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I just wondered if other podiatrists are also finding that home visits are getting more complicated . I am finding that I am seeing more patients in their late 80's and 90's
still living at home requiring home visits with much more complicated health problems. I am finding that I am getting more high risk patients that are more prone to ulceration. I am finding that when I do have problems with ulcerations and require dressing support I am getting less support from overloaded local district nursing teams. I am finding treatments are taking longer and I am the one that is ending up doing the dressings!

 

Yes, because the NHS keeps discharging more and more into the community.

This is privatisation by the back door.

 

Sadly, it's inevitable that with an aging population increasing pathology and polypharmacy will become, almost, the norm. However, look at it from a positive point of view, increased time = increased income; increased dressings = increased income.

All the best

Bill Liggins

 

Yes, home visit patients are becoming more complicated. As a Registered Nurse my Practice was set up 27 years ago to service this exact population, and has done so very successfully ever since. I think its great that elderly and disabled people can stay in their own home as long as they can, because that is what they want. Life in a Rest Home is not appealing for many.

These clients do not have endless money, so doing dressings for more money is not best practice. I liaise directly with Public Health and Practice Nurses, as part of my Collaborative Practice commitment, and find dressings are done satisfactorily.

Another plus is that these nurses, plus Carers, plus organizations like Diabetes Center and Aged Concern, refer people to me so their needs can be met.

Podiatrists could work more closely with Registered Nurses in a Collaborative way, to the benefit of all concerned. I refer clients to Podiatrists for care such as wedge resection, they refer to me for home visits. Defending ones patch is not the focus: best care for the patient is the focus.

 

I am a private practitioner and I have been visiting a patient with severe oedema and vascular insufficiency , as a result she presents with longstanding ulceration on her legs which the district nurse treats, and subungal ulceration which I have been treating on a weekly basis .Call me daft but I do feel I have a duty of care to her as a regular patient of mine and I have not been charging her for the redressings just for her routine treatments every 6wks or so , ( she is a pensioner on limited resources after all )Try as I may, but the district nurses were not interested in her feet at all and most of their visits they did not check her dressings and if they did they just said everything was fine when they weren't.
I'm glad to say since then this lady has had undergone angioplasty and her foot problems have improved dramatically .

 

Having discovered an interest in woundcare when I was a student, I went down the NHS career path where I could suggest review appts for wounds without the patient's (or indeed my own) financial status being a consideration.

Ydr, although I can understand your motive in doing the redressings for free, you weren't really helping your patient - it was the person who organised the vascular consult which led to the angioplasty that has really (as you admit yourself) made the difference in this case. Unless it is for a well-defined charitable event, working for free will push your business down the tubes and you to 'burn-out'.

Lottie, you don't say whether you work for the NHS or in private practice. It's frustrating when you can't get the support you need - there's only so much one person can do.
The health care system functions a bit differently in Scotland where I work, and as in everything in life, examples of good and not -so -good practice can be found. My clinic is in a community hospital and for my domiciliary caseload I liaise with the community nursing team here very productively and they include foot dressings as part of their normal caseload. We do joint visits and/ or discuss further care of high risk patients, I do any sharp debridement required and can refer on eg to orthotics, vascular, diabetes team etc etc as required.
Occasionally they will also help out with home dressings for my nail surgery patients who can neither cannot do it themselves nor manage up to the practice nurse to have it done - eg patients with severe mobility issues or dementia.

We are all, of course extremely busy, but personally I would be much more worried ,as a publicly funded service, if we weren't, ! The NHS is a huge target and hence very easy to criticize. With an aging population(own goal?) and an ever-increasing opportunity to incorporate improved drugs, equipment and procedures within a limited budget, it will inevitably never please everyone. We hope for strong leadership and robust processes, but the very fact that the deliverers of the service are human - kind, empathic, caring, helpful - also can mean they are fallible - impatient, uninformed, unwell, preoccupied, overburdened.

My own experience, as an employee (and of course as a user) for over 20 years has been a positive one overall and and we concern ourselves with trying to find solutions to the many and varied problems that come our way from whatever direction!

 

I must ask how does one earn more money by spending more time with a patient exactly, please feel free to inbox me

 

Your fees must reflect the time that you spend with your patient; hence > time > the fee.

Bill Liggins