INITIAL RESULTS OF A SURVEY OF CURRENT NHS

PODIATRY ACCESS CRITERIA

David Milns Lead Practitioner Podiatry Department East Cambs and

Fenland PCT

Background

• Involvement in research concerning the outcomes of a decision to deny defined low risk elderly patients access to NHS podiatry services

• What access criteria is currently in use within NHS Podiatry services?

Methodology

• Snapshot of criteria in use in September 2001

• 150 FOM members managing Podiatry Services across the UK contacted

• 90 responses received - a return rate of 60%

England 75, Ireland 3, Scotland 9, Wales 3

Survey Results

Broadly broken down into four groups:

• Open access - no defined criteria, no prioritisation and including social care: 15 (17%)

England 10, Ireland 0, Scotland 3, Wales 2

• Open access including social care but with some prioritisation of waiting lists:12 (13%)

England 8, Ireland 1, Scotland 3, Wales 0

Survey results cont.

• Service based on old “priority group” definitions: 20 (22%)

England 16, Ireland 1, Scotland 2, Wales 1

• Service based on meeting defined needs with patient prioritisation: 43 (48%)

England 41, Ireland 1, Scotland 1, Wales 0

Services with restricted access based on prioritisation of need

Formed 48% of the returns

Two main groups:

• Departments using scoring systems to determine access (20)

• Departments using risk definitions to determine access (23)

Risk definitions

Many variations

• High Risk: eg diabetes, ischaemia, RA, infection, ulceration, painful lesions

• Medium Risk: eg biomechanical conditions, corns, callous, nail conditions. Conditions requiring intensive treatment and discharge

• Low Risk: cutting of normal nails, verrucae, patients requiring treatment for chronic conditions

Summary

• Wide range of access criteria currently in use with considerable variations in risk definitions

• Some evidence of local political pressure influencing criteria

• Little evidence base apart from local clinical consensus. Often determined as a result of financial and waiting lists/times pressures