BOFAS and RCPod Sign Memorandum of Understanding (MoU)

The British Orthopaedic Foot and Ankle Society (BOFAS) and The Royal College of Podiatry (RCPod) have signed a Memorandum of Understanding (MoU), which creates a structured working relationship between podiatric surgery and orthopaedic surgery. BOFAS have outlined some of the history and background to signing this MoU with RCPod.

Advances in technology have been the driving force in developing all aspects of surgery. Amongst all surgical disciplines, orthopaedic surgery has probably benefited and expanded the most with technological developments. In turn, this has encouraged general orthopaedic surgeons to sub-specialise. Although the likes of Robert Jones have been inextricably linked with conditions and surgical treatments to the foot, 20th Century orthopaedic surgery British orthopaedic surgery was dominated by the development of large joint arthroplasty. Sir John Charnley’s low friction hip arthroplasty became the staple of general orthopaedic surgical practice. Therefore, in foot and ankle surgery, ‘simple’ pathologies such as hallux valgus and hallux rigidus were often relegated to the end of a general orthopaedic list. This has meant that the sub-specialisation of foot and ankle surgery has been a relatively recent occurrence.

In 1975, amongst others, John Angel, Basil Helal, Eric Anderson, Leslie Klenerman and Derek Wilson met in North London and formed the core of the British Orthopaedic Foot Surgery Society (BOFSS) in a bid to develop education and training within this area of orthopaedic surgery. With technological advances, a wealth of procedures are performed throughout the forefoot, midfoot, hindfoot and ankle so that arthroscopic and endoscopic procedures are routine, anatomic plating of all regions of the foot and ankle trauma is long-established and the survivorship of fourth generation total ankle arthroplasty continues to reach respectable levels. With this progress, BOFSS underwent an exponential growth in membership, changing its name to the British Orthopaedic Foot and Ankle Society in 2005. In 2025, the Society celebrates its Golden Anniversary boasting over 500 full members and over 100 trainee surgeons.

With the increasing demand from the public, podiatric surgery also began to expand in the 1970’s initially performing under-recognised, yet vital surgery to toe nails and lesser toe deformities, often in a primary care setting. During the same time frame, the scope of practice of this group of podiatrists practising podiatric surgery (PPPS) has evolved with a significant proportion of surgeons regularly performing forefoot procedures and a smaller group expanding their scope into the hindfoot and ankle.

Over the years, this has led to a significant tension between the two professions. The changing scope of practice with podiatric surgery has been a constant concern of the orthopaedic foot and ankle surgeons. Additionally, orthopaedic surgeons and PPPS have disagreed about the issue of ‘title’ particularly if patients make their choice of surgeon anticipating their surgeon to have a medical background. The words Mr/Miss/Ms, consultant and surgeon used in various combinations may not be clear and meaningful for a patient. As Wes Streeting, the Health Secretary said in November 2024, “As patients, we should know who we’re seeing, who’s in front of us and why, and we’ve got to take those issues seriously.”

The last area of contention between the two professions lies in the differences in regulation between the GMC-based appraisal system applicable to all surgeons and the HCPC managed process that makes PPPS appraisal an employer’s responsibility. Both professions agree that improvements need to be made to all appraisal processes in order to protect and reassure the public.

With this in mind, the two professions needed to start to resolve any differences and draw up respective position statements. Since the autumn of 2023, members of the BOFAS Council and the Faculty of Podiatric Surgery have worked together to draw up a memorandum of understanding (MOU). This is an expression of aligned will between both parties depicting the intent of a common line of action. It is designed to act as a foundation for negotiations and further discussions. This document details the areas of common agreement, namely in improving patient care in foot and ankle surgery. The differences in training, appraisal, revalidation, regulation and title are clearly detailed as are the areas of agreement and disagreement.

This document allows a foundation from which both professions can work towards greater collaborative working which will have positive implications for service provision in many areas of the UK. With the new Labour government, the DHSC has laid out its aims for the future of the NHS. Devolving some secondary care to the primary sector will require greater collaboration between the secondary care offered by orthopaedic surgeons and the more primary care focus of the majority of PPPS. In order to do so, this will be assisted by an evolution of analogue healthcare methods to a more digital base.

Download the MOU here.