Redbridge & Waltham Forest Podiatry Service Scrutiny Committee Scrutiny Committee Joan Twitchett
Service Information � Provides a service to the residents of Redbridge and Waltham Forest � In community clinics across the districts � At Whipps Cross and King George Hospitals � Local Mental Health Hospitals � For Housebound clients � Clients in residential and nursing homes
Who is eligible for treatment � People who have a clinical or medical need � Under 16 or over 65 � Certain medical conditions � Learning difficulties � Physical conditions that result in foot problems
Podiatry Services available � Care for people in community clinics � Education and assessment for people who require nail care or who have minor problems � Support for NSF for the elderly /Falls prevention � Nail cutting for people with no carer support � Multi disciplinary clinics in diabetes at hospital sites for outpatients and ward patients and domiciliary patients � Rheumatology and footwear clinics � Bio mechanics � Paediatrics � In growing toenail surgery � Care for socially excluded
Benefits of joint service � One management structure � One appointment centre � Choice of appointments � Emergency appointments available across both districts � Cover available � Broader range of experience � Training and mentorship at both hospital sites � Equity of care
Achievements / Waiting Times � All referrals are triaged daily by a senior Podiatrist .The department receives up to 170 new referrals per week � Emergency referrals(infection /ulceration) will be contacted within 48 hours and offered an appointment within a week usually at either hospital site � People who have foot problems (corns callus) and a medical problem(diabetes rheumatoid arthritis) are sent a letter inviting them to contact the department to arrange treatment, this will be 4-10 weeks following referral
Low risk Referrals � People who are referred with minor foot problems (long nails , corns , and calluses ) � This group of people will be sent a letter within a week of receipt of their referral inviting them to contact the department to arrange to attend an education and assessment session � Waiting time for education and assessment is between 4-6 weeks
Existing Patients � All existing patients and new people referred to the service will be treated according to their clinical need � Waiting times vary from treatment weekly to an appointment every six months depending on the type of foot problem � All patients are sent or given information regarding the care of their feet and details of how to contact the service should they develop an emergency foot problem
Domiciliary service re- design � The service has recently improved the service provided to housebound people � All patients are now encouraged to phone in to arrange their visits and are given a choice of times and dates / Reduced DNA rate � Senior specialist Podiatrists are carrying out holistic care for people who would normally be asked to attend the hospital sites for treatment liasing with other health professionals where indicated � Appointments can be sent in the post if necessary � Patients and carers are encouraged to carry out simple foot care if possible , and will be given a foot file and moisturising cream to assist with this task � A nail cutting service is still available for people who are housebound
Current Challenges Referral rate increase � The number of referrals since April 2004 has increased by 25% since the same period in 2003 � In Waltham Forest 257 people were referred requesting foot assessment for people with diabetes � 565 of these people with diabetes had foot problems In Redbridge and Waltham Forest there are approximately 14,000 people with diabetes 36% of these are of black and ethnic origin
Effect on the Podiatry Service � Reduction in capacity for existing caseload � Increase in people with severe foot problems � Increase in workload for the office staff � Waiting list for people requiring diabetic foot assessment � Extra time required to provide education to patients and other health professional � All Podiatrists require extra training � Longer appointment time required for more complex care
Increase in Diabetic/general referrals Action taken GMS requires that all diabetics have an annual health check this includes a foot assessment � A programme of education sessions has been introduced � In house training for GPs can be arranged � Multi disciplinary education sessions available for with diabetes � Prioritising all other referrals for people with diabetes or other health problems and offering appropriate care � Working with the local diabetes National Service Framework implementation group
Increase in the very elderly � The service has been working with the falls prevention service in Redbridge and Waltham Forest � Education sessions can be provided to nursing homes and carers groups � A small social nail cutting service is available in community clinics. However this is an area of concern
Diverse Population Reaching all of the people who have the diabetes and offering education /or treatment � Attend local groups to provide education � Working with the community health project providing care for socially excluded people � Recently supported RESPECT week � Access to translation service
Recruitment of Podiatry Staff Shortage of Podiatrist in the South East � Providing clinical placements for the University of East London � Investigating recruiting abroad � Have the facility of accommodation at King George Hospital � In the future skill mix
The Future Vision � Educate / provide foot health education in order to prevent problems from developing � Empower / people to care for their own feet � Easier access for those people who have foot problems requiring the treatment of a podiatrist
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