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
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