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NHS Podiatry Provision in Care Homes

Discussion in 'United Kingdom' started by Suhail, Apr 30, 2014.

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  1. Suhail

    Suhail Member


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    Setting the scene...

    There are 40+ care homes (encompassing Nursing, Dementia & Residential Care) in the area that the department operates in, of which half are served by the NHS on a regular basis. Currently the team visiting these comprises of three podiatrists, who have up to 8 clinical session between them each week dedicated for care homes.

    Due to the high demand, and limited resources, these homes are visited on a rotational basis for routine podiatry. However, at the same time we also undertake visits for 'urgent' requests and monitoring patients who have previously ulcerated, and remain at an increased or high risk of ulceration, as deemed clinically appropriate.

    We ensure we have an updated list of residents (new, moved, deceased etc) prior to visiting so that all the appropriate paperwork can be made up for their records, and also requesting medication lists for new patients. All this is done about a week in advance, providing the home with sufficient notice, with a courtesy call on the morning we visit. As most homes are unable to accommodate us before 10:00/10:30 due to breakfast and medication rounds, we usually deal with and urgent requests for visits or reviewing high risk patients.

    We then normally visit in pairs, usually met with a look of huge disappointment and inconvenience by the care staff, and told that they "Don't do feet!" but i digress.

    The issues we face are as below:

    1] The interval between routine visits is long (and gradually beginning to increase)
    2] There is a lack of carers willing to provide simple foot care for low risk residents
    3] There seems to be a fundamental breakdown in cooperation with ourselves in a majority of the homes. We are seen as a nuisance and have less importance than the hair dresser (I've witnessed first hand how the same carers be helpful and use their initiative)

    There are a few homes, with challenging patients, that demonstrate the system we operate has the potential to be successful. This i belive is only possible because the staff are extremely organised, accommodating and helpful. Usually one joint session is sufficient to have seen all the residents.

    What I am hoping for is for you lovely people of PA to share your local practices so that we can model/pilot an improved service where we are able to provide more regular/equal care for the residents in a care setting.

    We have considered offering foot care training to carers to manage low risk patients, but there is little interest and a huge turnover of staff in many of the homes.

    I should also note that the area in question is in the top ten for socioeconomic deprivation. Very few have the means to, or wish to pay for private podiatry. In addition to this the are nearly tops the tables for almost every risk status.

    - What are your local practices?
    - What works for you?
    - What approach have you tried that wasn't successful?
    - What advice would you give to our team - where are we going wrong?

    Often the answers are out there, but much to my annoyance it seems the NHS is set on re-inventing the wheel at all times. The lack of information sharing is diabolical.

    Your help, advice, insights, well whatever you can offer really will be much appreciated.

    I look forward to you responses, thanks in advance.
     
  2. M.C.

    M.C. Member

    Suhail ,

    ...... It's interesting that the residents and carers seem to regard the hairdresser more highly than their Podiatrist.....
    They have their hair done but cannot afford / wish to pay to have their feet done .
    Have you thought of contacting a local private practice that would be prepared to charge a cheaper , Block booking or sessional fee , and putting that proposal to the residents ?...... Surely this must be a better way to go than 'Training' the carers to carry out footcare on ''Low Risk ??'' , (Not many of those in Nursing homes), residents .
     
  3. Nads

    Nads Member

    In the department I work we provide (at a set charge) a foot care training programme for community nursing staff, volunteers (en age uk), and staff at assisted living homes and nursing and care homes. Then they can tackle the low risk basic nail care leaving the high risk patients to our team.
    This means that our time is better used.
     
  4. David Smith

    David Smith Well-Known Member

    Suhail


    What's the problem?

    Before you can design a solution you need to identify the problem, do you see that it your OP. I do see that you have too much work and not enough resources.

    What does 3 podiatrists with 8 clinical seesions look like in real time and number of patients seen, how does the marry with the number of patients needing weekly care. If you dont have enough pods to go round then then all the tweaking of time, form filling and reorganising the care home's staff won't fix it

    Is it that your doing the NHS thing whereby clints have to fit in with what the limited service the NHS offers instead of the NHS giving the service the client wants, when they want it, how they want it and so the client becomes a nuisance when they wont comply with instructions that suit the convenience of the NHS?

    Is it that you dont have he resources to fulfill the kind of service you would like to give and then get stressed out by the inevitable shortcomings?

    As a private practise we dont attempt to do half a job that we dont have time for and then get stressed at the half we cant do.

    In private practise when we have more business we employ more staff to do it or work longer hours or put up prices, we dont spread ourselves thinner, give the client less for their money and expect them to suck it up and be grateful and we don't tell our staff to do more for less because that just gets demotivated people. If the client can't or won't afford it then we don't do the work and we don't get stressed about it, although sometimes we do free treatments when someone's hard up and needs care.

    I realise that you may have an obligation to supply a service to the clients you mention and so you try to do what you can with what you have with the inevitable frustating outcomes. I don't know how you can adapt the private model to make the NHS model work better when you're not in control of your resources.

    dont know if this is helpful or if I just havent understyood your problem


    Regards Dave
     
  5. Lizzy1so

    Lizzy1so Active Member

    Hi
    I work in as a Dom Pod (NHS) we do very little work in care homes or nursing homes and even less nail care. Most of my Dom case load is high risk patients with wounds or at risk of developing wounds. In order to be eligible for a home visit patients must not leave their home for any reason, a home visit is not a choice. This might seem tough but with our increasingly aging and ill population we have to utilise our scant resources to the best of our ability. Have you thought of income generating for your trust by providing a nail care service (paying) yourselves? PM me your email address if you want to have a chat.
    Regards
    L
     
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