By transitioning from isolated, short‑term posts to secure, rotational first contact podiatrist roles, PCNs can protect the workforce they have invested in, argues Professor Jane McAdam, chair of the Royal College of Podiatry.

First contact podiatrists have transformed what PCNs can offer around musculoskeletal conditions (MSK) and early detection and diagnosis of many complications and long-term conditions which can deteriorate rapidly. 

They also enable general practice multidisciplinary teams to access timely specialist assessment, streamline condition pathways and manage foot and lower limb related presentations more safely in primary care. 

However, the way many of these posts are commissioned and employed under the additional roles reimbursement scheme (ARRS) is creating a vulnerable workforce with avoidable risks for both clinicians and services. 

Short‑term funding, variable contracts and separation from NHS community and acute podiatry teams can undermine stability, professional identity and career development just as these roles are beginning to deliver real value for patients.

Insecurity baked into ARRS funding

ARRS has enabled PCNs to bring podiatry expertise into primary care at scale, but the funding is tied to national contracts and medium‑term policy cycles, not to permanent local workforce plans. Many FCP podiatrists have been appointed on fixed-term or time limited contracts, leaving clinicians anxious about what happens if national priorities or local PCN finances change.​

PCNs also face uncertainty. While guidance indicates that ARRS roles are intended to be part of the core multidisciplinary team, local leaders know that if roles are not fully utilised, or if reimbursement rules change, they may struggle to sustain posts from baseline practice budgets alone. 

This insecurity can discourage experienced podiatrists from leaving substantive NHS trust posts, limiting recruitment to those willing to accept higher risk at a time when the profession is already facing workforce pressures.​

Fragmented professional indemnity and support

The vast majority of FCP podiatrists have moved from long-established NHS community trusts or acute multidisciplinary teams into small PCN-based services, often employed by GP federations, individual practices or host organisations rather than their former employer. 

While this can bring greater autonomy, it can also lead to professional isolation, reduced access to podiatry specific supervision and weaker links to high risk foot teams, community MSK and multidisciplinary pathways.​ 

Qualitative work on ARRS roles more broadly has highlighted how staff can feel ‘neither fully in primary care nor fully in their original service’, with blurred governance, inconsistent induction and uncertainty about career progression. For podiatrists, whose practice spans MSK, diabetes, vascular, rheumatology and public health, losing the daily connection with a wider podiatry team risks eroding the very breadth of expertise that makes them so valuable as FCPs.

Operational weaknesses: cover, capacity and continuity

Small standalone FCP podiatrists, while working in a larger multidisciplinary PCN team, may also be vulnerable operationally. The services offered by a single FCP podiatrist working across multiple practices can be limited when annual leave, sickness or CPD commitments arise. This can translate into cancelled clinics, long gaps in follow‑up and frustrated referrers who struggle to understand what the service can reliably deliver.​

Variation in how roles are developed – including differences in session numbers, estates and admin support – can compound these issues, leaving some clinicians working at or beyond the limits of safe caseload and scope, without robust peer support. Over time, this risks burnout and attrition, undermining the sustainability of FCP podiatry within primary care.​

Towards rotational and secondment models

One practical way to address these issues is to reframe FCP podiatry posts as rotational or secondment roles, jointly designed and governed by PCNs and community/ acute podiatry providers. Under this model, podiatrists retain a substantive contract with their NHS Trust, rotating into ARRS funded first contact sessions for fixed periods while maintaining clinical time in community or specialist pathways.​

This approach could:

  • Provide employment security and a clear professional home while still deploying staff into primary care where they add the most value
  • Enable robust cover for annual leave, sickness and CPD by drawing on a wider podiatry team, reducing the risk of service gaps for practices and patients
  • Support structured progression from band 6 community roles to band 7/8a FCP practice, with clear competency frameworks and supervision spanning both sectors
  • Encourage staff retention and satisfaction within NHS podiatry services and improve communication and integration of services.

Reconnecting primary care and community podiatry

Rotational and secondment models also strengthen clinical pathways. By keeping FCP podiatrists embedded in community and/or high risk services for part of their week, PCNs gain practitioners who understand ever shifting referral routes, thresholds and waiting times, and can navigate patients effectively between settings. This helps avoid duplication, reduces inappropriate referrals to acute services and promotes genuinely integrated care.

For podiatrists, maintaining a dual footprint protects professional identity, ensures ongoing exposure to complex caseloads and multidisciplinary work, and sustains the peer networks that support reflective practice and innovation. For systems, it offers a practical route to stabilise ARRS roles beyond political cycles, with PCNs and community providers jointly planning capacity, sharing risk, and using podiatry expertise where it can have the greatest preventative and productivity impact.​

By moving from isolated, short‑term posts to secure, rotational FCP podiatry roles, PCNs can protect the workforce they have invested in, give clinicians a credible long term career, and guard gains in access, mobility and reduced acute pressure that these roles are already beginning to show.

Professor Jane McAdam is chair of the Royal College of Podiatry