1. NHS LANARKSHIRE FOOT & ANKLE SERVICE
WISHAW HAIRMYRES MONKLANDS

2. ORTHOPAEDIC REFERRAL Electronic referral
RMS (Referral Management Service)
Urgent; vetted by Ortho Consultant
All Routine Referrals vetted by ESP Physio/Pod
Vet by body part (ESP Knee, Ortho Knee, ESP F&A, Ortho F&A)
Streamed to appropriate clinic/clinician

3. Referral Flow

4. Orthopaedic ESP Podiatry
2500 Orthopaedic F&A referrals annually
30% vetted to community MSK Podiatry
Of remainder >90% seen and managed by ESP
10% vetted to Virtual clinic, orthotist, pre surgery
Orthotics
500 Orthopaedic referrals redirected to Orthotic service annually ( usually from Virtual clinic, or F&A clinic)

5. Specialist Foot & Ankle Virtual Clinic
Orthopaedic
Consultant
Senior
Orthotist
ESP
Podiatrist
Diabetic
Physiotherapist
Nurse
Physicians
Assistant
Administrator
40 – 50
Patients PP
Clinical Portal
PACS
Specialist Foot & Ankle Virtual Clinic
TRAK Clinic
TRAK Vetting

6. Up to 60
Patients
Butterfly Clinic

7. THE INTEGRATED SPECIALIST FOOT AND ANKLE CLINIC
NEW PATIENT
(Including Complex seen by Trainee)
WOS
TRAINEE
30 MIN
6 New
Orthotist
ESP
Podiatrist
NEW PATIENT
(Likely to require Consultant)
30 MIN
6 New
ESP Podiatrist
RETURN PATIENT
(Discuss Scan/ post op
Complication)
20 MIN
10 Return
ORTHOTIC RETURNS
Post – op
Review with Consultant / Orthotist following Conservative Treatment
8 Return
Orthotist
30 MIN
Clinical Specialist
Podiatrist
RETURN PATIENT
(Post-Op Return
Commence Biomechanics Treatment)
20 MIN
10 Return
Diabetic Clinic
NEW / RETURN PATIENT
Discuss Management
(5 MIN)
1 - 4
New/Return
POST OP RETURNS
Dressings and Plasters
Nurse 1
Nurse 2
Nurse 3
30 MIN
15 Return

8. Transformed Foot and Ankle Pathway
ALL Patients receive conservative treatment
Up-skilled Community Podiatry Biomechanics
Up-skilled Orthotic team
Links to Acute Site ESP Podiatry

9. Rapid Delivery of Orthotics
Referral time to final fitting – 9 weeks
Contracts outsourced for manufacture to increase exponentially the time available for the orthotic clinician to spend seeing patients

10. Orthotic team Increased knowledge of:
Surgical interventions
Diagnostics
Realistic appreciation of non-resolving situations
Who to escalate to?
Close inter-professional working of Foot & Ankle team
Patient centred approach (care aims)

11. Orthotics escalation pathway
Patient referral
Patient seen by Orthotist
Successful fitting of orthotics
(by 2nd fitting)
Escalated to be seen jointly with more senior Orthotist no
yes
Patient referred to Foot & ankle virtual clinic for discussion
Care aim achieved? no
yes
Patient discharged

12. COMMUNITY MSK PODIATRY
4 MSK Lead Podiatrists and 8 MSK Podiatrists
Electronic referral
Auditable clinic outcomes
Pathways; Comprehensive but NOT prescriptive

13. Staff, not pathways, deliver service Pathway aids patient flow
Staff Development “Any fool can know. The point is to understand.” Albert Einstein
Staff, not pathways, deliver service
Pathway aids patient flow

14. Staff Development Experiential Learning

15. Staff Development Open Environment Physio Dept

16. Staff Development Positive experience Reduce impact on waiting times
Rolling programme

17. Staff Development Competency Document Based around 4 Pillars of Practice

18. Staff Development Foot & Ankle Clinical Competencies Incorporates 170 component parts of MSK F&A Assessment
Foot & Ankle Clinical Competencies
Incorporates 170 component parts of MSK F&A Assessment

21. RESULTS 9% of Forefoot conditions progress to surgery at 3 years
50% of Hind-foot arthritis treated and managed to the patients satisfaction in Orthotics

22. Thank You
Questions?