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How many ulcers in private practice?

Discussion in 'United Kingdom' started by Podiatrya, Nov 28, 2015.

  1. Podiatrya

    Podiatrya Member


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    Hi,

    Having worked in the NHS where we were trying to cope with an endless stream of serious foot ulcers and now being in private practice where i have so few i fear becoming de-skilled in wound care, i wonder if others find the same

    Its not as though i don't have lots of high risk patients as i have plenty, the same proportion as the rest of the population i expect. Now that the NHS do not routinely offer high risk patients palliative care where else can they go but private so i expect i have my fair share. I've been in private for a decade now and none of them develop serious ulcers at all. Small breakdowns that can be dealt with and the patient educated and padding used or shoes changed etc but none of the neuropathic feet end up with major ulceration let alone amputation. Of the 2 cases i can think of that wouldn't heal both were not diabetic, one was rheumatoid and the other ischemic (i remember well because of the nightmare getting them seen by a multidisciplinary team who refused all but diabetics).

    I'm not doing anything exceptional just good old fashioned podiatry care so i wonder how many others find the same.
     
    Last edited: Nov 29, 2015
  2. Podiatrya

    Podiatrya Member

    strange 248 views and not one reply. Does everyone work in the NHS here? I thought it was more of a private practice forum?
     
  3. horseman

    horseman Active Member

    Well I've been in PP for a lot longer, any wound requiring our local MDT gets referred on, partly because that's what they are good at and partly because the cost soon becomes too great for the patient. Also although I have the skill sets I don't have the rest of the team.

    As to how many: I spend a lot of time and effort preventing such wounds, perhaps PP patients are more likely to comply with the regime being in effect self selecting?

    Happy Christmas

    Tom

    :santa:
     
  4. Podiatrya

    Podiatrya Member

    I know what you mean about the cost, I've a few times asked for an urgent referral from the GP while i carry on seeing them, knowing the patient can't afford it for long, but so far each time it's healed before they get their first appointment. Really depends on how soon after it broke down i see it but a few weeks of good padding and advice takes care of most ulcers that have occurred between appointments on my regulars. 60 - 90 extra isn't much compared to needing something done to a tooth and most can afford it. Perhaps the extra cost is useful encouragement to comply to stop it recurring.

    So not many as well then? Obviously good preventative care is important and sadly under-provided for by the underfunded NHS. Not a total surprise but i am surprised at just how much the difference is. Good routine care seems to almost irradiate serious ulceration and amputation. I've seen statistics showing it makes a difference but not as much as it seems to be in practice.

    I'd be really interested to hear from others in PP if they have found as well they just don't get major ulcers on their regulars.
     
  5. fayp

    fayp Member

    I don't see many ulcers in PP either, but do frequently come across them in nursing homes. Then there is a dilemma, as many relatives refuse to pay for follow up, the trained nurses in the home tell me they are not allowed to dress the wound unless a GP has prescribed dressings, so they all get referred to the GP, who then agrees with me, that they need dressing, and the nurses can dress them! What a waste of the GP's time when it usually involves a call out! I could, of course provide the dressings but the family or nursing home won't pay for them!
     
  6. Claire72

    Claire72 Active Member

    The practice nurse from the residents GP practice will come out to either dress the wound, or call in the health visitor. Either of them will be calling in on a weekly basis for various conditions. The GP would not come out to an ulcer in a residential/nursing home any more than he/she would to a resident not living in a nursing/residential home.

    I know podiatrists in this situation are running a business and are not going to give away free treatment or medications, but there is a vulnerable human being at the other end of that ulcer, who is not receiving the care they need due to 'economics.'
     
  7. fayp

    fayp Member

    Thanks that is really helpful. Still seems crazy when nursing homes have trained nurses who are willing to dress wounds but not allowed.
    As you say, it is the vulnerable patients that suffer if we don't all act together.
     
  8. JackieSmith

    JackieSmith Member

    High risk patients are seen routinely in the NHS in my area. Return times are as clinically indicated to prevent breakdown and other complications.
     
  9. fayp

    fayp Member

    I live in Wales, where health is devolved, so we have a state owned airport and worse NHS! So in my experience it is very difficult for high risk patients to get NHS treatment especially if they are in a nursing home. We rang the NHS pod service a few months ago concerned about an unstable diabetic with a septic toe, and were told to ring his GP as the Pod service would only see him twice a year........and his family won't pay for PP..............
     
  10. Claire72

    Claire72 Active Member

    If this resident needs care for a septic toe and for whatever reason is not getting that care...then it is a safeguarding issue and should be reported to the CQC. If a difficult conversation needs to happen, or a finger to be pointed then so be it. Has the manager of the home been informed? Let's pretend that this resident is a member of our family. Was the GP phoned? Did he/she refer to the podiatry service?
     
  11. fayp

    fayp Member

    The patient did get care as the GP gave antibiotics until the family agreed to,pay me to remove the spike. I was just shocked that he is an NHS Pod patient and they refused emergency treatment.
     
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