1. BY MARY JAMES Trustee of The Lindsay Leg Club Foundation mary.james@legclubfoundation.com

2. WHY SET UP A LEG CLUB

3. BACKGROUND District nurses visit patients in their own homes, who are supposed to be ‘housebound’ Many patients are very isolated Approx. 60% of caseload is wound care. i.e. Acute surgical wounds, pressure ulcers, trauma wounds, leg ulcers and ‘leaking’ legs Travel can have a significant impact on District nurses’ time

4. AIMS OF LEG CLUBS Deliver research-based wound management in a friendly non-threatening, social environment. Provide an environment for staff development & learning Provide continuity of care & a coordinated approach to its delivery Adopt a simple, flexible ‘drop in’ approach Minimise recurrence by ‘well leg’ checks Achieve concordance with treatment through informed beliefs & peer support

5. WHY SET UP A LEG CLUB? 1.Patient Benefits Motivation & empowerment Reintegrated into the community. Less isolated. Peer support Enhanced quality of life - improved healing rates (Clark 2010), eliminates ‘sick role’ behaviour, improved morale & reduced pain. Well leg checks reduce recurrence.

6. WHY SET UP A LEG CLUB? 2. Healthcare Team Benefits Leg Clubs encompass all of the Government’s recent initiatives.(DOH 2010) Ensure appropriate skill mix & peer support Promote team working Promote education of nurses Chance to deliver health education Provide wound care experience for students

7. WHY SET UP A LEG CLUB? 3. Benefits to referrers Referrers can be assured of high quality care delivery because: Clinical practice is supported by formal pathways Written guidelines relating to infection control & risk analysis. Routine data collection & analysis Regular audit

8. WHY SET UP A LEG CLUB? 4. Resource benefits Research has demonstrated substantial savings for the NHS (Gordon et al 2006, Hampton et al 2005,Lindsay 2010) Reduction in travelling time & costs Provide an opportunity to enhance the productivity of junior grades e.g. HCAs

9. REASONS PEOPLE HAVE FOR NOT SETTING UP A LEG CLUB Fear of taking on too much work Is our knowledge of wound care good enough? Will we be judged by our colleagues? Will the Leg Club be a success? We have been trained to nurse not set up new ventures We still have to do our usual work as well as setting up a Leg Club ‘We only visit housebound’ patients. If they can walk, they should go to the practice nurse. NOT OUR JOB’ !!!

10. OTHER FEARS How do we find a venue? How will we find the rent? How can we buy the equipment Where do we find equipment such as folding dressing trolleys? Where will we find the volunteers? Transport? Where will we find the time to do everything?

13. ANY QUESTIONS SO FAR?

15. HOW DO WE SET UP A LEG CLUB? Ensure your nursing team are on board! Visit other Leg Clubs to see how they are run Talk to your Manager and CCG Talk to GPs Present case for setting up a new Leg Club to Ellie (template available from Ellie) Form steering group of nurses & Volunteers. Devise a constitution & define roles. Set up bank account

16. PRACTICALITIES Find suitable non-medical premises Generate funds & raise public awareness Explore other sources of funding e.g. grants Invite infection control, & manual handling advisors to inspect premises. Write extra risk assessments (There are standard Leg Club risk assessments) Purchase equipment Nurses to receive training by Ellie on documentation & Leg Club procedures

17. GET SUPPORT From Ellie, TVN & Lindsay Leg Club Foundation Trustee CCG Your Manager Your GPs Other Leg Clubs Company reps –to visit, give education, raffle prizes and cakes

18. FINANCE Treasurer should be a volunteer, not a NHS employee There should be a yearly AGM & committee meetings as required Approach the CCG to ask for some or all funding. Fundraising: Internally - weekly raffle/cake sale/Christmas hamper draw/100 club/2 nd hand book sale. Externally – Local charities/Rotary/Lions/Round Table/Supermarkets

19. HOW CAN INDUSTRY PARTNERS CONTRIBUTE? Education Publicity help for new clubs Visiting the clubs to talk to members and staff and offer support Sponsoring Leg Club nurses to go to the Leg Club conference annually

20. DIVE IN!

21. CONCLUSION Leg Clubs offer a valid alternative to both leg ulcer clinics & home visits. They are founded on evidence-based protocols They incorporate a ‘well leg’ aspect to maintain healthy legs They involve the community Despite the positive aspects, it can be daunting to set up a Leg Club – outside the comfort zone With support it can be done!

26. THANK YOU ANY QUESTIONS?

27. REFERENCES Department of Health (2010) Equity & Excellence: Liberating the NHS. The Stationery Office. London Gordon L, Edwards H, Courtney M, Finlayson P, Shuter E, Lindsay E 92006) A cost-effective analysis of two community models of care for patients with venous leg ulcers. Journal of Wound Care 15(8) 348-53 Hampton S, Lindsay E (2005) Empowering patients to take control of leg ulcer treatment through individualised management, Journal of Wound Care 14(5). 238-40 Lindsay E (2010) Leg Clubs: a clinically & cost-effective approach to lower limb management. British Journal of Community Nursing 15(6,Suppl). 16-23 Clark M (2020) Social model for lower limb care: The Lindsay Leg Model. Presentation at EWMA Conference. Geneva, Switzerland