the labourer is worth his or her wage and is not taken for granted.”
Please note that what follows is not meant to constitute advice, merely act
as a guide. The Council suggests that where necessary you should discuss the commercial aspects with your practice’s accountant or business
adviser.
A podiatry practice is similar to any other in that revenues must exceed
outgoings if the business is to survive. There are several elements that go
towards determining pricing, including:
• The cost of providing the service
• The type of service provided and time taken for the service
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• Government regulations
• Desired lifestyle
• Profit required
Fees that you charge must be sufficient to cover the forecast costs, including your remuneration, as well as a return on investment of your funds,
and a reward for the business risk which you undertake. Also an understanding of what clients will pay and what the competition may be charging is important.
Calculations to Consider
Note: Use annual figures in the following.
8.10.2 Income Required
Practice expenses - All recurrent expenses incurred by the practice.
Principal’s remuneration - It is essential that proper allowance be made for
your own remuneration which should be set at a level at least equal to that
available to you as an employee in the field in question.
Return on net assets - Rate of return on net assets representing gross Assets
less liabilities.
Totaling these three measures will provide you with the total income required by the practice.
8.10.3 Base Hourly Rate
The second step requires calculation of actual patient time, i.e. the total
number of hours taken by all podiatrists in the practice in actually providing services to patients.
This must take account of the normal number of working days per year.
This time must be reduced for idle time between appointments, and that
spent on research, administration and promotion of the practice. The reverse applies if you work more than normal hours.
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Dividing the total income required by the total number of patient hours
will give a base hourly rate.
8.10.4 Your Standard Consultation Fee
You then need to determine the average length of time for a standard consultation and how many of these there are in an hour. Dividing the base
hourly rate by the number of standard consultations in an hour will give
you a value for your practice’s standard consultation fee.
8.10.5 Other consultation types
The next step is to consider how other consultation types relate to the standard consultation (time, consumables etc) in order to determine fees for the
other services you provide.
8.10.6 Market Knowledge
Another important aspect of setting your fees is an understanding of the
market in which you operate. At a basic level this involves ascertaining
what the competition in your area is charging.
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Module 9 - Personnel
Employment Issues
and
Please note this is for information only and should not be taken
instead of appropriate advice. Please consult your
accountant and / or legal advisor for independent advice.
9.1 Staff Recruitment
9.1.1
Overview
The need to employ and select staff is common to all businesses. This section is therefore general by nature and you should consider the points
raised in the light of your own practice requirements.
The decision to recruit someone into the practice should not be taken lightly.
Employees often are a practice’s greatest asset and the investment required
is considerable. Not only are funds required to meet salary and related expenses (for example, workers compensation, superannuation, holiday and
sick pay) but also adequate training and settling in periods need to be budgeted for, as often new staff may take time to be economically productive.
Initially the need for the practice to employ someone should be justified.
This justification can be carried out by considering a number of questions,
for example:
• How many people does the business need in order to operate effectively?
• What is the reason for the vacancy?
• Taking into consideration the return on investment, how many
people can the business afford to employ?
• Can the additional person’s expected contribution be quantified? For
example, some businesses work on the basis of employees bringing
in three times their salary: thus one third goes to cover salary, one
third overhead expenses and one third profits to the business.
• Is the vacancy for a permanent or temporary position?
• Is the vacancy a replacement situation or a new position?
• Has the additional person been budgeted for?
On the basis that you believe the business can justify employing someone,
the recruitment and selection process should follow.
The need for adequate screening and recruitment procedures is vital. Mistakes can prove extremely costly, especially in terms of high labour turnover, mismatching of applicants to suitable positions, absenteeism, retraining and disability claims. This need is further highlighted by the fact that
management’s right of termination is not absolute. Employment contracts
can often be difficult to terminate. Employees who do not meet satisfactory standards of work performance can also have a detrimental influence
on other employees. Care and thoughtfulness, therefore in the recruitment
process is paramount.
9.1.2
The Vacancy
Job vacancies arise within business organisations for various reasons.
When a vacancy occurs there is the opportunity to review existing staffing
structures. Before automatically replacing employees, the following questions should be considered:
• Does the position require a full-time, part-time or temporary employee?
• If it is a short term assignment would the employment of a consultant or contract worker be more appropriate and cost effective?
• What is stated in the relevant award?
• If it is not a new position, how has the job grown or contracted over
the years?
Before advertising the position the following points should be considered
to assist in both advertising and in screening applicants.
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• What is required for the position?
• Draw up a list of duties (job specification)/Position description.
• Determine what skills, qualifications and experience are needed by
the person filling the job (job specification). Be realistic in your requirements.
• Establish what salary and benefits are applicable to the position.
Advertising for an Applicant
Ensure that all applications are in writing. This enables you to evaluate
English skills and leaves the telephone free for patients.
Respond appropriately to all unsuccessful applicants.
9.1.3
Screening
Some applicants will not be suitable from the outset and should be screened
out.
If initial telephone applications are being received, basic details pertaining to the applicant can be summarised by the receptionist. When this is
analysed, it will quickly reveal which candidates are suitable for interview.
When written applications are invited, all applications should be acknowledged promptly.
It is important that the screening process be quickly and efficiently completed as a delay may result in the withdrawal of a suitable applicant.
Once this initial screening has taken place, there will be a group of candidates who show potential. To explore the suitability of each in more depth
an interview is required.
9.1.4
Interview
The interview can sometimes be just as nerve racking for the interviewer as
it is for the applicant. Create a relaxed easy going atmosphere that enables
you to learn the true character of the applicant.
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It is a good idea to have at least one other person to assist in the interviewing process. The supervisor or manager of the prospective employee
would be a logical choice.
Suitable questions may include:
• Why do you want this position? (This is a most important question
which is used in most interviews. It requires the interviewee to give
an indication of their understanding of the position. It also requires
them to talk about themselves - their likes, dislikes, strengths etc.).
• Qualifications/ past employment experience?
• Have you been to a podiatrist before (non clinical staff)?
• Health attitudes?
• Willingness to attend weekend seminars?
• Involvement in community groups (source of referrals)?
• Do you live in the area?
• Other commitments?
• Is there anything in your personal circumstances which may affect
your ability to carry out the requirements of the position?
It is also useful to provide the interviewee with some hypothetical workplace scenarios (eg. an abusive patient) and ask how they would respond in
that situation. This will give an insight into their personality and temperament and whether they think on their feet.You should only ask questions
that are relevant to the skills, abilities, experience and knowledge required
for the position. For example, you should not ask questions which require
a person to comment on his or her marital status, sexuality, religious beliefs
or prior workplace injuries or sick leave history. Federal and State and Territory anti-discrimination prohibit discrimination on the grounds of who
may be offered employment therefore inappropriate interview questions
could form the basis of a discrimination claim.
Reference Checks
If the potential employee nominates a past employer as a referee, you should
contact the employer and check for details of absenteeism record, position
held, work performance, reason for leaving and attitudes to safety.
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Do this by way of a telephone call and remember to have listed the questions you want to ask. Always ask whether that company would re-employ
the person. Any reservations indicated by the employer should be investigated.
Most but not all employers will provide such information and it is usually
reliable. All information must remain confidential.
Where a potential applicant produces written references, these should be
substantiated. Generally, written references only really confirm dates of
employment.
Never telephone an applicant’s present employer without the applicant’s
permission. You should not contact a former employer without the potential employee’s consent in writing.
9.1.5
Offer
Once the final choice has been made, a Letter of Offer should be sent to the
successful applicant detailing the job title, benefits and conditions, date
and time of commencement and hours of work. An acknowledgment of
this letter of offer should be sent back by the successful applicant, signed
and dated.
It is important to note that it is a requirement under the Fair Work Act 2009
(“FW Act”) that all new employees must be provided with a Fair Work
Information Statement. The statement is published by the Fair Work Ombudsman and is available on line. The statement must be provided as soon
as practicable after the employee starts his or her employment. The failure
to provide the statement is an offence for which fines can be imposed. As
a matter of good practice a copy of the statement should be attached to any
employment agreement or letter of offer.
A copy of the statement is available at:
http://www.fairwork.gov.au/FWISdocs/Fair-Work-Information-Statement.
pdf
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As a matter of common courtesy all unsuccessful applicants must, without
any undue delay, be advised that they were unsuccessful. Advice should
be by letter.
9.1.6
Induction
A person’s first day in a new job is an important experience. Every effort
should be made to ensure that it is a positive one. Ensure that the person is
properly welcomed, the job is ready, the necessary ‘tools of trade’ are available and proper instruction and training is provided. It is essential that the
new employees are shown and instructed in the safe working practices
relevant to your organisation, particularly with regard to infection control
and are familiar with office protocols relating to confidentiality.
9.2 Important Issues when Employing
Staff
• Fair Work Act 2009
• National Employment Standards
• Awards
• Taxation and P.A.Y.E.
• Employee or Self Employed Contractor
• Workers Compensation
• Superannuation
• Employee Records
• Employment Contracts
This checklist is designed for a business employing workers for the first
time and for existing employers to ensure they are meeting their legal obligations. There are a number of areas with which you are legally required to
comply when employing staff. The major ones are covered in this section.
9.2.1
Fair Work Act 2009
With limited exceptions, all employers (outside of Western Australia), who
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rated entities are covered by Federal employment laws under the FW Act
which contains the National Employment Standards often referred to as
the NES. The FW Act does not apply to sole traders, partnerships or unincorporated entities in Western Australia and the applicable industrial laws
continue to apply in that State.
9.2.2
National Employment Standards
The National Employment Standards are 10 minimum conditions for National System Employees. Together with the national minimum wage, they
are a minimum safety net for employees. They include minimum entitlements for leave, public holidays, notice of termination and redundancy
pay. An employee’s minimum entitlements can also come from a modern
award or agreement.
9.2.3
Awards
As an employer you are legally obliged to follow the terms and conditions of the Modern Award which applies to your employees. The Modern
Award which covers Podiatrists is the Health Professionals and Support
Services Award 2010,
http://www.fwc.gov.au/documents/modern_awards/pdf/MA000027.pdf
Modern Awards commenced operation on 1 January 2010.
They set out minimum entitlements in respect of rates of pay, penalty and
overtime payments, allowances, annual leave, sick leave, maternity leave,
long service leave, hours of work, meal and tea breaks, termination and
superannuation and the like.
As a matter of good practice, you should obtain a copy of the Health Professionals and Support Services Award 2010 and ensure that you are familiar with the minimum entitlements contained therein especially in relation
to base rates of pay, overtime, loadings and penalty rates and the like.
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9.2.4
Taxation and P.A.Y.G.
You are required by law to deduct income tax from employee’s wages. For
new employers the Australian Taxation Office publishes a kit called “Tax
Basics for Small Business” and a booklet entitled “A Guide to Pay as You
Go”. PAYG summaries, declaration of TFN when starting employment,
general exemption declaration forms to be completed by employees and
taxation schedules can also be obtained online or by contacting the Australian Taxation Office.
9.2.5
Registration for PAYG Withholding
You must register for PAYG Withholding if you have withholding obligations.
9.2.6
Group Tax
You must pay the amount of the tax instalment deductions you have made
from your employees’ earnings to the Tax Office following the deductions.
9.2.7
Payroll Tax
This is a state tax which may apply in your state. Search for “payroll tax”
at www.business.gov.au for details.
9.2.8
Employee or Contractor
The taxation of your income as an associate or a locum will be dependent
on whether you are deemed to be an employee or a contractor for tax purposes. There has been much contention as to what factors regarding your
relationship with your principal are significant in defining your status for
tax purposes. We recommend practitioners use the “Employee/Contractor
Decision Tool” available on www.ato.gov.au to assist in determining the
status of contractors. We do not recommend that you should engage any
person as a contractor who provides services using an Australian Business Number (ABN). Specialist employment law advice should be sought
before you engage contractors as it is an offence under the “sham contracting” provisions of the FW Act to engage a person as a contractor in circumstances where the person is an employee.
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Employers should note that workers may be deemed employees for a variety of purposes including superannuation, workers compensation, legal
liability and taxation. It’s important to understand whether your workers
are genuine contractors or are deemed employees.
9.2.9
Workers Compensation
Workers compensation schemes operate on a state basis throughout Australia. You must be registered under the state workers compensation scheme
if you have employees. There may be a minimum wage level where you do
not need to register but your employees are still covered.
Details of workplace health and safety and workers compensation are
found at: www.safeworkaustralia.gov.au.
The definition of a worker often includes a person who has entered into or
works under a contract of service at common law, or is deemed to be working under a contract of service. Thus, in certain circumstances, a locum or
self employed associate may be considered to be an employee. If a locum
or associate is deemed a worker then appropriate workers compensation
premiums should be made by the principal.
9.2.10 Superannuation
Employees are able to choose the super fund that works best for them.
A business with employees (and some contractors) must make superannuation payments for eligible employees. A failure to pay superannuation
will result in penalties being applied by the ATO and a loss of tax deductibility of contributions. Modern Awards also contain default superannuation funds into which the superannuation contributions must be paid if the
employee does not have a nominated fund. Podiatrists need to become
familiar with key information that involves them as an employee and / or
an employer. Note that from July 1, 2013 the rate of superannuation contribution will be 9.25%.
The Australian Government Superannuation Website contains information
and links on key superannuation issues. Please go to: www.ato.gov.au/super
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9.2.11 Employee Records
In any organisation, it is most important that up to date records for all
employees are kept. Hours worked, the rate of pay, taxation and any other
emergency contacts should be recorded.
It is a requirement under the FW Act to keep employee records for a minimum period of 7 years. The FW Act sets out the types of records which
must be kept and includes records relating to personal details, pay, overtime, averaging of hours, leave, superannuation, termination of employment, transfer of business, guarantee of annual earnings and individual
flexibility arrangements.
9.2.12 Employment Contracts
It is vital to have an employment contract negotiated between the principal
and the prospective employee. The contract should include references to
the following:
a.
Details of a trial period of employment if appropriate
b.
Details of dates for renewal of employment contracts and status
c.
Reference to conditions of employment, (e.g. working hours, leave
entitlements, and performance reviews)
d.
Duties and responsibilities of the position
e.
References to rates of payment and other benefits of employment
f.
Details of any bonus system if applicable
g.
Details of events that may terminate employment and the notice of
termination periods that apply upon termination
h.
Responsibility for superannuation and workers compensation
i.
Details of any post termination restraints such as non-competition
and non-solicitation clauses
j.
Adherence to policies such as confidentiality and privacy requirements, the code of conduct
k.
Details regarding allocation of travel expenses and supply and usage of equipment
l.
Clauses which deal with the ownership of patient files
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Many details should properly be included in the principal’s manual on
working conditions such as hours, conduct, expectations, dress code. Please
check with your member association as they may have more information
on employment contracts.
Policies and Procedures
It is very important that your business has formal (written) policies and
procedures that deal with bullying and harassment, workplace discrimination, workplace grievances and work health and safety (OHS). New
employees should be provided with copies of any such policies and procedures at the commencement of the employment and be required to sign an
acknowledgement that they have read and understood the policies.
Work Health and Safety
Occupational health and safety laws have changed recently and there is
now an integrated national work health and safety framework which has
been adopted (in most cases) into existing State and Territory occupational health and safety legislation. The obligations imposed on persons in
control of businesses or undertakings (PCBUS) are onerous therefore it is
important that you are aware of the duties and requirements that apply.
For example, A PCBU must ensure, so far as is reasonable practicable, the
health and safety of workers engaged by the PCBU and also workers carrying out activities which are influenced or directed by the PCBU. The
laws require that you must ensure that there is a safe work environment,
there are safe systems of work, there is workplace consultation, you maintain safe plant and structures and that you provide information, training,
instructions and supervision to protect persons from risk of harm. If you
are unsure of your obligations, you should obtain specialist advice from a
qualified advisor.
9.3 Administrative Staff
Administration staff commonly employed within a clinic are receptionists,
assistants and practice managers. The majority of practitioners will openly
admit that a good receptionist and/or podiatry assistant can mean the difference between a successful practice and an average one. Receptionists
and podiatry assistants very much determine the atmosphere within the
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clinic. The atmosphere that you desire for your clinic will give you a lead
to the type of person you require. The need to employ a receptionist and/
or podiatry assistant should become apparent at the appropriate time. The
‘ideal time’ will be different for individual businesses.
9.3.1
Practice Manager
As a reference to more information on practice Management, please see:
http://www.aapm.org.au/ Australian Association of Practice Managers
(AAPM).
9.3.2
Receptionist
The employment of a receptionist should be considered from the outset,
as it leaves the podiatrist free to carry out their professional services effectively and ensures greater efficiency in the office.
The receptionist is a very important member of a podiatry practice. A receptionist is a trained person and should be regarded as such by other
members of the practice.
Usually the receptionist is the first member of the health team that the patient meets or speaks with. First impressions are important, and a pleasant
personality and a sympathetic yet efficient manner are essential. Common
sense, calmness, dress, attitude, knowledge and skills are prerequisites for
an efficient receptionist.
A good telephone manner is vitally important. Often the receptionist must
make a decision whether to put a call through to the podiatrist or to try to
deal with it personally. Common sense and tact are essential.
Basic fundamentals required for any receptionist position
• Calm demeanour
• Receptionist experience
• Typing skills
• Book keeping skills
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• Computer literacy
• Experience in handling money
• Ability to organise and plan ahead
• Basic Maths and English skills
• Experience of working in busy situations
9.3.3
Confidentiality
Probably the most important aspect of the receptionist’s role concerns confidentiality. Podiatrists are legally responsible for the actions of their staff
members in the course of their employment and must ensure that staff
members comply with relevant laws and regulations. A signed confidentiality agreement at the start of employment is advisable. Patient confidentiality must be maintained; staff members must not discuss patient issues
with any party where the provision of information is not reasonably required in the provision of the service.
Any facts that the receptionist learns about a patient, either from the patient, the patient’s records or from the podiatrist or any other health professional must never be disclosed to others.
A receptionist should not give information to a patient unless specifically
told to do so by the podiatrist. A receptionist should never discuss patients
or their problems in the hearing of other patients. Confidentiality must
also apply to any information the receptionist gains about the financial and
personal affairs of the podiatrist and the practice.
9.3.4
Record Keeping
An efficient filing system and a methodical appointment system is necessary for good office operations. Simple bookkeeping may also be a part of
the receptionist’s duties, together with familiarity with the current health
insurance schemes and common types of insurance claims, such as Workers’ Compensation, as well as the documentation processing required by
the Department of Veterans’ Affairs.
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9.3.5
People Skills
Look for people with experience in people related jobs and who are active
in community or volunteer groups.
Qualities to look for include:
• Empathy
• Active listening
• Confidence (without being over bearing)
• Ability to communicate with people of different socio-economic
groups (depending on clientele)
• Ability to remember details about patient’s family, etc. (Helps if reminder notes are used)
Empower the receptionist
Give the receptionist as much responsibility as they can competently handle. Involve them in decision making and staff meetings. Seek their advice on how the practice could improve - their perspective is usually more
closely aligned to that of the patients. The more a receptionist feels a sense
of ownership, the more committed they will be to the well-being of patients and with the growth of your practice.
Clearly defined job description
A detailed “Office Policy” which is updated regularly gives the receptionist a clear direction of their responsibilities.
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Module 10 - Marketing
10.1Marketing
Practice
and
Promoting
Your
Promoting your practice is an important aspect of being a successful practitioner. There’s not much use in establishing a practice with the latest equipment and great staff if you don’t let people know about it. The majority
of business for most podiatrists seems to be generated through word-ofmouth and referrals from other health professionals, but when you’ve just
started out it’s especially important that you know how your professional
association can help you to promote yourself and your practice. It’s also
important for both yourself and the profession that you are aware of any
limitations which may exist in relation to advertising your own practice.
To allow us to work best for you please also ensure that your Member Association has your current practice details on record.
10.1.1 Advertising Your Practice
There are a range of different statutes and guidelines regulating how health
professionals including podiatrists can advertise. Please refer to the PBA
Advertising Guidelines to ensure you are compliant with these guidelines
- http://www.podiatryboard.gov.au/Policies-Codes-Guidelines.aspx/.
Practitioners ought to be aware that the National Law does not contain a
definition of ‘advertising’ therefore practitioners should be mindful of the
Guidelines for all forms of advertising, whether it be printed, electronic
media and includes business cards, letterhead, telephone directory listings,
and professional directory listings.
Unacceptable advertising includes advertisements that are ‘false, misleading, or deceptive’, or that encourage the ‘indiscriminate or unnecessary’
use of health services. It is also prohibited for advertisements to create unrealistic expectations of successful outcomes, to include testimonials, or to
advertise special offers such as discounts or other inducements without
also displaying the terms and conditions of the offer.
If practitioners choose to use any graphic or visual representations in their
advertising they ought to be aware of the specific requirements for this
because photographs have a significant potential to be misleading or deceptive.
Before advertising your services, we recommend that you review the following web resources:
http://www.podiatryboard.gov.au/Policies-Codes-Guidelines.aspx - Podiatry Guidelines for Advertising of Regulated Health Services.
http://www.accc.gov.au/publications/professions-and-the-competitionand-consumer-act - ACCC Guide to Professions and competition.
http://www.accc.gov.au/system/files/Advertising%20and%20selling.pdf ACCC Guide to Advertising and Selling
http://www.tga.gov.au/industry/advertising.htm -the Therapeutic Goods
Administration website on advertising therapeutic goods.
http://www.austlii.edu.au/au/legis/cth/consol_act/caca2010265/ - Competition and Consumer Act 2010
10.1.2 Australasian Podiatry Council’s Role
in Public Relations
The Council produces a range of promotional materials such as brochures
and newsletters which is available in electronic format. Contact your state
association to ensure you are on the list to receive resources as they are
updated.
Each year the Council also plans a public relations strategy for Foot Health
Month, usually held in October, which is the profession’s major annual
promotional event. The Council produces a range of materials for the use
of Member Associations during the week including media releases, radio
announcements, posters and brochures. Member Associations often run
their own promotional campaigns during the week, and will often call on
individual members to help promote podiatry through a range of means
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from handling media interviews These are more difficult to do now adays
with insurances, please consult your local member association.
The Australasian Podiatry Council also oversees sponsorships on a national level, arranges publicity and support for its biennial national conference, and regularly provides the media with information about podiatry
through media releases and articles.
10.1.3 Your Member Association’s Role in
Public Relations
Each Member Association has public relations capacity to undertake local
PR. The role and availability of the public relations consultant varies, so it’s
worth checking with your Association. Member Associations are always
looking for enthusiastic podiatrists to get involved in various promotional
activities, and to help come up with ideas for media opportunities and
other promotional opportunities. Your Member Association may also have
additional promotional materials available, which may include items for
loan such as display boards and slides for public speaking engagements.
10.2Promotional Resources
The Member Association has a range of resources available to help you to
promote yourself. These materials are listed in the Resource Order Form.
Copies of the Podiatry Patient Information Brochures are available from
your Member Association.
Resources include:
• Series of full colour brochures on various podiatry-related topics,
i.e. children, diabetes, footwear, orthoses
• Brochure holders
• Podiatry marketing logo
• Window Stickers
• Posters
• Website -resource order form
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10.2.1 Podiatry Marketing Logo
In order to promote the podiatry profession in a consistent and professional manner, the profession has developed its own distinctive marketing “P” logo. There
are great benefits to you in using this logo in any promotional materials you produce, indicating that you
belong to a credible registered profession. Where possible, please use this logo in any promotional materials
you develop, including your letterhead.
Please note that this logo is a registered trademark – unauthorised use of
the logo is prohibited. Only members of the Australian Podiatry Association may use the logo. Logo use must comply with the APodC rules.
High resolution artwork of the podiatry logo is available to all members,
and can be provided direct to a printer for all your printing requirements.
Instructions for use of the marketing logo also comes with the file. Order
your copy by email [email protected], or through your Member Association.
10.2.2 Accredited Podiatrists
What is the Accredited Podiatrist Program?
The Accredited Podiatrist Program is an Australasian system designed to
enhance and encourage continuing education and professional development opportunities for practicing podiatrists.
It provides a mechanism for recognising the efforts of practitioners in
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maintaining and developing their knowledge and skills in podiatry practice, ultimately rewarding individuals with accreditation status. Why do we need an accreditation system?
Increasingly, the general public is seeking reassurance as to the qualifications and competence of health practitioners. Health care, like many industries, is rapidly changing and consumers demand expertise in current
methods and standards of practice.
Government funding bodies and third party organisations have proposed
a variety of systems for accrediting practitioners - one system, driven by
the profession is simpler for individuals and third party organisations. It
ensures a relevant and appropriate approach is taken.
Who can participate?
Any podiatrist who holds current membership with their local podiatry
association or society may participate in the program.
Please direct any queries to your Member Association.
More details can also be found on the Australasian Podiatry Council website: www.apodc.com.au.
10.2.3 Some Ideas for Promoting Your
Practice
• Do your preparation. Prepare a brief statement that clearly states
what your unique value proposition is (why use your service rather
than the already established service providers). Ensure it’s deliverable as a pitch in less than 30 seconds.
• Organise to speak to your local sporting clubs/primary schools/senior citizen’s groups about relevant health issues.
• Write a letter to the editor of your local newspaper about topical
health issues.
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• Set up a photo opportunity with your local newspaper, i.e. “looking
at the feet of children for back to school footwear advice”, or examining the feet of football players during the football season.
• Conduct an advertising campaign in your local newspaper.
• Sponsor a local sporting club or event by offering free medical support on the day, or during matches.
• Sponsor a prize for social club raffles in your local schools or sporting clubs.
• Arrange to introduce yourself to your local medical practitioners
and other sources of potential referral.
• Visit the Medicare Locals office in your area and find out if there are
ways to get involved in local projects.
Remember the Council websites which are available for your use at: http://
www.apodc.com.au and our podiatrist locator: http://findapodiatrist.org
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Module 11 - Policies
of
the Australasian Podiatry
Council
Accredited Podiatrist Program (APP) Logo
Trade Mark and Logo Authorised Use
11.1Accredited Podiatrist Program (APP)
Logo
An Accredited Podiatrist is a podiatrist who:
• Has completed the requirements of the Accredited Podiatrist Program, and
• Is in possession of a current Accredited Podiatrist Program Certificate.
The design must not be tampered with or modified in any way. However,
the size may be reduced or enlarged as required.
The Accredited Podiatrist logo may appear on any surface (e.g. signs, brochures, clothing, letterhead, appointment cards, etc) at the discretion of the
member provided it is not deemed to reflect poorly on the profession as a
whole. An opinion should be sought from the Australasian Podiatry Council if the member is in any doubt.
USE OF THE APP DESIGNATION AND LOGO
Accredited Practising Podiatrist is a title reserved for members of an Australian podiatry association who are registered podiatrists.
Members who have achieved APP status may describe themselves as such
in parenthesis – so John Black (Accredited Practising Podiatrist) or Dr John
Black (Accredited Practising Podiatrist).
Please note that the title Accredited Practising Podiatrist is a post-nominal
referring to an individual podiatrist. It should not be used so as to encourage the perception that a podiatry practice or group of podiatrists is accredited.
Furthermore, use of the term Accredited Practising Podiatrist by non-members, or by members who are not current, or who have not been awarded
the title by one of the Australian Podiatry Associations, may constitute a
basis for legal action on grounds such as “passing off”, under the provisions of the Trade Practices Act 1974 (Cth) or State or Territory fair trading
legislation.
11.2Affiliated Bodies
The following bodies are affiliated to the Council:
• The Australian Academy of Podiatric Sports Medicine
• The Australian College of Podiatric Surgeons
11.2.1 Roles/Responsibilities
It is the responsibility of the affiliated bodies to oversee the practice of podiatry in their areas of interest, and to recommend minimum standards of
education required of their members.
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Affiliated bodies must act within their respective constitutions.
The affiliated bodies act as the informed body for comment on issues pertaining to their areas of interest.
11.2.2 Accountability
The affiliated bodies are accountable to their membership.
The affiliated bodies are also accountable to the profession for policies
which they develop in relation to their areas of interest.
Affiliated bodies must maintain communication with the Australian Podiatry Council. They must also provide a current copy of their constitution,
code of ethics and report to the Australasian Podiatry Council as determined from time to time by the Council.
11.2.3 Authority
The affiliated bodies do not have authority through the voting process, as
they are not members of the APodC, but affiliated due to their similar aims
and objectives.
The only authority which is vested in the affiliated bodies is the authority
to set the standards of education required for membership of those bodies.
Affiliated groups must be incorporated under the Companies Code
or Associations’ Act.
The objectives of an affiliated organisation must be complementary
to the objectives of the APodC.
11.2.4 Australian
(APodC).
Podiatry
Council
Affiliated bodies must require all their members to maintain membership
of a state podiatry
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Association-Member Association (Clause 53 of Australian Podiatry Council Articles of Association).
Affiliated groups must be organised on a national basis.
Affiliated organisations must liaise and co-operate with the Australian Podiatry Council in relation to:
(i)
Submissions to Federal Government
(ii)
Public relations activities
(iii)
Any other matter which may impact on the entire profession
11.3Trade Mark and Logo (Authorised Use)
11.3.1 Background
On the 21st April 1993, the Australasian Podiatry Council
(‘the Council’) registered the trade mark number 600610,
with an image description: “x-ray of foot in rectangle;
convex side; all atop rectangle” (hereinafter referred to
as ‘the Logo’).
The Trade Marks Act 1995 (Cth) (‘the Act‘) provides that:
a.
Registration of a trade mark gives the trade mark owner exclusive
rights to:
(i)
Use the trade mark
(ii)
Authorise other persons to use the trade mark
A trade mark owners’ rights are infringed if a person uses as a trade mark,
a sign that is substantially identical with, or deceptively similar to, the
trade mark in relation to the classes of goods or services in which the trade
mark is registered.
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“Deceptively similar” is defined by the Act as the use of a trade mark that
“so nearly resembles that other trade mark that it is likely to deceive or
cause confusion”.
A Court may grant the following remedies to the Council for an infringement of its trade mark:
(i)
An injunction and/or
(ii)
Damages or an account of profits
The Council authorises the use of the Logo in its discretion in accordance
with the ‘Australasian Podiatry Council Trade Mark Use Policy’ below, and
may withdraw its consent for the use of the Logo by a user at any time.
11.3.2 Australasian Podiatry Council Trade
Mark Use Policy (the “Trade Mark
Use Policy”)
Objectives
The Objective of the Trade Mark Use Policy is to:
• Define who may be authorised to use the Logo.
• Define the way in which the Logo may be used by authorised users.
• Ensure that the use of the Logo reflects positively on the profession
and the values of the Council.
• Monitor the use of the Logo and to take any action that may be necessary to protect the Logo pursuant to the provisions of the Act.
Conditions of use
1.
Authorised users
Subject to the terms of the Trade Mark Use Policy and any other
conditions determined by the Council from to time the use of the
Logo is granted by the Council to the following:
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(a)
Member associations who are registered financial associations of the Council (“Member Associations”) and
(b)
Individual financial members of the member associations
operating a podiatry practice (“Individual Members”)
(collectively referred to as “authorised users”).
2.
3.
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General conditions of use of the Logo by all authorised users
(a)
The image design of the Logo must not be tampered with
in any way, save and except for reduction or enlargement of
the size of the Logo as required.
(b)
The colour of the Logo is with colour coding PMS 285; black
or alternate colours may be used.
(c)
The word “podiatry” may be left off the when using the
Logo if it appears in prominence adjacent to the Logo – for
example, on a sign board for a podiatrist’s room, the Logo
may appear without the wording if “podiatrist” or “podiatry” appears beside the Logo and the connection is obvious.
(d)
The Logo may only be used by the authorised user and in
accordance with the Trade Mark Use Policy.
(e)
The context in which authorised users may use the Logo
must always be to uphold and reflect well on the podiatry
profession.
(f)
The Council has the authority to withdraw the use of the
Logo from any user.
Restrictions on use
(a)
The Council may grant the use of the Logo by the authorised user subject to conditions at the time it grants the use
of the Logo. The Council may vary these conditions or issue
the authorised user with further conditions in respect of the
use of the Logo from time to time.
(b)
If the Council withdraws its authority for the use of the
Logo, the authorised user must immediately cease to use
the Logo in any way whatsoever.
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(c)
4.
The authority to use the Logo is given by the Council to
Individual Members. A group/ business entity/department
may use the Logo unless all the members of that group/
business entity/department are Individual Members under
the terms of the Trade Mark Use Policy. For example, a podiatry practice may not use the logo on corporate material
if one or more members do not meet the criteria outlined to
be considered Individual Members.
Use of the Logo by Member Associations
Member Associations are authorised to use the Logo as follows:
5.
(a)
On letterhead, brochures, with compliment slips, business
cards, official signage, accounts (“stationery”) produced for
use by the Member Association.
(b)
On public relations materials and programs which promote
the practice of podiatry.
Use by Individual Members
Individual Members are authorised to use the Logo only as follows:
6.
(a)
On stationery used in the Individual Member’s podiatry
practice.
(b)
On signage used within the podiatry practice premises and
on the exterior of the premises to advertise the Individual
Member’s practice.
(c)
On clothing worn by Individual Members or their employees, primarily at the Individual Member’s place of business.
Notice to Users
The Council requires that all authorised users agree and acknowledge that the Logo will be used in conformity with the Trade Mark
Use Policy.
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