1 / 32

9 th March 2011 Podiatry Managers’ Training Event Northampton Park Inn

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.

diella
Download Presentation

9 th March 2011 Podiatry Managers’ Training Event Northampton Park Inn

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 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

  2. The History Podiatric Surgery in UK • Late 1970’s early 1980’s (Podiatry and LA) • Day Surgery theatres in Primary Care • King’s Fund Audit 1997 • 150 podiatrists involved in podiatric surgery 42 consultants in podiatric surgery (1550+ orthopaedic surgeons – 60+ foot surgery as main sub-specialty)

  3. The story so far…. 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

  4. The story so far…. 2002 Memorandum of Agreement • Collaboration between RCS Edinburgh RCPS Glasgow Society of Chiropodists & Podiatrists Glasgow Caledonian University & Queen Margaret University

  5. The story so far…. PODIATRIC SURGERY SERVICES • offering a whole system solution to national Orthopaedic redesign projects • providing a Scottish Podiatric Surgery service fully integrated with Orthopaedic surgery • delivering joint clinical training to Podiatric & Orthopaedic surgery trainees in Scotland

  6. The story so far…. 2003: 1st BUSINESS CASE PRODUCED “Ye cannae dae that!” • No recovery area • No evidence that podiatry contributes positively to Orthopaedics • Podiatric Surgery can’t work in partnership with Orthopaedic Surgery

  7. The Funding Challenges 2005 Business Case to redevelop theatre • £400k from CCI in 2005 to re-develop day theatre in department of podiatry, Southern General Hospital, South Glasgow

  8. The story so far…. 2006 Business Case to establish Orthopaedic Triage “Ye cannae dae that!” • No evidence that podiatry keeps patients off Orthopaedic waiting lists

  9. The Funding Challenges 2006 Business Case to establish triage • £76k from CCI in 2006 to develop primary care foot and ankle triage posts IN PARTNERSHIP WITH ORTHOPAEDICS

  10. The story so far…. 2006 Business Case to establish Podiatric Surgery “Ye cannae dae that!” • No evidence that podiatric surgery will work in Scotland (since we are different from England!)

  11. 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

  12. 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

  13. 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

  14. The Team • William Money Allied Health Consultant in Podiatric Surgery • Primary & Secondary Care Podiatrist • University links • Direct links with orthopaedics

  15. The Outcomes Capacity & Productivity Activity & Casemix Referral Sources Clinical Effectiveness Sequellae

  16. 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%.

  17. 2 Activity & Casemix

  18. 3 Referral Sources

  19. 3a Orthopaedic Triage Model 30% Complex / In Patient / GA 30% Surgery 70% Minor / Intermediate / Major / Day Case / LA 80% 70% Podiatry 20% Orthopaedics / Orthotics

  20. 3a Orthopaedic Triage Model 30% (7.2% Total) Complex / In Patient / GA ORTHOPAEDIC / PODIATRIC SURGEON 30% Surgery (24% Total) 70% (17% Total) Minor / Intermediate / Major / Day Case / LA PODIATRIC / ORTHOPAEDIC SURGEON 80% 70% Podiatry (56% Total) Out Patient ORTHOPAEDIC PODIATRIST 20% Orthopaedics / Orthotics

  21. 3a Orthopaedic Triage Model

  22. 4 Clinical Effectiveness PRE AND POST OPERATIVE FOOT FUNCTION SCORES (Quantitative) Manchester Oxford Foot Questionnaire (MOXFQ) (n = 117)

  23. 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%

  24. 5 Sequellae

  25. Summary 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

  26. The story so far…….. • 1999 Appointment of new Podiatry Manager • Creation of SAB in Scotland • Validation of MSc in Podiatric Surgery • First Business Case produced • 2005 £400k to redevelop Podiatry Day Theatre • £75k to establish Orthopaedic Podiatric Triage in 1o care • Lobbying of MSP’s • £110k to establish Podiatric Surgery • Pilot Podiatric Surgery Pilot report produced • 2011 Latest Business Case produced (14th!!) “Ye cannae dae that!”

  27. The story so far…….. Other things “Ye cannae dae!” • 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

  28. Business Case Overview of Structure • Executive Summary • Benefits of Podiatric Surgery • Increased activity • Increased capacity • Increased productivity • Increased effectiveness • Costs of Podiatric Surgery

  29. Business Case Overview of Structure 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.)

  30. Business Case Overview of Structure 3 Costing options Consultant and registrar staff costs only Support staff from existing nursing or podiatry service pool c. £160k Consultant & registrar staff costs plus consumables Support staff from existing nursing or podiatry service pool c. £240k Full marginal costings c. £350k (Cost per case no more than £750 for anything up to Major)

  31. Business Case Overview of Structure 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)

  32. Podiatry on the brink… of what? Thank You

More Related