REDESIGN OF FOOTCARE SERVICES PROJECT Jamie Quin CSM Podiatry & Care home services

Podiatry service in GG PCT and now in GG&C chps 2002 had registered patients Had 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 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: Self GP Tertiary HCP Triage Assess ment& 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 groups Global sample n=20,004 Group (2) senior Podiatrist 21% Group (3) Podiatrist 28% Group (1) No Podiatry need 14% Group (4) Shared care 36% Other 1%

Percentage of level 1-4 Level 1= 6% Level 2= 33% Level 3= 31% Level 4= 29%

Patient presentation to GP Orthopaedic 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 ESPRoutine Podiatry Orthopaedics Elaine Yule ESP Podiatrist Ramsay Sloss ESP Podiatrist Jenny Ackland Project Manager 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 conditions refer directly to the hospital diabetic /podiatry service.( See local referral guidelines.) Acute/active rheumatoid foot conditions refer 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.