Westminster PCT Podiatry Services

1. Westminster PCT Podiatry Services Access and Eligibility Criteria Mark C Brogan Head of Podiatry Services and Allied Health PEC Representative Your Health is our Primary Concern

2. Background The Podiatry Service in Westminster PCT was formed from two different Health Trusts. It only became a department in November 2003. Since that time much work has been undertaken in establishing a whole service, harmonising different systems and standards and developing a workforce able to undertake the challenges we face in modernising the NHS. Your Health is our Primary Concern

3. Service Description Podiatry Services provide assessment, diagnosis and treatment of disease and conditions affecting the foot and lower limb. Treatment is focused on relieving symptoms, improving function, maintaining independence and well-being and disease prevention. Your Health is our Primary Concern

4. Service Description It is widely recognised and important to understand that poor foot health has a direct impact on an individual’s independence, quality of life and health status. Podiatry is a low cost, high volume, clinically effective service, which is absolutely fundamental to maintaining a mobile, independent and healthy population. Your Health is our Primary Concern

5. Philosophy of Care Podiatry Services should be a focal point for problems affecting the foot and lower limb. It should focus on progressive cure and discharge and provide or support effective care plans for those patients assessed with a need for on-going, longer term care. It should take a public health role in the prevention of foot disorders and disease, undertake population based needs assessment, holistic health promotion and ill-health prevention activities. Your Health is our Primary Concern

6. Principles of Service Delivery • Care is provided free at the point of delivery • Care is available to all based on assessed clinical need • Care is provided equitably, no one should be disadvantaged • Best Practice and Evidence Based Care should be provided • Care should be provided by appropriately trained and clinically competent staff Your Health is our Primary Concern

7. Eligibility and Access Criteria • Access to the service is via application, no-one is excluded • Patients are assessed on needs alone • Assessment is based on clinical (medical) and podiatric (foot problem) needs • Physical and Mental Health needs are also assessed under the clinical need Your Health is our Primary Concern

8. Clinical Priorities Priority is given to those patients who’s medical or foot condition considerably increases their morbidity or reduces their mobility and independence and/or puts them at risk of losing limb or life. Your Health is our Primary Concern

9. High Needs Assessment Patients with a high clinical and/or foot need are offered one of the following • Chronic long term ongoing care and education • Acute episode of care and discharge • Education on self care, then monitored long term Your Health is our Primary Concern

10. Low Needs Assessment Patients with a low clinical and/or foot need will be offered one of the following • Episode of care and discharge • Episode of care and annual review • Education and Empowerment on self-care and discharge Your Health is our Primary Concern

11. A Wider Professional Remit The profession has the potential to make significant contribution to the challenges facing the NHS. • Reducing secondary care waiting times • Supporting service redesign • Community Health Partnerships • Pressures around elderly and Chronic Disease Management • Health Improvement Your Health is our Primary Concern

12. Challenges and Pressures • Workforce planning and skills mix issues • Previous lack of leadership with a matrix management system • Harmonising two previous organisations • Clinical capacity issues • Lack of appropriate care pathways and clinical specialists • Poor understanding of criteria and service purpose amongst partners and users Your Health is our Primary Concern

13. Challenges and Pressures • Inappropriate referrals • Poor new patient waiting times 12 weeks in some area’s • Archaic booking and registration systems • No dedicated administration/support staff • No focal point for Podiatry Services • High volume of low needs patients 15% caseload/ on average use 4,000 appointments per year Your Health is our Primary Concern

14. Challenges and Pressures • Lack of partnership working with other care providers • No alternative providers for social care group • Not enough Patient Empowerment • Not enough Patient and Public Involvement • Lack of general education • Highly desired and sought after service Your Health is our Primary Concern

15. Some Podiatry Statistics • 12 official complaints 2004/05 • 3 Clinical complaints • 9 Complaints concerning booking and administration systems • 23 Staff establishment • ~45,000 Appointments and Treatments • 15% Low clinical need Your Health is our Primary Concern

16. Developments to Date • Undertaken a full clinical governance review of the service • New staffing structure established and recruited to • Clinical Specialist leads established in MSK and Diabetes • Established education for professionals in Diabetic Foot screening and risk assessment • Successful LDP bid, increased establishment including 2 Diabetes Specialists and an Administration post Your Health is our Primary Concern

17. Developments to Date • Access project and mapping exercise undertaken • Established patient pathways in various treatment types • Reviewed and harmonised service standards • Produced comprehensive referral guidelines • Established partnership working with Physiotherapy Services and established a Rehabilitation Podiatry post • Reduced NP waiting times, 3 week average Your Health is our Primary Concern

18. Modernisation / Next Steps • Introducing central referral for new patients • Introducing an enquiries number and support line, e-mail enquiries can also be made • Increasing capacity with new site developments • Re-launch of the referral guidelines • Offering podiatry promotion talks to referrers and partners • Developing a triage and health education/promotion post Your Health is our Primary Concern

19. Modernisation / Next Steps • Introducing patient education and empowerment sessions • Evaluating the role Podiatry needs to play with regards to Public Health, i.e. linking to Obesity and Exercise • Increase Patient and Public Involvement • Extended Scope Practitioners • Develop further partnership and alternative patient pathways Your Health is our Primary Concern

20. Wants and Needs • Podiatry is a very desirable service, a lot of people “want” the service but not all “need” it. • We offer assessment, advice and education to anyone but cannot provide on-going care to people assessed with a low or no-need. • Providing on-going care to those with a low need inevitably impacts on the quality of care that has to be delivered to those with a recognised high need. Your Health is our Primary Concern

21. Should we prioritise on this? Your Health is our Primary Concern

22. Or This? Your Health is our Primary Concern

23. Summary • Access by application/referral to central office • Podiatry is delivered on a needs basis • The Service has to give priority to those patients at risk • Low risk patients should be supported with, advice, information, education, health promotion and empowerment Your Health is our Primary Concern