PACE Podiatry: Accessible Care for Everyone

Sally Mogg, Highly Specialist Podiatrist – MSK portfolio
Maureen Hillier, Highly Specialist Podiatrist –Wellbeing portfolio

Cardiff and Vale Health Board

Background

Patients who are referred to Cardiff and Vale Podiatry department are offered assessment and treatment based on foot health need and medical risk. Approximately 700 patients are discharged monthly because they don’t meet the All Wales Guidelines.

Patients who are discharged often have no affordable alternative than to wait for their condition to deteriorate. This presents issues within the health inequality arena. In order to provide the right care at the right time, it is essential that the right staff is available. This project will offer this opportunity and NHS staff will provide the workforce.

Project Aims

A social enterprise is planned to provide low cost routine and simple foot care for this cohort of discharged patients. This is a safety net in place to provide rapid re-access back into NHS care of foot health deteriorates. The more vulnerable patient with multiple co-morbidities will benefit. Contact with the GP will be reduced by no need for a new referrals.

The provision of a low cost but NHS governed service will ensure that patients receive preventative care and maintain a reduction in the development of more complex foot health needs. There will be an associated improvement in population health and deliver outcomes that matter to people.

Healthcare worker holding patient's feet

NHS staff will be supporting this venture. There should be an associated improvement in Health and wellbeing due to more flexible working. Public, patients and professionals will work as equal partners through co-production in the Social Enterprise.

PACE will reduce inappropriate variation in healthcare by using developing healthcare models to identify interventions that have the highest patient, technical and allocative value. Patients are expected to retain a greater awareness of their foot health status.

Challenges

Slow development due to Executive Board changes. The application was supported by CAV UHB Strategic Planning who assisted with the detailed paperwork

Reduced protected time. Staff shortages due to re-deployment and illness.

Cultural/political attitudes to NHS service being free at point of care. Priority treatments continue to be provided. Low risk patients are activated to find alternatives.

Concerns raised by stakeholders e.g. CHC. The effects of Covid on service priorities has led to altered service demands.

Media exposure. This was avoided initially due to a potentially controversial project.

Right location. Request to use established NHS Podiatry site awaiting agreement

Key Outcomes

Patient experience: Patients expect practitioners to provide excellent care and this will be achieved by using ‘gold standard’ NHS Podiatry staff. Feedback surveys will be distributed to patients at 6 monthly intervals for one year. This will provide ideas and opportunity for improvement.

Health outcome: Providing the right care for the right patients at the right time using the right skill mix of staff will maximise the health of the community. Less complex needs will be met by PACE and health inequality reduced. This will be the first scheme to address the needs of the discharged patients in Wales.

Measurements: Costs have been assumed based on 700 patients discharged monthly. This matches the more affordable end of the market. It is expected that 1680 patients would request 4 appointment annually. If 20% of these patients attended PACE, the service would raise £134,400.

Resource efficiency: NHS Staff will be given the opportunity to provide support for the project. It is expected to use current facilities out of hours to reduce set-up costs. A co-existence with Age Connect may provide opportunities for locations closer to patient’s home. The wellbeing of staff will be increased by improving the flexibility of the working week.