9 th march 2011 podiatry managers’ training event northampton park inn
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SURVIVE AND PROSPER: The Orthopaedic Triage and Podiatric Foot Surgery Experience David A. Wylie Head of Podiatric Services, Acute Services Division. 9 th March 2011 Podiatry Managers’ Training Event Northampton Park Inn. The History. Podiatric Surgery in UK. - PowerPoint PPT PresentationTRANSCRIPT
SURVIVE AND PROSPER:The Orthopaedic Triage and Podiatric Foot Surgery ExperienceDavid A. Wylie
Head of Podiatric Services, Acute Services Division
9th March 2011
Podiatry Managers’ Training Event
Northampton Park Inn
Podiatric Surgery in UK
Late 1970’s early 1980’s (Podiatry and LA)
The History
King’s Fund Audit 1997
Day Surgery theatres in Primary Care
150 podiatrists involved in podiatric surgery 42 consultants in podiatric surgery (1550+ orthopaedic surgeons – 60+ foot surgery as main sub-specialty)
1999 Appointment of Head of Podiatry
Key Result Area “Get that @*!ing theatre working!”
“The day I support podiatric surgery will be the day my Royal College supports podiatric surgery!”
Surgical Director
The story so far….
2002 Memorandum of Agreement
Collaboration between RCS Edinburgh RCPS GlasgowSociety of Chiropodists & PodiatristsGlasgow Caledonian University & Queen Margaret University
The story so far….
providing a Scottish Podiatric Surgery service fully integrated with Orthopaedic surgery
PODIATRIC SURGERY SERVICES
delivering joint clinical training to Podiatric & Orthopaedic surgery trainees in
Scotland
offering a whole system solution to national Orthopaedic redesign projects
The story so far….
2003: 1st BUSINESS CASE PRODUCED
“Ye cannae dae that!”
The story so far….
• No recovery area• No evidence that podiatry contributes positively to Orthopaedics• Podiatric Surgery can’t work in partnership with Orthopaedic Surgery
The Funding Challenges
£400k from CCI in 2005 to re-develop day theatre in department of podiatry,
Southern General Hospital, South Glasgow
2005 Business Case to redevelop theatre
2006 Business Case to establish Orthopaedic Triage
“Ye cannae dae that!”
The story so far….
• No evidence that podiatry keeps patients off Orthopaedic waiting lists
The Funding Challenges
£76k from CCI in 2006 to develop primary care foot and ankle triage posts
IN PARTNERSHIP WITH ORTHOPAEDICS
2006 Business Case to establish triage
2006 Business Case to establish Podiatric Surgery
“Ye cannae dae that!”
The story so far….
• No evidence that podiatric surgery will work in Scotland (since we are different from England!)
The Funding Challenges
2009 Business Case to establish pilot Podiatric Surgery service
£110k from Scottish Government in 2009 to establish pilot Podiatric surgery service for 39½ weeks
The Service Model
• (A) 0.4 wte AFC Band 9 AHP Consultant in Podiatric Surgery
• (B) 0.3 wte 1 AFC Band 8a Extended Scope Practitioner
• (C) 0.2 wte AFC Band 7 Extended Scope Practitioner
• (E) 0.2 wte Honorary AHP Consultant in Podiatric Surgery(Glasgow Caledonian University)
• (D) 0.2 wte Rotational ESP Primary / Secondary Care
Figure 1 Podiatric surgery pilot staffing model
The Service Model Triage by Orthopaedic Triage Podiatrist
Listing by Orthopaedic Triage Podiatrist Pre-op assessment by AHP Consultant in
Podiatric Surgery
Day Case surgery
Local Anaesthetic
1 week dressing 2 week follow up 12 week follow up
The Team
William Money Allied Health Consultant in Podiatric Surgery
Primary & Secondary Care Podiatrist
University links Direct links with
orthopaedics
The Outcomes
1. Capacity & Productivity
2. Activity & Casemix
3. Referral Sources
4. Clinical Effectiveness
5. Sequellae
1 Capacity & Productivity
2 new day case theatre sessions established in the redeveloped department of Podiatry
theatre
No planned theatre sessions were cancelled during the pilot.
Conversion rate for patients referred for surgery of 98%.
Mar – Nov 2010
Pod Surgery
SGH
As a % ofTotal
Procedures (135) Example of level of surgery
OrthopaedicsGGH
As a % of total
procedures(390)
COMPLEX NA Complex hindfoot / ankle 18 4.6%
MAJOR + NA Ankle / hindfoot 60 15.4%
MAJOR 36 26.5% Forefoot / midfoot 134 34.4%
INTER 95 70.5%Usually soft tissue or small
bone 146 37.4%
MINOR 4 3.0%Wound debridement,
injections, etc. 32 8.2%
TOTAL 135 100% 390 100%
2 Activity & Casemix
3 Referral Sources
Referral Source TOTAL %
PRIMARY CARE PODIATRY ORTHOPAEDIC TRIAGE 16 14
ORTHOPAEDICS SGH Mr R Carter 32 28
ORTHOPAEDICS GGH Mr S Moir 45 40
PODIATRY SGH 20 18
TOTAL 113 100
3aOrthopaedic Triage Model
Minor / Intermediate / Major / Day Case / LA
20%
80% 70%Podiatry
30%Surgery 70%
30%
Orthopaedics / Orthotics
Complex / In Patient / GA
3aOrthopaedic Triage Model
Minor / Intermediate / Major / Day Case / LAPODIATRIC / ORTHOPAEDIC SURGEON
20%
80% 70%Podiatry(56% Total)
30%Surgery(24% Total)
70%(17% Total)
30%(7.2% Total)
Orthopaedics / Orthotics
Complex / In Patient / GAORTHOPAEDIC / PODIATRIC SURGEON
Out PatientORTHOPAEDIC PODIATRIST
3aOrthopaedic Triage Model
4 Clinical Effectiveness
Manchester Oxford Foot Questionnaire (MOXFQ) (n = 117)
DIMENSION Pre-operative Score
Post-operative Score
Significance
Walking & Standing
54 14 p < 0.000
Foot Pain 54 18 p < 0.000
Social Interaction
47 10 p < 0.000
PRE AND POST OPERATIVE FOOT FUNCTION SCORES (Quantitative)
4 Clinical Effectiveness
PATIENT SATISFACTION (Qualitative)
How satisfied are you with your surgery?
PASCOM-10 (n = 117) 90%
How likely would you be to recommend your surgical experience to someone else?
PASCOM-10 (n = 117) 93%
5 Sequellae
The creation of Podiatric Surgery posts deliver the most advanced clinical roles available to AHPs in line with the National AHP Strategy “Building on Success” (2002)
Podiatric Surgery has been shown to deliver excellent outcomes in terms of patient satisfaction, post-surgical complications and clinical outcomes
AHP Consultants in Podiatric Surgery enable established surgical specialists to utilise their skills more appropriately whilst also delivering cost effective and clinically effective outcomes
Summary
1999 Appointment of new Podiatry Manager 2002 Creation of SAB in Scotland2003 Validation of MSc in Podiatric Surgery
First Business Case produced2005 £400k to redevelop Podiatry Day Theatre2006 £75k to establish Orthopaedic Podiatric
Triage in 1o care2007 Lobbying of MSP’s 2009 £110k to establish Podiatric Surgery 2010 Pilot Podiatric Surgery Pilot report
produced2011 Latest Business Case produced (14th!!)
“Ye cannae dae that!”
The story so far……..
Dermatology: • Harvesting of plantar keratoderma biopsies• Botox injections
Diabetes• Supplementary prescribing• Patient admission
Vascular• Triage of PVD patients
Rheumatology• Triage of foot referrals to orthopaedics
Other things “Ye cannae dae!”
The story so far……..
Overview of Structure
Business Case
Executive Summary
Benefits of Podiatric Surgery• Increased activity• Increased capacity• Increased productivity• Increased effectiveness
Costs of Podiatric Surgery
Overview of Structure
Business Case
1 Introduction
2 Description of Service
Capacity (How many sessions?)
Locus of delivery (Where and when in the system?) Volume and casemix (with justification)
Staffing & skill mix (with justification/ evidence of safety etc.)
Overview of Structure
Business Case
3 Costing options
Consultant and registrar staff costs onlySupport staff from existing nursing or podiatry service poolc. £160k
Consultant & registrar staff costs plus consumablesSupport staff from existing nursing or podiatry service poolc. £240k
Full marginal costingsc. £350k(Cost per case no more than £750 for anything up to Major)
Overview of Structure
Business Case
4 Job Plan
5 Links with other services (inc. referral management)
6 Anticipated outcomes (inc. Key Performance Measures)
7 Appendices(inc. surgical pathways showing
governance arrangements etc)
Podiatry on the brink… of what?
Thank You