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