London Diabetic Foot Audit 2014/15 Community Services ... · 2014/15 Community Services survey results ... clinics and acute ulcer clinic regular presentations and case histories

Date

London Diabetic Foot Audit 2014/15 Community Services survey results London Foot Care Network Meeting

NHS England - London Strategic Clinical Networks

Thursday 4 February 2016

Acute Survey 2015

https://www.surveymonkey.com/r/communityfootcare

Which CCG does your team provide podiatry services for?

CCGs Providers

3

• Bexley CCG

• Camden CCG

• City and Hackney CCG

• Croydon CCG

• Greenwich CCG

• Haringey CCG

• Harrow CCG

• Hounslow CCG

• Kingston CCG

• Lewisham CCG

• Newham CCG

• Redbridge CCG

• Richmond CCG

• Croydon Health services

• Croydon Health services

• Your Healthcare

• Healthshare

• Healthshare

• CNWL

• Hounslow & Richmond Community Healthcare

• Whittington health

• Oxleas Adult Community Health Services - Bexley

• Oxleas NHS Foundation Trust

• Homerton University Hospital NHS Trust

• London North West Healthcare NHS Trust

• ELFT

• Lewisham and Greenwich NHS Trust

• Lewisham & Greenwich NHS Trust

16 results returned for 13 CCGs

London CCGs (32)

4

• Barking and Dagenham

• Barnet

• Bexley

• Brent

• Bromley

• Camden

• Central London (Westminster)

• City and Hackney

• Croydon

• Ealing

• Enfield

• Greenwich

• Hammersmith and Fulham

• Haringey

• Harrow

• Havering

• Hillingdon

• Hounslow

• Islington

• Kingston

• Lambeth

• Lewisham

• Merton

• Newham

• Redbridge

• Richmond

• Southwark

• Sutton

• Tower Hamlets

• Waltham Forest

• Wandsworth

• West London (Kensington and Chelsea)

What are the Whole Time Equivalent (WTE) staffing levels of the service?

Community Survey 2015

Comments:

FCAs - 2

FCA x 2

How many podiatry patient chairs does the service have on site?


Comments: not all clinics used everyday

What days do the community podiatry service operate?


Comments:

This would be a false economy to do.

There was no 7 day working

What other health care professionals are available to the community podiatry service?


podiatric surgeon consultants contactable through podiatry at the hospital which is provided by community podiatry

Comments:

What tests and results does the community podiatry service have direct access to?


Comments:

we have direct access to the results All request via GP but cannot view results in community through podiatry at the hospital which is provided by community podiatry

Is rapid access to the community podiatry service available for GPs?


Comments: Urgent Referrals are seen in SOS slot Via written referral but can phone if concerned all referrals are triaged according to our criteria by urgent referral, picked up by podiatrist in triage

Is an orthotist available to the community podiatry service if needed?


Able to refer via the GP to orthotist in outpatient setting

Comments:

Are 'off the shelf offloading devices' available?


Comments:

Kerraped plantar ulcer shoes padding Via Orthotics which require a referral - can refer directly but have to copy GP in. Only ever ordered Prevalon via TVN. Have Kerraped order forms in clinic. Some via referrals only from podiatry at the hospital which is provided by community podiatry

What are the Whole Time Equivalent (WTE) staffing levels of the Foot Protection Team?


Comments:

our community foot health team is our foot protection team (figures not given) we are a small team so all our staff are part of the foot protection team (figures not given) Community podiatry are also the FPT - same staff

What days does the Foot Protection Team Operate?


Comments:

this is a combination or ulcer clinics / doms and ongoing routine high risk clinics our services are 5 days a week in the community and at the Hospital

What other health care professionals are available other than in the Foot Protection Team


Dates of the meeting vary, FPT is made up of podiatrists Podiatry only meetings There are no scheduled meetings we do not have scheduled meetings, meet weekly with the district nursing team the community clinic on hospital site works with vascular and diabetes consultants and we all communicate but formal MDT once a month on Thursday

Comments:

Is there shared care between the Foot Protection Team and the local acute MDT?


our podiatry wound care team is integrated between the hospital and community (excellent model of care), with acute sites B7 Community pods also work in the hospitals 8a podiatrist based in hospital setting

Comments:

Is there a published pathway agreed with your local acute Trusts for the referral of patients with an active foot ulcer for use across both primary and secondary care?


Tier 3 and tier 4 Guidelines present since 2001

Comments:

Is there a published pathway agreed with local Trusts for the prevention, early detection and management of diabetic foot disease?


Is there an emergency service available for local clinicians to refer in to?


They can phone the office if concerned and patients will be seen if possible

Comments:

Are patients with potential foot problems supplied with a 24 hour a day, 7 days a week nominated clinician /person including telephone numbers?


told to go to A&E out of hours

Comments:

Is there a dedicated clinical session for the treatment of painful neuropathy available through the Foot Protection Team?


Comments:

Acupuncture

Is there an agreed structured, tailored diabetes education programme for foot care offered to all patients with diabetes through the Foot Protection Team?


Comments:

DESMOND

Is Topical Negative Pressure available through the Foot Protection Team?


providing via acute MDT and district nursing Can access it via TVN if indicated via the TVN

Comments:

Is continuing education in diabetes care available to Foot Protection Team staff regarding diabetic foot?


Is continuing education in diabetes care available to Foot Protection Team staff regarding diabetic foot?


Comments:

all new staff have wound care training placements in community ulcer clinics and acute ulcer clinic regular presentations and case histories at team meetings Staff attend the diabetic foot module External & In-House CPD Encouraged to attend SOCAP course Funded CPD External & In-House Encourage attendance on SOCAP course on going Own responsibility to request training Clinical rotations, training offered by complex wound team All Podiatrists attend module in diabetes. All podiatrists shadow/rotate through diabetes clinics. and have on going diabetes education/forum meetings regular update at staff meetings

Summary of main findings

From the responding providers:

• 13 (of 32) CCGs provided from 16 responses.

• Majority of podiatry delivered by Band 6 podiatrists.

• Admin assistance is generally available

• Average 8.6 Podiatry couches per CCG.

• No weekend working.

• There is variation in the number of other specialities available to podiatry in community.

• Less than half community services have access to blood tests,

radiology and histology. Only 2 have access to Duplex scanning.

Over half have access to microbiology.

• 85% have rapid access to community podiatry for GPs.

• 54% have no access to an orthotist.

• 30% of community clinics have no basic offloading devices.

• The majority of podiatry in the Foot Protection Teams is delivered by

Band 6 podiatrists.



From the responding providers continued:

• No foot protection teams work at the weekend.

• There is variation in the number of other specialities available to the

Foot Protection Team.

• 85% of Foot Protection Teams share care with the hospital MDT.

• There is a published pathway agreed with local acute Trusts for the

referral of patients with an active foot ulcer for use across both primary and secondary care in 77% of CCGs.

• There is a published pathway agreed with local Trusts for the

prevention, early detection and management of diabetic foot

disease in 77% of CCGs.

• There is an emergency service available for local clinicians to refer

in to in 77% of CCGs.

• There are no CCGs providing patients with potential foot problems

a 24 hour a day, 7 days a week nominated clinician /person including telephone numbers



From the responding providers continued:

• Only 15% of Foot Protection Teams provide a dedicated clinical

session for the treatment of painful neuropathy.

• 46% of CCGs have no agreed structured, tailored diabetes

education programme for foot care offered to all patients with

diabetes through the Foot Protection Team

• Topical Negative Pressure is not available through 69% of Foot

Protection Teams

• Continuing education in diabetes care for Foot Protection Team

staff regarding diabetic foot is variable.


Documents

London Diabetic Foot Audit 2014/15 Community Services ... · 2014/15 Community Services survey results ... clinics and acute ulcer clinic regular presentations and case histories