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Forwarding diabetic foot screens to G.P.s

Discussion in 'Diabetic Foot & Wound Management' started by clod, May 23, 2011.

  1. clod

    clod Active Member


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    Hi all,
    Im just looking for a bit of advice from the private practioners.
    I set up a mobile round a few months ago (after many months of tryin for NHS job - not an excuse!) and today I was asked to send on a copy of a diabetic foot screen to a patients G.P from the patients diabetic nurse. This was not a problem (have done) but got me thinkin - should I be forwarding on copies of all my diabetic patients foot screens to their G.P.s or just when I'm asked to do so?? This might seem like a silly question but I just want to make sure I'm doing everything by the book. When training (I qualified last year) all referralls etc were taken care of by NHS clinic so am a bit in the dark. I do feel a bit 'out of the loop' sometimes (workin on my own), I was under the impression that diabetic foot screens are a tool for us to assess whether the patients risk has increased and then refer back to G.P or diabetic foot team. Am i wrong? please advise, thanks.
     
  2. tracyd123

    tracyd123 Member

    Hi

    I'm in Australia but here we ask for the client's permission then forward a foot screening letter to the GP/endo as appropriate.

    It is helpful for the GP to follow up that their clients are seeing a podiatrist regularly and having their feet screened. Which hopefully the GPs are doing!

    Also it is also a great way to establish rapport with your local GPs.

    Hope this helps

    Tracy
     
  3. kitos

    kitos Active Member

    Hi,

    I always pass copies to the GP as a matter of course. Most patients where I am don't get to see a NHS Pod and the tests done by the nurses are woefully short of what I do... so the GP or more often the diabetic nurses can see that a full evaluation has been done and the results. Plus it allows you to pick up tachcardia or arrythmias and send a quick note to the GP on the bottom of the assessment.

    Hope that helps.
    Best wishes

    Nick
     
  4. clod

    clod Active Member

    aaaah thanks kitos and tracyd123, I'll get on with that. I have around 15 diabetic patients up to now and all low risk - just generally want nails cutting at home for convenience (mostly out of hours so they dont have to book time off work), a couple use me inbetween NHS appointments because of the waiting times for appointments but I'll forward these on too anyhow. Thanks again.
     
  5. blinda

    blinda MVP

    Hi Clod,

    It is good practice to send a copy of the diabetic assessment to the GP or diabetic nurse, BUT you do have to obtain each patients consent before doing so. Otherwise you will be in breach of patient confidentiality. Indeed, you are required to obtain such consent before discussing anything with any other health professional.

    I undertake the annual diabetic assessments for a couple of GP surgeries here, something which any private practitioner could offer. Keeps you `in the loop` and creates useful pathways into the NHS.

    Cheers,
    Bel
     
  6. clod

    clod Active Member

    Thanks belinda, will obtain consent with patients when they rebook, then forward screens on. Makes sense really! Will also pass info on to a few fellow grads who are also doing mobile rounds. Thanks again.
     
  7. heathpod

    heathpod Welcome New Poster

    Hi Clod!

    The G.P.'s actually get paid by the NHS to perform an annual foot screen as part of their yearly 'MOT' of their diabetic pts. You are under no obligation to forward your information to them, but sometimes the G.P's and nurses will ask you for your findings, so that they don't have to do it themselves.

    Whether you give them the info depends how nice you are, and how many referrals from them you expect to get!! However, if you are referring a patient to them (or anyone else), you would be expected to provide the info as part of the referral.

    I hope that helps!
    Heather
     
  8. clod

    clod Active Member

    aaah the plot thickens.
    Thanks Heather, very interesting. Basics i don't remember being discussed at Uni? I guess its stuff you pick up along the way. (with a little help :D)
    Although some extra referrals fron the G.P.s would be very welcome!
     
  9. W J Liggins

    W J Liggins Well-Known Member

    Hi Clod

    Heather makes a good point here. When you forward the info., do make sure that it is addressed to the GP and not the nurse. That way you may pick up more patients and anyway, you establish good communications at the right level.

    All the best

    Bill
     
  10. kitos

    kitos Active Member

    Hi Clod again,

    Don't forget when you do send it on attach a Compliments slip with all your details on so they know who it comes from !

    Nick
     
  11. clod

    clod Active Member

    Hi Nick!
    I attached a cover letter to the screen i was asked to forward on to G.P, with all my details on, however under the R.E. PATIENT DETAILS bit I just wrote please find attached pt's diabetic foot screen as requested for records etc. I did think at the time maybe to something like 'any patients that you feel would benefit from home visiting service please pass on my details?' although being a newbie you presume they have already got referrals sorted. However i do know that where i live i'm the only 'just' mobile pod at the moment and has worked in my favour thus far!! So do you think next time i pass on to G.P. it would be acceptable to send something along those lines? Can't do any harm can it?
     
  12. Try and be a bit more subtle than that.

    Have you got a letterhead A4 done,

    If not get to a printer get a letterhead done with your name, contact details etc. A put somewhere Mobile Podiatrist or Patients treatment at your home or something like that.

    Be professional with your Diabetic screening and reports 1st but be subtle with can you start sending me patients- if they like your reports and patients ( who are their patients as well ) give you the thumbs up or are more likely to get referrals.

    You can also go meet them one one one say hi etc more professional than the letter request.

    Ring up explain to the receptionist who you are and that you have had a patient who also a patient of Dr X - ask if the Dr would like to meet. etc etc

    Good luck
     
  13. blinda

    blinda MVP

    Yep, what he says. Professionalism will speak volumes when you send any correspondence to GP`s.

    If you want a copy of the introductory letter that I sent to local GP surgeries, PM me your email addy and I`ll whizz it to you.

    Cheers,
    Bel
     
  14. W J Liggins

    W J Liggins Well-Known Member

    Might also be worth entering negotiations to hire a room/couch at the GP practice. They usually do a good deal and it really is the best place to be for footfall, referrals, interprofessional communication, drugs etc etc. It will also save your back and you can still do doms as and when you wish. Heads you win, tails you win!

    All the best

    Bill
     
  15. clod

    clod Active Member

    Thanks Bel thats really helpful.
    I have done a letterhead which says Mobile Podiatry/Chiropody (in bold) under my name at the top.
    Currently I'm using the SCAP foot screen, however I've added an extra page (the pre printed outlines of feet) and then add on the areas of sensation with the neurotip, as on the screen it just says ?/10 normal/abnormal which therefore doesn't give you any idea of location of sensation. Which screens do you use? Are we allowed to design our own? Also it doesnt include the blunt/sharps test, however when training some trusts didnt use and others had different ways of doing so results often open to interpretation. Hmmmmm
     
  16. clod

    clod Active Member

    Hi Bill,
    I have thought about this but a few years ago, where I live most of the local G.P surgeries were amalgamated into two new health centres which both include a podiatry department :mad:
    However there are no private pod clinics at all, except in neighbouring areas so subtly letting the G.Ps know of my presence may be the best bet.
     
  17. W J Liggins

    W J Liggins Well-Known Member

    Hi Clod

    You could still work there privately. Many NHS departments are discharging non-urgent cases - you win 3 times over.

    All the best

    Bill
     
  18. fishpod

    fishpod Well-Known Member

    every gp in england and wales sends for every diabetic pt on their books for a once a year foot screen as heathpod says they get paid for it. so its abit pointless sending out letters unless u really wont to. must be nice being a gp somebody else does the graft you get the dosh.
     
  19. kitos

    kitos Active Member

    Ditto to what Mike said Clod. Be subtle and professional. GP's aren't going to refer to you straight away as to many we are still snip and slash merchants.

    I placed my cards with GP surgery receptionists and made sure that they knew who I was as they get the queries from patients. I now work out of a GP surgery (still private practice) and have my brochures and cards and an advert dispalyed there. I now get referrals from all the clinic nurses and most of the GP's as well as the local NHS waiting list is beyond dire.

    If you want to let me have your email address I'll send you a copy of my neuro vasc assessment form which I send on to all GP's and to patients if they want a copy (thankfully very few do !)

    Best wishes
    Nick
     
  20. PATSHORT

    PATSHORT Welcome New Poster

    I agree with Fishpod. They get paid loads to make up their targets so you are just giving them a free service. They hardly ever refer to private practitioners , they hardly know enough to refer to NHS cilnics in the same building!
     
  21. blinda

    blinda MVP

    Yeah, well why don`t we just keep on moaning and griping about the fact that GP`s don`t often refer patientss to us and isolate ourselves from them and all other health professionals, who also don`t play ball with us. That will really help business :rolleyes:

    So what if they receive payment for diabetic checks that they delegate to others, i.e. me. Personally, I like having a slice of it. And, in the meanwhile, create professional relationships and pathways which benefit the pt.

    Just my opinion, of course.

    Bel
     
  22. clod

    clod Active Member

    ok so taking on board all of the above (and i would like to say having experienced busy pods taking time out to pass on advice has been a real eyeopener and made me feel not so insular and is much appreciated)
    This is the plan (i'm a bit of a 'listy' person)
    1. Improve/redesign foot screen
    2. Wait til diabetics rebook/book then ask permission to forward on
    3. Wait and see if any referrals come
    4. If not subtly add in compliment note or letter explaining service
    5. Still no/few referrals make appointments to see G.Ps and offer services and also enquire about providing service on site - i do agree with bel on this point that its an opportunity to be 'in the loop' and be aware of other things that may be going on
    6. Get run off my feet with extra bookings
    7. Buy everyone a doughnut
     
  23. cornmerchant

    cornmerchant Well-Known Member

    Bel-you were very short with PATSHORT, a new poster who once upon a time you would have welcomed!

    Fishpod-with you on this one. I cannot see the point of repeating or even doing for a fee, the work that is already done by the diabetic nurse or GP who get paid for it. . If there is a problem they refer on to the NHS pod department, not to a private practitioner. And quite frankly I don't want complex diabetic patients who need the multidisciplinary team. Having a slice of it does not necessarily have any advantages in pp.

    Clod, I am sure that it is not going to be the case very often that you get asked for a written diabetic report, so I wouldn't spend too much time on developing pathways for this , it may pay ypu better to find yourself an appropriate clinic space, it does look a little more professional than just doing doms.

    CM
     
  24. blinda

    blinda MVP

    Heather - My post was not directed solely at Patshort, just the general negativity/apathy which has manifested in some of the posts on this thread. However, you`re right. I failed to notice that was Patshorts first post...so:welcome: Patshort.

    It would appear that your experience of referral pathways to and from GP`s is quite different from mine. Personally, my practice does benefit from professional relationships with many GP`s in my area.

    Each to their own.

    Cheers,
    Bel
     
  25. cornmerchant

    cornmerchant Well-Known Member

    Absolutely Bel, I agree that good professional relationships with the GPs is to be encouraged. Luckily I work within 2 GP practises so it has been easier for me maybe as I am on the spot so to speak. They tend to refer patients to me when they themselves or the nurses for that matter have something they cannot deal with or something that they know I do which is of course out of their remit.


    CM
     
  26. Catfoot

    Catfoot Well-Known Member

    The new NICE Footcare Guidelines for those with Diabetes seem to indicate that fewer and fewer high risk Diabetic patients will find their way into private practice.

    http://www.diabetes.co.uk/news/2011...are-guidelines-for-people-with-diabetes-97461

    I agree with Cornmerchant that we do not need to re-invent the wheel. so if the GPs get paid for doing Diabetic screening then why should the patient have to effectively pay twice?

    I have only ever been asked once, by another AHP (in 17 years in private practice) for a written Diabetic assessment.

    regards

    Catfoot
     
  27. fishpod

    fishpod Well-Known Member

    hi i am all in favour of establishing good links with your local gps i work out of 3 gp practices ,psthey dont read your notes the receptionist opens the 200 letters a day then another lady scans them on to the computer the gps only read the test results from path lab and other hospital letters that the staff red flag for them they are mega busy if they had your assessment they just shove it in atray to be scanned and thats it about 5 seconds worth or their time. if u want prof links with gps try dinner parties and golf u get alot more referals.
     
  28. W J Liggins

    W J Liggins Well-Known Member

    Sadly, this is largely true. However, I do take issue with fishpod on the issue of professional and social links. You may well obtain more referrals from social links, but for many reasons, not least medical defence, in my view professional links should be exemplary.

    All the best

    Bill
     
  29. fishpod

    fishpod Well-Known Member

    funny bill i dont see hospital consultants feeling guilty or worried about getting private referals from their extensive nexwork of mates who just happen to be gps cerching another 150 quid im not suggesting u sleep with them or give out backhanders, its called networking some people are better at it than others
     
  30. mimmypod

    mimmypod Member

    Hi Clod,

    May I please ask what you charge for each home visit? Do you keep a manual file for each client at home?

    Cheers,
    Mimmy
     
  31. clod

    clod Active Member

    Hi Mimmy,
    I'll pm that one if thats ok! as it may turn into a pricing debate and that was not my original post. Lets just say i've done the research and its within the average for where i live. I do keep patient records at home in lockable cabinet.
    Cheers
    Clod
     
  32. mimmypod

    mimmypod Member

    Sure :) Makes sense. Thanks for your reply and go well with it all!! Cheers, Mimmy "D
     
  33. W J Liggins

    W J Liggins Well-Known Member


    If you look at patient records in a private hospital, you will see that all referral letters are replied to and the GP is well aware of what treatment each specialist is carrying out. The issue as I see it, is not whether the referral from the GP comes as a result of networking or anything else, just that the professional interaction is correct.

    All the best

    Bill
     
  34. fishpod

    fishpod Well-Known Member

    Hi
    I'm speaking on fishpods log in
    Im a GP.
    He's right
    I read all results, scan letters to the end to ma,ke sure I do whats necessary for patients (Pysch letters are up to 4 pages longs have 15 minutes to sign 20-40 scripts and look over letters)
    Insuance requests, CMO warnings and a few PCT/GPCC letteres I'll skim but the rest is binned.
    I dont even open drug company bull****, It a waste of trees! seriously true.
    Sending a suggestion and compliment slip will be binned
    "walk the talk" go and see and chat
    do what they need for their QOF/better patient care and get the GPCC to commission this as an added value care service. They dont want extra work/reading they want life easier to move patients through a pathway quicker.
    Dont get me wrong the qof points are a way fo making money but money we made anyway when the Labour Govt rolledall the old red book into the QOF and global sum. its ours anyway!
     
  35. W J Liggins

    W J Liggins Well-Known Member

    Hi GP

    I accept what you say, obviously, because you are in the position to know. The fact remains that if professional courtesies are followed and a proper GP letter sent, then should an adverse reaction occur in a particular patient, and the practitioner be hauled up in front of the HPC (in our case) or legal action taken by the patient then we are covered. As you will be aware, the MPS and MDU use gallons of ink repeating record keeping, record keeping, record keeping and sending an appropriate GP letter, a copy of which is lodged in the record is simply a part of this. In this sense, what the GP decides to do with the letter is therefore largely irrelevant; we have protected ourselves.

    Incidentally, I am a podiatric surgeon and all of my patients are referred by their GPs.

    All the best

    Bill Liggins
     
  36. kal

    kal Member

    Hi Clod

    I have recently left the NHS service to work in sunny oz but at the trust I was at it was normal practice to send a copy of the diabetes screen to the GP. This was done for numerous reasons the main one obviously being that the GPs recieve payments for producing the data as it earns them quaff points.
    Secondly I think from a legal perspective it is always good to document everything and if you have sent copies to the GP and anything was to go wrong then you have followed guidelines and documented everything.
    Thirdly I think in the profession we are in any form of communication with other professions can only be a good thing. Also I think if we dont promote our work in this way then they will happily hand over the screening responsibilities to DNs and where will that leave us in the future?

    Hope that helps
     
  37. Heather J Bassett

    Heather J Bassett Well-Known Member

    Hi, I like to think that an Annual Diabetes Foot Assessment done by a Podiatrist may involve more about feet than the GP and nurse.
    When it comes to looking at nails,sulci, dermatological signs and symtoms, footwear and biomechincal considerations we should know more?? 3-5 years at Uni? What do you think Mim?

    Cheers
     
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