1. Pathways Sarah Rodrigues MSK CATS Team Lead (Watford/Dacorum)

3. Virtual Foot/ankle pathway

4. Virtual Podiatry clinic Expected outcomes include: Small reduction in ‘new’ appointments at the Acute Trust Refined pathway for patients requiring referral for surgery attending Community podiatry clinic Improved communication between Community and Acute Trust clinicians Reduction in need for patient to attend multiple outpatient appointments Outcomes measured by: Numbers of patients booked directly to surgery (Local data collection) Reduction in numbers of new appointments at the Trust (may be difficult to to ascertain as numbers are relatively small) Patient satisfaction questionnaires Staff satisfaction questionnaires

5. Benefits to patients Improved access to patient care Improved access to patient care Refined pathway Refined pathway Reduction of out patient appointments Reduction of out patient appointments Rapid assessment and resulting treatment Rapid assessment and resulting treatment One stop shop service One stop shop service Seen by the most appropriate clinician Seen by the most appropriate clinician Safe service: MDT approach with consultant expertise. Safe service: MDT approach with consultant expertise.

6. Other Benefits Benefits to Clinicians/Staff Opportunity for ESP (Podiatry) to develop their skills in MSK Surgical referrals Improved integration between services Increasing effective use of Community Consultations Benefits to PCT Reduction in referrals to Acute Trusts outpatients Increased efficiency within Community Care settings Reduction in unnecessary investigations

7. Conditions include:  Hallux Valgus  Morton’s neuroma  Haglund’s deformity  Achilles Tendonopathy  Tarsal Coalition  Os Trigonum syndrome  Tibialis Posterior Tendon Dysfunction  Osteoarthritis/exostoses  Ganglion  Footballers Ankle  Chronic/repeated ankle sprains  Peroneal Tendon Subluxation Syndrome

8. Costs and savings

9. Full year cost/savings (12 Months) Consultant * 1 PA per month £300 per PA (4 hours) Includes 5% on-costs 3780.00 ESP Podiatrist (Virtual Clinic) 4 hours per month @ £35.91 per hour (clinical) 1 hour per month @£35.91 per hour (administration) Including 10% on-costs 1896.05 Including 10% on-costs 474.01 Additional Admin 1.5 hour per month (Point 17) @11.74 per hour Including 10% on-costs 232.41 Prescribing Nil00 Project resources Within current teams00 Estates Nil00 Total Costs 6382.47 Savings Outpatient savings 120 New Appointments @ £174.27 (includes MFF) 20912.40 Total SavingsSavings minus total costs 14529.93 Part Year Effect Savings (6m) 7264.97

10. Future plans/ideas. Pain pathway Pain pathway CTS out come measure CTS out come measure CTS research CTS research ?Virtual Shoulder clinic ?Virtual Shoulder clinic ?Ultrasound guided injection clinics ?Ultrasound guided injection clinics Name change! CROPS Name change! CROPS