NHS LANARKSHIRE FOOT

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NHS LANARKSHIRE FOOT ANKLE SERVICE
WISHAW HAIRMYRES
MONKLANDS
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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 FA,
  Ortho FA)
• Streamed to appropriate clinic/clinician

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Referral Flow
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Orthopaedic ESP Podiatry

• 2500 Orthopaedic FA referrals annually
• 30 vetted to community MSK Podiatry
• Of remainder gt90 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 FA clinic)

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40 50 Patients
PP
Clinical Portal
PACS
Specialist Foot Ankle Virtual Clinic
TRAK Clinic
TRAK Vetting
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Butterfly Clinic
Up to 60 Patients
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THE INTEGRATED SPECIALIST FOOT AND ANKLE CLINIC
NEW PATIENT (Including Complex seen by Trainee)
WOS TRAINEE
6 New
30 MIN
Orthotist
ESP Podiatrist
NEW PATIENT (Likely to require Consultant)
30 MIN
6 New
RETURN PATIENT (Discuss Scan/ post op
Complication)
ESP Podiatrist
20 MIN
10 Return
ORTHOTIC RETURNS Post op Review with Consultant
/ Orthotist following Conservative Treatment
8 Return
30 MIN
Orthotist
RETURN PATIENT (Post-Op Return Commence
Biomechanics Treatment)
Clinical Specialist Podiatrist
20 MIN
10 Return
Diabetic Clinic
1 - 4 New/Return
NEW / RETURN PATIENT Discuss Management
(5 MIN)
POST OP RETURNS Dressings and Plasters
Nurse 1
Nurse 2
30 MIN
15 Return
Nurse 3
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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

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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

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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)

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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
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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?fileId889

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Staff DevelopmentAny fool can know. The point
is to understand. Albert Einstein

• Staff, not pathways, deliver service
• Pathway aids patient flow

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Staff DevelopmentExperiential
Learning
..................................................
..................................................
.............................
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Staff DevelopmentOpen EnvironmentPhysio Dept
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Staff Development

• Positive experience
• Reduce impact on waiting times
• Rolling programme

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Staff DevelopmentCompetency DocumentBased
around 4 Pillars of Practice
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Staff DevelopmentFoot Ankle Clinical
Competencies Incorporates 170 component parts
of MSK FA Assessment

• Foot Ankle Clinical Competencies
• Incorporates 170 component parts of MSK
  FA Assessment

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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

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Thank You

• Questions?