1. INITIAL RESULTS OF A SURVEY OF CURRENT NHS PODIATRY ACCESS CRITERIA David Milns Lead Practitioner Podiatry Department East Cambs and Fenland PCT

2. Background Involvement in research concerning the outcomes of a decision to deny defined low risk elderly patients access to NHS podiatry services What access criteria is currently in use within NHS Podiatry services?

3. Methodology Snapshot of criteria in use in September 2001 150 FOM members managing Podiatry Services across the UK contacted 90 responses received - a return rate of 60% England 75, Ireland 3, Scotland 9, Wales 3

4. Survey Results Broadly broken down into four groups: Open access - no defined criteria, no prioritisation and including social care: 15 (17%) England 10, Ireland 0, Scotland 3, Wales 2 Open access including social care but with some prioritisation of waiting lists:12 (13%) England 8, Ireland 1, Scotland 3, Wales 0

5. Survey results cont. Service based on old “priority group” definitions: 20 (22%) England 16, Ireland 1, Scotland 2, Wales 1 Service based on meeting defined needs with patient prioritisation: 43 (48%) England 41, Ireland 1, Scotland 1, Wales 0

6. Services with restricted access based on prioritisation of need Formed 48% of the returns Two main groups: Departments using scoring systems to determine access (20) Departments using risk definitions to determine access (23)

11. Risk definitions Many variations High Risk: eg diabetes, ischaemia, RA, infection, ulceration, painful lesions Medium Risk: eg biomechanical conditions, corns, callous, nail conditions. Conditions requiring intensive treatment and discharge Low Risk: cutting of normal nails, verrucae, patients requiring treatment for chronic conditions

12. Summary Wide range of access criteria currently in use with considerable variations in risk definitions Some evidence of local political pressure influencing criteria Little evidence base apart from local clinical consensus. Often determined as a result of financial and waiting lists/times pressures