Good Practice on Scale

The past, present and future of Foot and Ankle Pathways in NHS GGC

Elaine McLure

Nicola Munro

David Wylie

NHS GGCFoot and Ankle Triage Service

Elaine McLure

ESP Podiatrist

Presentation Outline:

Orthopaedic Foot and ankle services in GG&C

– Why the need for service change?

• National Policy and the CCI project• Orthopaedic redesign & waiting times• Project Aims• Public Involvement events• Outcomes

National policy

“Where ever possible, and it is in the interests of the patient, AHPs should be first point of contact and take the lead in the delivery of the service”

Malcolm Chisholm, Minister for health and community care

Orthopaedic redesign

Traditionally 15% of all orthopaedicreferrals are foot and ankle related

with an 18 month waiting time.

• 30% of those go on for surgery

• 70% are discharged with no surgery

Project aims:

Reduce the current waiting times for initial consult.

Improve the conversion rate for surgery.

Provide a more local service.

Project aims: Ensure that patients are seen by the most

appropriate clinician.

Develop service based on public and users involvement.

Develop care pathway .

Develop highly skilled clinicians.

Public Involvement

• Two public involvement days– Newsletters

• Comments from event 1 and newsletter 3/2005

• Comments from event 2 and newsletter 5/2006

Outcomes• Waiting times reduced.

• Conversion rate improved.

• Local service delivered.

• Appropriate clinician.

• ESP training programme developed.

• Service developed on the PFPI events.

This is at the very heart of Delivering for Health and I hope to see

more initiatives like this one developing across Scotland.

Andy Kerr, Health Minister 2004- 2007( speaking of the foot and ankle triage service in Glasgow)

• The Foot and ankle triage service won first place at the UK Awards for Allied Health professionals and Healthcare Sciences in London held on 3 November 2005. The project was short listed to 3 from 50 applicants.

• The commitment by multi professions to improve current service provision.

• It has delivered a service to a local community normally delivered in hospitals.

• It has bridged the gap between primary and secondary care (care pathway).

• It has networked a multidisciplinary team of specialists.

What made this project a success?

What made this project a success?

• It has increased surgery sessions.

• It has enhanced the role of the specialist podiatrists.

• It was built on patient led guidance and continues to develop this way.

How was this achieved?

• Mainly with open shared mentorship.

• Ability to triage to other services directly.

• GP meetings.

• AHP team involvement.

• Ongoing mentorship.

How does this relate with current best practice?

Pathway of patient from referral to surgeon is:

Quicker – Conservative care is often carried out at source– Assessment ,diagnosis and treatment are

established at point of contact– Direct access to surgical listing – Direct access to Diagnostics– Direct access for case discussion with consultant

Current GG&C Foot and Ankle services

5 ESP podiatrists within the Acute setting:

– Glasgow Royal Infirmary (20 sessions)– Western Infirmary (10 sessions)– Southern General/Victoria Infirmary (2 sessions)– Vale of Leven (3 sessions)

2 ESP podiatrists in community:

– East Glasgow (10 sessions)– South Glasgow (10 sessions)

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/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

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

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 local diabetic service.(see local referral guidelines)Acute/active rheumatoid foot conditionsrefer directly to the local rheumatology service. (see local referral guidelines)

NHS GGCMSK

Foot and Ankle Pathways

Nicola Munro

Project Manager

The Story so far

• Stakeholder engagement– AHP Staff including all levels of all

professions– AHP Professional leads– Other Specialities– Other Boards– Patients

Goal of Pathways

• Try to promote equitable and consistent treatment and information for all patients

• Guide for clinicians to the best evidenced treatment for patients

• Information on how to refer to other services and the best service to refer to.

Clinical Knowledge Publisher

• http://www.clinicalknowledgepublisher.scot.nhs.uk/Published/PathwayViewer.aspx?fileId=1371

MSK Entry Screen

Foot and Ankle

Area of Presentation

Area of Presentation

First Line Intervention

Escalate

Second Line Intervention

Third Line Intervention

Non Evidenced Treatments

MD Complex Case Clinic

Surgery

David Wylie

Podiatry Service Manager & Professional Lead

Project Sponsor

The Future?

Implementation

• Training

• Evaluation

• Impact