REDESIGN OF FOOTCARE SERVICES

PROJECTJamie QuinCSM Podiatry &Care home services

Podiatry service in GG PCT and now in GG&C chps

• 2002 had 65000 registered patients• Had 15000 NPs per year• Major Patient complaints about waiting times• Major Patient complaints about getting access to

the service• Major gatekeepers complaint• Major staff moral challenges• Just under 90WTE staff

USER INVOLVEMENT

• PATIENT FOCUS GROUPS- Elderly patients

• QUESTIONNAIRES-Domiciliary / Nail Surgery/Biomechanics

patients

THE VISION

• SELF REFERRAL• CALL CENTRE • APPOINTMENT WITHIN 7-10 DAYS• ONE STOP CLINIC- 60 Minute appointment• PACKAGES OF CARE - SHORT AND LONG

TERM• PODIATRISTS NOT DELIVERING BASIC

FOOTCARE

WORK TO BE PILOTED

• SELF REFERRAL

• PiMS• CALL CENTRE APPROACH

CALL CENTRE

• Preference to use an existing call centre

• Initially new patients only then existing patients

• Initial access 9am-6pm to make appointments

PILOT SITES

• Clarkston Clinic - Sept 2002

• Possilpark Health Centre - Oct 2002

• Springburn Health Centre - Oct 2002

• Evaluation throughout pilot

• Changes made - roll out across the city commencing March 2003 - 1 year

Introduction of triage

• Average referral numbers increased with self referral by 100%

• Telephone triage introduced Oct 2003

• Triage clinics September 2004( because of PIMS)

Patients journey

Person has

problem with foot

Referral process:

SelfGP

TertiaryHCP

TriageAssessment&Treatm

ent Plan

Other Speciality

Other Discipline

Specialist Podiatrist

& Podiatrist

Podiatrist&

Podiatry Assistant

Lanarkshire only:

Paper triage and potential

discharge

SERVICE GAINS FOR USER

• SELF REFERRAL • INCREASED ACCESS TO MAKE

APPOINTMENT• CHOICE OF TREATMENT LOCATION• SHORTER WAITING TIME• ONE STOP CLINIC• HIGHER PRIORITY FOR THOSE WITH

GREATEST NEED - MORE FREQUENT TREATMENT

• HELP WITH BASIC FOOTCARE

SERVICE GAINS

• MORE APPROPRIATE USE OF SKILLS• BETTER STAFF MORALE• BETTER USE OF RESOURCES• RECRUITMENT AND RETENTION OF

STAFF• RAISED PROFILE OF PROFESSION• JOINT WORKING WITH SOCIAL SERVICES• BETTER COMMUNICATION - IM&T• MARKET MODEL TO OTHER TRUSTS

GLOBAL PROFILE RESULTS

Podiatry patient profile groupsGlobal sample n=20,004

Group (2) senior Podiatrist

21%

Group (3) Podiatrist

28%

Group (1) No Podiatry need14%

Group (4) Shared care36%

Other1%

Percentage of level 1-4

• Level 1= 6%

• Level 2= 33%

• Level 3= 31%

• Level 4= 29%

level 4

level 3

level 2

level 1

Patient presentation to GPOrthopaedic Surgeon

•Assessed by consultant.

Orthopaedics Foot and Ankle Triage Service Patient Pathway Referral Guidance

Routine Podiatry Referrals

•All foot /ankle complaints e.g. Corn, callus, nails, plantar fasciitis or metatarsalgia. 1st line treatment of all foot conditions can be treated with appropriate referral to routine podiatry.

Biomechanics Clinics

•All musculo -skeletal conditions e.g. foot/knee/hip, where altered foot posture/gait may be improved via orthoses /exercise programme.

Contact Information

ESP Routine PodiatryOrthopaedics

Elaine Yule ESP Podiatrist 0141 232 1553Ramsay Sloss ESP Podiatrist 0141 531 6810Jenny Ackland Project Manager 0141 211 3696

ESP Podiatrist-Foot and Ankle Triage clinic

Referrals triaged for surgical option.

Care plans advised and referred onto the appropriate health care

professional.

Urgent referrals to Orthopaedic Department

•Suspected malignancy, Osteomyelitis,Charcot foot

•Suspicion of ruptured tendons

Foot and Ankle Triage Service.

•All conditions normally referred to the Orthopaedic department for surgery who are willing to undergo surgery for their complaint.

Biomechanics

Special attention

Acute/active diabetic foot conditionsrefer directly to the hospital diabetic /podiatry service.( See local referral guidelines.)

Acute/active rheumatoid foot conditionsrefer directly to the hospital rheumatology/podiatry service. (See local referral guidelines.)

3 top tips

• Identify you key challenges

• Engage with all stakeholders

• Sell, sell and sell the advantages and continuously monitor.