NHS LANARKSHIRE FOOT & ANKLE SERVICE 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 ----------------------------------------------------------------------------- Orthotics 500 Orthopaedic referrals redirected to Orthotic service annually ( usually from Virtual clinic, or F&A clinic)

Specialist Foot & Ankle Virtual Clinic Orthopaedic Consultant Senior Orthotist ESP Podiatrist Diabetic Physiotherapist Nurse Physicians Assistant Administrator 40 – 50 Patients PP Clinical Portal PACS Specialist Foot & Ankle Virtual Clinic TRAK Clinic TRAK Vetting

Up to 60 Patients Butterfly Clinic

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

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 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

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, not pathways, deliver service Pathway aids patient flow 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 .................................................................................................................................

Staff Development Open Environment Physio Dept

Staff Development Positive experience Reduce impact on waiting times Rolling programme

Staff Development Competency Document Based around 4 Pillars of Practice

Staff Development Foot & 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?