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NHS MSK Appointments

Discussion in 'United Kingdom' started by cambspodman, Feb 17, 2011.

  1. cambspodman

    cambspodman Member


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    Hi I work as an MSK for an NHS Trust and we are looking at the issue of assessment appointment times.

    My Questions are:

    1. How long do peaple give for an initial assessment appointment.
    2. Do you write detailed 1st contact letters to GPs or other referrers.
    3. Do you always review patients or do you offer a review with a time span.
    4. How long are patients kept on the "active list" or are they automatically discharged after a time period.

    All feedback appreciated.
     
  2. RobinP

    RobinP Well-Known Member

    cmabspodman

    I'm not actually an MSK podiatrist but i do a lot of NHS biomechanics/MSK work. Initial assessment appointments are 30 mins and I would love to write letters to the GPs / consultatnts but time is a major factor there. I review at 3/12 again due to appointment constrainst. Ideally 6/52 would be sufficient to be able to get a handle on how effective treatment would be. Patients are kept on the list for 2 years following supply but if they do not contact us within that time, they get discharged and will require rereferral if they want further orthoses(this is surprisingly common - people think that they are doing the correct thing by not coming back and "hassling us" but the powers that be dictate that using your orthoses and taking care of them is punishable by having to go back through the triaging system - go figure) I understand why they do it. There has to be some arbitrary cut off point otherwise the caseload would become ridiculous.

    Privately, I give an hour for biomech assessment. Letters go to GP/referrer and to the patient. Follow ups at 6 weeks. Wish it was that way in the hospital.

    Hope this helps

    Robin
     
  3. Paul_UK

    Paul_UK Active Member

    We give 60 minutes for initial appointment and assessment and depending who refers the patient in we send out a "pre-written" letter to GP's etc saying thanks for referral and what was done etc.
    Patients will be seen 6-8 weeks after initial assessment and are kept on the waiting list for 2 years where, like Robins trust, if they do not contact us they are discharged and will need re-referral for another appointment.
     
  4. fatboy

    fatboy Active Member

    I only work in NHS

    1 All assessments and/or reviews are 30 mins, does away with clerical 'errors' (8 pts in the morning and 7 in the afternoon)
    2 Only if specifically requested or if I want the GP to do something
    3 Varies on the person from 2-3/12 to 6-9/12 or contact if you want us
    4 Pts are advised to return within 12/12 and will be discharged after 18/12 if no contact though it's more ike 24/12 as it can be time consuming so it's done once a year

    hope it helps
     
  5. Sally Smillie

    Sally Smillie Active Member

    Must preface that I am F/T paeds, and 90% of that is MSK.
    1. Initial apt's: 45 minutes. 90 min for Autistic or known complex behavioural problems
    2. Detailed letters: yes. cc to all involved. If I don't have time to do these on initial apt's, I will do at some time until condition resolved
    3. I review all patients with pain or pathology at 4-6/52 intervals. 2/52 if trialling a temporary device.
    4. Pt are active until condition resolved, usually 2-3 appointments. 'Worried wells' we discharge with advice and a letter to referrer (and info sheet). Pt can self-refer for a returning condition. If no contact for 2 years, we discharge automatically

    Hope that helps
     
  6. podtiger

    podtiger Active Member

    I think there should be 45 minutes to an hour for initial msk appointments. Sadly there is usually only 30 minutes. There is always so much pressure in relation to the waiting list that youre constantly cribbing on your own time and quality falls away, perhaps more so from junior staff who really need time to develop.
    Letters are usually written over lunch time if you have access to a computer. If you see 4 new patients throughout the day. It's almost impossible to write a really detailed letter. Admin time needs to be made to help with this.
    Discharges need to be pursued aggressively to help with the waiting list. Otherwise they keep coming back.
     
  7. davidh

    davidh Podiatry Arena Veteran

    I work solely in Private Practice, doing mostly biomech work.

    Pretty much all my new patients are GP or Consultant referral by letter.
    30 minute 1st appointment. A detailed letter goes out to the referrer in every case.
    30 minute 2nd appointment if I want to collect gait data and cast.

    Why do you need more than 30 minutes for an initial consultation (apart from some paeds and special cases)?

    What does your initial consultation consist of?
     
  8. RobinP

    RobinP Well-Known Member

    I do everything in my first appointment that you do in your 1st and 2nd.

    I must confess though, to spending the majority of the time explaining to patients what their problems are and how we are going to proceed. I also talk about device limitations and what the next step will be in the event that conservative management is unsuccessful.

    I'm probably very much in the minority here but I do explain the biomechanics of forces etc and am constantly surprised at how much my patients understand (or seem to have a basic grasp). Seems to help with tolerance of devices if they can understand why that hard bit of plastic is the way it is.

    Robin
     
  9. davidh

    davidh Podiatry Arena Veteran

    Wait - you do all that (which must include a diagnosis) and collect gait data and cast in 30 minutes:rolleyes:?

    Have I misunderstood?
     
  10. davidh

    davidh Podiatry Arena Veteran

    Robin, I see you are an Orthotist so presumably you don't need to diagnose before treatment?

    30 minutes is still very fast if you are collecting objective data and casting with POP.
    I appreciate that foam memory boxes are much faster, and you may use these?
     
  11. RobinP

    RobinP Well-Known Member

    Yes

    I was referring to my private work


    Why would you presume that?
     
  12. JB1973

    JB1973 Active Member

    My Questions are:1. How long do peaple give for an initial assessment appointment. 2. Do you write detailed 1st contact letters to GPs or other referrers. 3. Do you always review patients or do you offer a review with a time span. 4. How long are patients kept on the "active list" or are they automatically discharged after a time period.
    Hiya
    1- I give an Hour for initial assesment. Paperwork probably takes up 15 of this.
    2- mostly i only write back to the GP if the GP has directly referred them. I think this is only polite. I would like to do this for every patient but time is sometinmes against us.
    3- i review if i need to review. If i do, its around 6 weeks but it all depends on what i find.
    4- Our protocol is that if they are not specifically discharged, they remain on 'the books' for 1 year and then discharged. i would like that to be shorter but i dont make the rules!
    cheers
    JB
     
  13. davidh

    davidh Podiatry Arena Veteran

    Do Orthotists diagnose?
     
  14. RobinP

    RobinP Well-Known Member

    I do

    RP
     
  15. tompayne

    tompayne Member

    Hi,
    I work solely in the NHS doing biomechanics.
    Initial assessment: 45 minutes for new patients, 30 minutes for podopaediatric patients.
    All referrers get a letter detailing the consultation with a copy going to the patient. In our department we have one morning and one afternoon a week for non-clinical activities and letters are dictated then (or written by the clinician if urgent).
    Re reviewing patients it depends. Sub-acute and severe problems may be reviewed fairly soon (a few weeks) and an appointment booked at the initial consultation. With less severe problems the patient may be asked to contact us as required if symptoms fail to respond as expected.
    Very recently our policy has changed with regard to discharging patients. If we don't book a follow-up appointment the patient is discharged but records remain on the computer system to be accessed if the patient contacts directly again (up to a year or so), even if that be after two weeks. If a patient hasn't been in contact for, say, a couple of years they are considered a 'lapsed' patient and we require a new referral from a health professional.

    Tom
     
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