Consultation on the National Personal Footcare Draft Guidance

Section 5: Different models of personal footcare

This section provides information on a range of models that could be adapted to address the personal footcare needs within an area. Acknowledging the impact that good personal footcare can have for older people, in 2009 the Department of Health carried out a service review of personal footcare in England and produced best practice guidance for service providers and commissioners. This was centred on a range of potential models and examples for safe and effective personal footcare service provision. 'Footcare: Footcare services for older people: a resource pack for commissioners and service providers' (DH, 2009).

Four of these care models have been adapted for application within a Scottish context as described:

Model 1. Supported self care for individuals- where education/awareness on personal footcare is provided by NHS podiatry services. This is usually delivered on a personal or small group basis to individuals, families and unpaid carers who can assist and support self-care and empower people to take part in it.

Model 2. Integrated personal footcare services - this can take the form of education and training to groups of employed care staff in all care sectors. It is organised in partnership by NHS boards and local authorities, and where NHS or local authorities undertake a governance role.

Model 3. Social enterprises/voluntary sector - these can be enterprises or voluntary services that already provide a range of support services that may include personal footcare. The service may be contracted by health or social care services or independently provided. People may be charged for this service.

Model 4. Independent podiatry practice - where people access personal footcare services (as distinct from podiatry treatment) via the private sector.

Case examples of each of these models are detailed highlighting examples of good practice currently in place in Scotland.

Model 1: Supported self care model for individuals

Case example: NHS Tayside Self Management Programme

Patients referred to NHS Tayside podiatry service that are considered to have a low potential for foot pathologies/problems and able to manage their own footcare effectively are invited to attend a self management programme.

At the start of the session participants are asked to complete a questionnaire to ascertain how competent they feel about managing their own footcare and they are asked to re-evaluate this at the end of the session.

Wherever possible, the sessions are delivered in a non-clinical environment and the podiatrist delivering the programme does not wear a uniform, in an attempt to de-medicalise the content. Attendees watch a very short DVD followed by a presentation and a practical session.

Carers and family members are encouraged to attend, especially if they are the person to be carrying out the nail care.

Following attendance at the session, patients are discharged from the podiatry service although they are able to re access the service for a further 12 months, without having to re-submit a new referral form, should a problem arise. Very seldom do patients actually make contact and if they do, a podiatrist will call them back within 48 hours with advice. If this does not suffice, the patient is given an emergency appointment to attend a clinic for that specific problem.

For details contact Judith Murrie, Podiatry Lead, Perth and Kinross, NHS Tayside. judith.murrie@nhs.net

Case example: NHS Greater Glasgow and Clyde

A joint project between health improvement and podiatry services targeted new patients referring to podiatry. Patients who have a personal footcare need and could manage to self care, or, those who had assistance with this from a carer or relative were referred on to an educational workshop. The educational workshop consists of a presentation and discussion from a podiatrist covering aspects of personal footcare and nail care. This is followed by a group discussion by a home safety co-ordinator on all aspects of safety at home on how to prevent falls.

During the project phase, all attendees were given an educational pack to take away. This contained the following: foot file, shoe horn and education/information leaflets on footcare, medication and falls prevention, smoking cessation and home safety.

For details contact Paul Higgins, Podiatry Manager, NHS Greater Glasgow and Clyde. Paul.Higgins@ggc.scot.nhs.uk

Model 2: Integrated personal footcare services

Many NHS podiatry services across Scotland provide education and awareness sessions for staff in hospitals, care homes and care at home staff.

Case example: NHS Tayside Podiatry Services and Care Homes

Every six months all care homes in the Perth and Kinross area of NHS Tayside are invited to send care staff along to a footcare education session at a central location. Local private nursing homes and voluntary care agencies or other organisations across all sectors e.g. Capability Scotland, are also invited to attend.

This session lasts about 90 minutes and outlines the role of the podiatrist; expectations for care staff in relation to contributing and providing footcare; personal footcare advice/instruction, including the cutting of nails and protocols in referring to podiatry. There is also an opportunity for care staff to practice nail cutting on one another if they so desire.

Attendance rates average 40 care staff at a time and enable care homes to release staff in small numbers and provide the opportunity for new members of staff to be educated. Carers are given a certificate of attendance.

For details contact Judith Murrie, Podiatry Lead, Perth and Kinross, NHS Tayside. judith.murrie@nhs.net

Case example: NHS Fife Care Homes Training and Healthy Footsteps Map

NHS Fife Podiatry service has a dedicated care home team which regular provides training sessions and support sessions to carers, care home and care at home staff. Over the past 10 years a power point presentation has been provided highlighting the role of the carer and how they can improve the foot health of the residents by undertaking simple personal care tasks. The training session enables the carer to carry out their role but also ensures they know when to refer onto the podiatry service.

Over the past year the care home team has been working with the NHS Fife Podiatry Diabetes educator to develop a new training format. Together they have produced a healthy footsteps map. Evidence shows that adults learn more from interactive training rather than a lecture style. Therefore this map is designed to allow the participant's maximum discussion with the educator taking a facilitators role and encouraging discussion from the group. The project is currently being evaluated, however early figures indicate the number of inappropriate referrals to podiatry from care homes has decreased.

The podiatry service is also involved in creating a DVD for care home and care at home staff and is also working on an e-learning project to educate and support these staff.

For further details contact Karen Hutt, Lead Podiatrist for Learning Disabilities and Care Homes, LyneBank Hospital, NHS Fife Karen.Hutt@nhs.net

Model 3: Social Enterprises and Voluntary Sector

Case example: Shetland Voluntary Nail Cutting Service

The Shetland Voluntary Nail Cutting Service has been up and running for a number of years now and continues to expand. Volunteer "nail cutters" receive basic coaching by a Podiatrist on how to cut toenails. Volunteers are required to be members of the Protection of Vulnerable Groups (PVG) scheme. The service is run by an elected committee and receives funding for expenses from NHS Shetland. The volunteers work in a person's own home, health centres and access a room at out-patients department of local hospital on a Saturday morning. Referral to the service is via a health care professional using a simple referral form. All referrers receive guidance on referral from both the service and the Podiatry department. The service has a constitution and is a stand alone organisation. People receiving this service are given a pair of nail nippers and a file, which they keep and bring along to each appointment.

For details contact Chris Hamer, Podiatry Lead, NHS Shetland, c.hamer@nhs.net

Case example: NHS Forth Valley and Age Concern Falkirk

A twelve month pilot project was carried out in 2011/2012 which offered a geographically defined local population a personal nail cutting service. The service is provided to people over the age of 50 who are unable to cut their own toenails. Clients are charged £10 for the treatment to help cover some of the costs incurred. Evaluation of the service has demonstrated that clients are extremely satisfied with the service they receive.

A Service Level Agreement allows for a Podiatry Technician to be seconded from NHS Forth Valley to Age Concern approximately three sessions per month to undertake the nail care. Age Concern Falkirk pay for the Podiatry Technician's time.

The pilot is to be extended by another 12 months until March 2013. People can continue to self refer to the service and be screened for their suitability over the phone by an Age Concern volunteer as this has shown to be an effective model. Volunteers who screen people are given training so they can screen out those who do not meet the eligibility criteria and therefore reduce the number of inappropriate referrals. Volunteers also undertake reception duties when the nail cutting clinics are in operation.

For further details contact Claire Pickthall, AHP Manager, clairepickthall@nhs.net

Model 4: Independent podiatry practice

Case Example: Private Practice Podiatry - Reduced cost service for personal footcare

There are a number of independent podiatry practices in Scotland that offer a reduced cost service for patients with a personal foot care need. At the first appointment the patient will be fully assessed and if their need is for personal footcare only, the patient will be offered future appointments at a reduced cost than what is normally charged in private practice. The first appointment will be charged at the normal rate.

For more information contact the Podiatry Room on info@thepodiatryroom.co.uk

All four models have benefits and advantages that would support the gap in the current support for individuals to self care and the provision of personal footcare.

The establishment of a range of solutions to support personal footcare would provide favourable options to address the current gap. It is envisaged that to address the personal footcare needs within a local population, a range of models and variations of these would be required.