Podiatric Surgery Mike Townson

Background Previous commissioning interest Venue? Care UK – Walk in Centre Lower Limb Pathway Persistence Good data Good recruitment Integration

Service November 2010 155 procedures 1 theatre session Lower limb assessment and follow up clinics

What has happened Profile Consultant led Up skilling Integration

Activity 13 Surgical Procedures 8 Injection Therapy Scarf & Akin PIPJ Arthroplasty Chielectomy Amputation Lapidus Exostectomy 8 Injection Therapy

Orthopaedics Back log Injection midfood right Fusion ipj left 2nd toe Fusion left hallux ? Removal of screws right hallux Bilateral scarf/akin Removal of toenail left hallux TMTJ right fusion foot Wedge excision nail bed left little toe Orif non-union left metatarsal Open debridement right talus Scarf/akin left hallux Excision MT head right 2nd toe Lapidus right hallux Excision right foot ganglion Arthroscopic ankle fusion left

Primary OPCS Procedure Desc HRG Code HRG Desc GP Age LOS Primary OPCS Procedure Desc HB33B INTERMEDIATE FOOT PROCEDURES FOR NON -TRAUMA CATEGORY 1 WITH CC 62 6 FUSION OF FIRST METATARSOPHALANGEAL JOINT NEC 67 3 HB32Z INTERMEDIATE FOOT PROCEDURES FOR NON -TRAUMA CATEGORY 2 69 2 PRIMARY ARTHRODESIS AND INTERNAL FIXATION OF JOINT NEC 75 CUNEIFORM OSTEOTOMY PROX.PHALANX RESECT.HEAD FIRST METATARSA HA31C MAJOR FOOT PROCEDURES FOR TRAUMA WITHOUT CC 33 PRIMARY OPEN REDUCT/FRACTURE/LONG BONE/EXTRAMED/FIX USING PL 61 1 PRIMARY ARTHRODESIS AND EXTERNAL FIXATION OF JOINT NEC

Governance Medical Director Vascular Professor Medicines Committee Strong process Quality documentation Transparent audit Evidence of team training

Where next? All foot surgery has no value!? Whole time post Develop team Change pathway Links to other services/pathways