Nhs insoles??

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Hi everyone I currently work in a small community nhs dept doing what we call biomechanics! Every year we get budgets slashed and we have basically come down to spending approx 6k on OTC insoles - yet we are still asked to save cash as a dept. This usually means that the biomechanics service has to take the hit. We spend stupid amounts on disposeable instruments for palliative care and that is where most of the budget is used up. I have now been told that even though we issue OTC insoles and post etc ourselves ( a nice cheap option) the management is looking at only issuing one insole per pt in their life!!!! I have tried to argue that in a year a palliative pt may have 3 treatments using 3 sets of instruments to have their nails cut costing about the same as an insole which basically can change a persons life if they are in pain.

Has anyone else experience of this in their nhs trust or have any other bio pods been given such a policy. Would be good to also know what other trusts policies are regarding insoles

Thanks

Regards

Bartypb

 

Hi Barty,

Gosh sounds so like some NHS depts!

I have to say I have seen some patients come in with NHS ortics from all over the country. Some are so dire with stick on additions that they are actually giving patients the problem. Others use Talar made orthotics so you can see the range is huge.

Basically I think Pod is always the poor man/woman in the market place. they will spend thousands on Physio kit and as you say stupid amounts of disposable instruments yet can't let you have the basics. Bit like giving you one Moores disc per patient for life.

Come the revolution is all I can say and I feel for you and all others like you who are hampered in doing the job that you want to do well by total bureaucracy.

Good luck

Nick

 

Why not send the patients to private practice to pay for orthotics?

 

This is happening in the East of England. If they re over the shelf insoles I see no problem in this, especially as budgets are so tight. It's either a piece of moulded plastic for a patient that they can purchase or something more importnat that is slashed

 

Hi
In a NHS Service, not so far from Linda's, the MSk patients have been restricted to just those with a high risk medical condition + MSk problem. OTC and simple insoles are ordered [one pair per treatment round]. Casted orthoses are obtained through Surgical Appliances.
It's not perfect, and certainly the indirect consequence is that many needy / appropriate podiatry patients are either not assessed or are sent to orthopaedics [at many times the cost].
My team has collected great financial and capacity information, so if it was chosen to be invested in by the new GP Care Groups we can give a very accurate business plan. This would be the third cycle of 'boom and bust'. It seems that MSk is the Cinderella arm of the Cinderella Service.
However, have you tried partnership working with physios , child physios, rheumatology teams - who are or were very pleased with what we do when we overlap care? Sometimes persistantly lobying your manager with your great ideas pays off...
Good luck.
FF

 

I can see one advantage there. If it trains you to learn that biomechanics is more than orthoses it's a good thing!

One cannot make bricks without clay. But I believe that we often overemphasise the importance of what precise type of device we use over advice, exercises, physical therapies, appropriate referrals, lifestyle change, footwear etc.

Thus what you do is not "what they call" biomechanics, it IS biomechanics. You've had one small part of your array of treatment options curtailed. If that causes you that big a problem I think you need to broaden your approach.

Oh and get some catalogues. Prefabs are not dear and pts are often happy to pay if they need to.

 

Thanks everyone for the posts so far some valid points raised, I agree with you Anthony about the fact that insoles are not the be all and end all. We use a variety of treatments from education classes, strength and conditioning programmes to foot moilisation techniques, with and without insole therapy. My point is that there are patients out there that need and rely on insoles for their day to day life and mobility, and otc insoles have a shelf life. The area where I work is very diverse and some patients haven't got money to spend on insoles, we serve about 250000 population and an insole budget of 6K, so you can see that value for money our service is doing very well yet it is still going to get stripped at some point!

 

I fail to see how stripping £6k from your budget can help the overall savings to the NHS budget, which is billions. It is a case of yet again, NHS managers on massive salaries making decisions to shave coppers off the bottom which affect a few thousand pts, rather than strip away layers of expensive management tiers which only occasionally add to local patient care.

 

In my experience the biggest unnecessary cost in the nhs is the ceaseless re organisation, restructuring, consultations, affirmative action, cost saving program's, etc etc etc.

And yet through all of those, the same podiatrists treat the same patients in the same rooms. Everything changes... And yet nothing changes.

That and the centrally dictated lurches in whichever direction politics dictates we have to be seen to be acting. When the c diff thing broke, there was a huge drive for alcahol hand gel... Which does not kill c diff. But that is public and overt, whereas a few more cleaners would have more impact but less visibly.

 

Couldn't agree more, its frustrating as hell at times working in the NHS. We all know that with each restructuring, the management protect themselves by squeezzing themselves into jobs they have created for themselves, or by taking the redundancy and cropping up in another trust a few months later doing exactly the same job.:bang:

Im band 7, and have been told that to get a band 8, I have to undertake a management role. So there we have it, the NHS will only reward with a good salary, those who manage, not those who wish to earn better money for being a better Clinician.
Ask yourselves how many managers in the NHS have management qualifications

 

Hi Peter you sound as frustrated as every pod I know in the nhs, unfortunately I can't see things changing, there are band 8 physio' s with the title esp - however even when you compare job descriptions they are the same pretty much as mine and I to am band 7. We seem to be the bottom of the barrel and there lies the problem most nhs trust don't realise what we can offer and realistically how much money we can save with our intervention. I am becoming more and more disillusioned and am really considering my options for the first time in 14 yrs!!

 

Hi Barty

I'm less frustrated as we have an excellent budget for braces/FW adapts, OTC orthoses, custom devices, corticosteroid, can access MRI, X-ray, undertake in House US scans , access to bloods, orthotist etc...so am not in the same position as you. My own frustration is that the NHS will only give a good salary to management. Why can't I get better pay for the skills I have? Why do I have to drop some clinics and potentially lose some skills just so i can manage?

Cheers

 

Wow seems like clinically you have everything sorted, I have access to pretty much nothing! I can request xray and U/S but usually take ages to get back - I have to refer to Orthopaedics for an MRI which costs 2-3x what it would if I requested it as the Ortho has to see the Pt! We are trying to get FT status and I have been told to expect once this happens all T&C's will change including agenda for change and they will try and reduce everyones payband. So it may be different where you are but not sure what the future holds for podiatry well msk podiatry anyway! Still we must carry on the fight!!

cheers

 

I had to swim through some $h!t to get to this place, and even a Band 8 to work with what i had previous (roughly where you are) isn't worth the pay rise

 

I hear you maybe I'll have to PM you sometime to get some tips, I'll have to decide whether it is really worth it though!

barty

 

Hi Bartypb,

I manage the Orthotic Lab for Kent Community Health NHS Trust Podiatry and may be able to help you with your orthotic provision. If you want to discuss please call me on 01227 594750.

Kind regards

Jit

 

Hi jit that would be helpful as I am trying to gather information to just see how other trust are utilising their orthotic budget. can I ask are you a podiatrist, orthotist, physio?

Regards


Marc

 

Hi Bartypb

None of the above - I'm a Chemist by trade and was made redundant but current role was a good fit for me.

I fully appreciate your situation as we've been there but have managed to significantly reduce our costs and I would be very happy to help you in any way i can.

Kind regards

Jit

 

Sounds good thanks for that I'll be in touch

Marc

 

i think its the same in evry trust we all have savings to make but some service are asked to make more than reductions than others !!!!

one way to deal with this reduction is to start asking patients to buy the off the shelf insoles (slimflex simples) themselves and to bring them in for modification also insoles and wedging are now on nhs logisitcs (at least in our trust):wacko: