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.
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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.
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