NHS LANARKSHIRE FOOT & ANKLE SERVICE

WISHAW HAIRMYRES MONKLANDS WISHAW HAIRMYRES MONKLANDS

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

Referral Flow

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

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Orthotics• 500 Orthopaedic referrals redirected to Orthotic service annually ( usually from Virtual clinic, or F&A clinic)

PPPP

40 – 50 Patients

PACS

TRAK Clinic

Clinical Portal

TRAK Vetting

Specialist Foot & Ankle Virtual Clinic

Butterfly Clinic

Up to 60Patients

THE INTEGRATED SPECIALIST FOOT AND ANKLE CLINIC

Nurse 1 Nurse 2 30 MIN 15 Return

WOSTRAINEE

30 MIN

ESP Podiatrist

20 MIN 10 Return

ESPPodiatrist

30 MIN 6 New

20 MIN 10 Return

Orthotist 30 MIN 8 Return

6 New

Clinical SpecialistPodiatrist

Orthotist

Nurse 3POST OP RETURNS

Dressings and Plasters

ORTHOTIC RETURNSPost – op

Review with Consultant / Orthotist following Conservative Treatment

NEW PATIENT(Including Complex seen by

Trainee)

Diabetic Clinic

(5 MIN) 1 - 4 New/Return

NEW PATIENT(Likely to require Consultant)

RETURN PATIENT(Discuss Scan/ post op

Complication)

RETURN PATIENT(Post-Op Return

Commence Biomechanics Treatment)

NEW / RETURN PATIENTDiscuss Management

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

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

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)

Orthotics escalation pathwayPatient referral

Patient seen by Orthotist

Successful fitting of orthotics

(by 2nd fitting)no

Escalated to be seen jointly with more senior

Orthotist

yes

Care aim achieved?

yes

Patient discharged

noPatient referred to Foot &

ankle virtual clinic for discussion

COMMUNITY MSK PODIATRY• 4 MSK Lead Podiatrists and 8 MSK Podiatrists

• Electronic referral

• Auditable clinic outcomes

• Pathways; Comprehensive but NOT prescriptive

• http://www.clinicalknowledgepublisher.scot.nhs.uk/Published/PathwayViewer.aspx?fileId=889

Staff Development“Any fool can know. The point is to understand.”

Albert Einstein

• Staff, not pathways, deliver service

• Pathway aids patient flow

Staff Development

Experiential Learning

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Staff DevelopmentOpen Environment

Physio Dept

Staff Development

• Positive experience

• Reduce impact on waiting times

• Rolling programme

Staff DevelopmentCompetency Document

Based around 4 Pillars of Practice

Staff DevelopmentFoot & 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

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

Thank You

Questions?