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Can the NHS and MDFTs Better Support Private Practitioners who Treat and Refer High Risk Patients?

Discussion in 'Diabetic Foot & Wound Management' started by Jonix, Feb 14, 2013.

  1. Jonix

    Jonix Active Member

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    Because of a number of situations in my clinic, I recently posted a thread titled High Risk Foot and Ulcer Care in Private Practice, asking for opinions as to the ethics of private practitioners seeing, or refusing to see, very high risk patients in our clinics. Hoping that there can be dialogue with our NHS colleagues involved with specialist high-risk work especially those on the MDFTs, I have re-worded it, as it was mainly other PPs who responded to my earlier thread.

    Though I have done some long-ish periods in MDFTs, when I left the NHS, I did not really anticipate a substantial proportion of my patients in PP to be at-risk. I have been including diabetes CPD for about 7 years and it has also been necessary to refresh my my wound assessment skills for rapid access to the A&E when patients book nail care but incidentally happen to have a wound I can probe to bone.

    But I didn't really anticipate an increasing number of patients requiring ongoing high-risk care.

    It kind of creeps up though, and the following situations highlight the problems PPs face if they do decide to accept very high-risk patients. (For various reasons, not all do.)

    Last week, three new patients came seeking a private practitioner to take on their long-term foot care and one came for a second opinion. Between them they have histories that include combinations of OM, amputation, immunosurpressant drugs after an organ transplant, heart and vascular disease, long term but healed foot ulceration, recent foot ulceration, and diabetes.

    In the same week, a long standing patient of mine who had presented with an infected foot ulcer which I deemed required rapid access into the MDFT. The NHS department I tried to get her to see has had a huge chunk cut from their budget and rapid access was not at all easy to arrange. The patient had been discharged from the service some time ago, and there was no facility for a private practitioner to refer her back in.

    So. My question to you is.. When then these patients develop acute problems, what is their status as regards rapid access to the MDFT? Is it equal with NHS patients, because NICE guidelines don't differentiate.

    If you agree that it should be equal, how best can I rapidly refer them?

    Finally, how best can I review my own practice here so that there can be better information exchange, and more seamless continuity, for my patients when they do need to move into the MDFT - and hopefully back out of it again?

    Many thanks in advance for your thoughts and opinions. They are all welcome.
  2. davidh

    davidh Podiatry Arena Veteran

    Good post Jo,

    I don't have any answers other than I suspect the problems vary from district to district and would need to be dealt with at a local level.

    It may be worth exploring AQP?
  3. fishpod

    fishpod Well-Known Member

    david what use would exploring aqp be. THe specification for all the midlands thats derby staffs notts leicster etc specifically excludes all high risk diabetic treatments. other areas may be different AQP is just a different care pathway for some specific pod patients. not usually for high risk diabetics this is left to higher tier podiatry ie the nhs trusts, most aqp contracts are for core podiatry/ and or nail ops.
  4. Yes as it should be - but terms and conditions apply. Remember they are guidelines and PCTs are not bound by law to abide by them - it may be the goal of clinicians and the organisation - but service capacity will clearly impact on factors that contribute to meeting the needs of all patients. With all the referrals to the HCPC by NHS trusts recently for the basic misdemeanors like not responding adequately in time to patients requests for appointments,I wonder just when we will see a clinician in a MDFT being hauled up for not adhering to NICE guidelines on dressing frequency. The CQC may criticise the organisation, but it is the individual clinician who appears more at risk from organisational failure!
  5. davidh

    davidh Podiatry Arena Veteran

    Where does it say the OP is from the Midlands?

    I am aware that different localities have different AQP needs, and just said it may be worth exploring. AQP will certainly open up referral pathways into the OP clinic - the pathways may be of use for traffic from the clinic too.

    Mark is correct. Guidelines mean very little in clinical negligence or alleged clinical negligence cases, and the individual practitioner usually carries the can.
  6. Jonix

    Jonix Active Member

    London is where I am

    I wasn't thinking of going AQP! Well not hopefully not. It sounds like you both think that the NHS doesn't provide much protection against litigation even for clinicians..

    David, whilst there are these cuts, do you think it possible for NHS and private practice to be a bit more mutually cooperative as regards patients moving between the two?

    Just in the fact that a number of my patients would do better for being able to do that at the moment, and looking at how many diabetics I have on my books, this number might be increasing

  7. davidh

    davidh Podiatry Arena Veteran

    Hi Jo,

    There is nothing to stop you going to see your local NHS Managers and explaining what you want/need as regards some of your high-risk patients.

    In practice the outcomes are likely to be varied, but you may find one who is willing to put you in touch with someone further up the chain who can help.

    I still think AQP is worth exploring, even if only to check the patient categories which are eligible for treatment.

    Mark is far more experienced than I at the current ins and outs of day-to-day NHS work, and I would hope he will comment further.


  8. fishpod

    fishpod Well-Known Member

    Just as a matter of information. All aqp contacts must be signed by the end of march. This is a dept of health announcement. They last for 3 years and all offers have been closed for the last 6 months . So in conclusion unless you have qualified stage 1 and 2 aqp is off the table for at least 1 year until new offers come onto supply 2 health web site hope this info is usefull.you will need an NHS smart card choose and book capability a data protection number and. An enhanced crb check which you cannot get without the help of another agency ie a locum agency you cannot pay for one on yourself.
  9. davidh

    davidh Podiatry Arena Veteran

    Couldn't be clearer - thanks:D.
  10. Jvm620

    Jvm620 Member

    I have had similar problems referring high risk patients back in to the local NHS service, it took 1 month to get a patient seen by a vasc team after presenting with gangrene & infection in both feet - he only lost toes but was lucky not to lose a limb! After this i discovered that the best way to access emergency treatment is to refer the pt to A&E at a hosp where there is a vascular team- the local podiatry dept did not have fastrack access. I have also asked the local NHS Podiatry team for a fax number to refer urgent (non emergency) patients & so far that has worked well i.e. pts are seen within a week.

    I agree though that there should be better/clearer communication pathways between NHS & PP rather than everyone negotiating their own local system.
  11. Jonix

    Jonix Active Member

    Agree with all three points you have made. Especially about pathways being clearer rather than locally negotiated. It is the ulcers without gangrene or frank infection that provide the dilemma. At this point I would first have to ask my local NHS for a favour, but if that doesn't work I'd then use a sledgehammer. (However, I have now written and started the ball rolling)

    It is actually way easier to deal with when the patient turns up with something that you can send to A&E !

    I recently discovered that drop-in centres can be absolutely excellent, though I suspect this is variable.

    Slightly off the topic of the NHS.. There is also the thing about patient education and old fashioned self help. Two of my recent patients who can anticipate long term dressings, actually expect to have to do these themselves or with relatives, and are happy to do so for a simple dressing change.

    They both agreed fortnightly visits with a direct contact number. And indeed, they have both contacted me with non-urgent concerns. (Not so good for my stocking and glove neuropath with visual impairment!)

    So I feel this that whilst this is a step back to a different era, in some ways it is perhaps not so bad. It engages the patient in their own care, but they feel supported. A little how I would hope the NHS would support me, infact!!
  12. Jonix

    Jonix Active Member

    Phew. That's me off the hook till the next round... Admin not being my greatest love!!

    However the information you put there is excellent. Thank you.
  13. fishpod

    fishpod Well-Known Member

    glad to be of use jo, if you dont like admin like me aqp is a nightmare i have 2 contracts you will have to come to love it. you will have endless paperwork to qualify and loads of meetings with local ccgs. the list of policies they want in place is enough to make you want to end it all.if youre thinking about it do some of the donkey work now. my wife is considering being a paid mentor for pods who want to apply as she organised much of my application it took about a months worth of effort. regards fishpod.
  14. Jonix

    Jonix Active Member

    You aren't selling this Fishpod!!

    No, I wasn't thinking of AQP, it was an idea that came up on this thread. After reading your replies, I am more knowledgable as to WHY I won't be doing AQP, though... I'd have to get married!! Seriously!

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