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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?
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