Clinical Groupings for Patient Care

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Is anyone using 'clinical groupings' to identify the appropriateness of those seeking access to their podiatry services? And are you then using care pathways associated with these groupings? Any chance you may 'care to share' on this? Would be most grateful!

 

Clinical Groupings?

Hi Lena,

I am very interested in the term:- "Clinical Groupings?" Admin. has mentioned in his amendment of your post that those outside the UK. would not be familiar with this term. This one in the UK is also guessing at what the term means, not working in the NHS.! Sounds interesting, would you care to give it's definition? Also, Care Pathways?

Could this be part of the new PCT's. by any chance?

Regards,

Colin.

PS. Ask the daft question and hopefully get the d**t answer!

 

Hi Colin,
The theory is that we place patients into groups e.g high risk, medium risk, low risk etc in order to prioritise treatment (or none at all) and then develop standards of care associated with these groupings. E.g. A patient with severe rheumatoid arthritis might be considered as high risk due to the presence of intrinsic foot pathology, tissue breakdown etc, standards of care might relate to the provision of footwear, vascular assessment,regular podiatry treatment. Low risk might constitute the diabetic with no foot pathology or complications of the condition. No risk might indicate no foot pathology or underlying medical condition that requires podiatric intervention, these patients may require basic or social nail care. I presume that using care pathways will be a way of standardising clinical care but are by no means set in stone as they will vary from patient to patient.
This is my understanding! I'm looking for different takes on the issues.
Lena

 

re groupings

Here in my PCT we are trying to formally introduce NICE 2 guidelines for diabetes and the management of the diabetic foot.

Had a meeting with a group comprising
me Pod
The manager of AHP's
GP
Practice Nurse
IT manager
Modernisation manager

So conclusion of trying to follow the 4 classifications of nice

1 Low Risk
2 Increased Risk
3 Pathology and Risk
4 Ulceration

So as we see it :

Newly dignosed Diabetic

1 Practice Nurse does the annual foot check. We provide a one off health education session.

2 Practice nurse does 6-12 monthly foot check. We provide one off health education session.

3 We do 3-6 monthly foot health check, provide health education session, provide necessary treatment.

4 We do 3-6 monthly foot check, provide health education session, provide necessary treatment including wound care up until such point as Specialist intervention from Acute Hospital.

Could the Nurse get off the subject of her nice grannies getting their nails cut? NO She bloody well couldnt.

The Gp suggested it would be nice to have one of my colleagues come into his surgery for a couple of hours a week to t/t his pts.

So in conclusion not a very successful afternoon.

I was naive enough to think that vested interest was not going to be an issue.

Wooooopppppsssssss wrong again.

Our diabetic assessment form was criticised for being too comprehensive and it would not fit the current GP computer system.

I replied we will use it you take out what you want and adapt for your use.

I thought this simple piece of logic was a great idea

wrong again.

So it seems that this process may be scuttled on day one.

oh well we tried.

regards David

 

"Could the Nurse get off the subject of her nice grannies getting their nails cut? NO She bloody well couldnt."

He he , obviously the same for you over the border! What i find amazing is that the PCT's, LHB's all want reductions in waiting times/ lists etc and provision of services towards medical needs and yet at the end of these meetings they STILL want someone cutting toenails of that very vocal patient group!!!!

 

PS. Added!

Now Lena, David,

You didn't think you were going to get away with it that easy? The Nurses Grannies are bloody well bigger than all of us, you know!!!

Regards,

Colin.

PS. Besides I was always taught to look up to and listen to my Grannies! It was considered risks on several counts not to do so! It all depended on you and how you were on ducking?

 

Hi David,

My perception of the NHS generally, as it affects podiatry, and at "coal-face" level, is that (broadly) medics and Consultants call the shots. In Primary Care GPs certainly call the shots.

So, no matter what guidelines are issued, and by whom, the GP will tell you what he or she wants (but probably not have the funding to pay for it).

Forms are easily altered, as you rightly say - but altering forms probably wasn't on the agenda.............

One of the reasons I came out of the NHS, never to return, was the "wasted afternoons"!


Regards,
Davidh

 

Meanwhile, if the meeting lasted about an hour, about 120 people somewhere in the world lost a log to diabetes......

 

Hi John

didn't know there were that many lumberjacks with diabetes John ????

Cheers fella

Derek

 

AAArgh- it should be leg?!! ))
That'll teach me to check 'em before I post 'em

 

Hi John

I'm used to your spelling !!

I just thought I would highlight it for the wider community.

That's what friends are for are they not ??

Cheers fella

Derek

 

Thank you John and Derek,

I'm no good at crosswords, you know!

Cheers,

Colin.