James MacKinnon & Joanna Stewart, Specialist Podiatrists NHS Greater Glasgow & Clyde

Phase 1 story (Spring / Summer 2020)

How have you been able to keep a focus on what matters to people during COVID?

The podiatry service has had to adapt very quickly in the way it provides its service. To  protect the public and reduce footfall in health centres we have had to reduce the  number of clinical locations available. A new working rota was developed which would  allow members of the team to work from home and support better social distancing.  

Working in high risk foot protection, we have had to ensure that we continue to provide  care to our most high risk patients. A main priority is to keep high risk patients out of  hospital. Managing the risk of infection by continuing to provide wound care in  community ulcer clinics and through home visits, and supporting patents and carers to  manage dressings via virtual appointments. Focusing care on these patients reduces  hospital admission rates and attendance at A&E. We provided support to fellow  podiatrists who have had to adopt new roles and practice at short notice.  

District Nurses were also asked to take on new roles and to facilitate this we took on their  caseloads of foot and ankle wounds. Home visits have substantially increased to provide  continued wound care to high risk patients who are shielding. We wear PPE & follow the  current guidelines regarding Covid 19 to protect patients and reduce risk of infection.

What have you had to do differently and what made this possible? 

Before Covid, we had initially been piloting virtual (Near Me) clinics for wound review and  providing support to patients and family/carers for managing their own treatments. 

During this time only 16 patients opted to use Near Me and 81% of those did not attend.  During Covid this picture changed dramatically and 184 patients attended during a 9 week  period with only 18% not attending, with technology being cited as the biggest reason for  this. Near Me has been fully integrated into our practice and become a very normal way  of consulting with patients. This has been especially useful in triaging patients from care  homes. Working alongside the nurses and support staff in these settings, we have been  able to continue to provide a consistently high level of care.  

Communication has been key between staff, patients and carers. There has been great  support between colleagues and management in embracing new ways of communicating  including Microsoft Teams. This has allowed us to discuss patient management plans,  tweak rotas but I think most importantly allowed us to continue to interact and bounce  off of each other despite not being in the same room which has definitely helped morale. 

What have you noticed that has been better?  

We were a close-knit team before the pandemic and we have really pulled together to  support patients and each other, which has made us even stronger as a team. Everyone is  willing to help each other and we have shown a great deal of flexibility and adaptability.  

We have also used Microsoft Teams for clinical supervision giving us an opportunity to  reflect and share our experiences of working through this strange and challenging time.  

For patients, virtual clinics have given them the peace of mind that they are able to  continue to access the service despite shielding, and their foot health has not suffered as  a result. This has also provided support to staff and patients in Care homes & nursing  homes, helping them feel supported. Patients have shown a real willingness to be more  involved in their care which has been a great help to the service over this difficult time. 

How did this make you feel?  

The service has taken a great step forward in terms of using technology to interact with  patients and carers and I think this will only get better the more we use it in the future. 

Our team has certainly grown closer and that is largely down to our regular teams  meetings and online social interaction. I feel proud of the way we have continued to  work together as a team to provide care for our patients and also enabled and  encouraged patients to be as pro-active in their own care as possible. 

What have you learned through this?  

Our management team have continued to be extremely supportive and have shown a  great deal of flexibility to all staff. With all the change that Covid has brought, we have  learned we are all stronger and more resilient than we think, that in times of adversity and uncertainty you take on challenges that previously may have seemed daunting. Our  staff are willing to quickly learn new skills to continue to provide a high level of care.

Phase 2 story (Autumn 2020)

What has continued to help keep a focus on what matters for people during the pandemic? 

We have focused on creating multiple opportunities for communication for both staff and  patients to ensure that everyone feel connected during the pandemic. Clinically we have  developed systems that enable patients to access the right treatment at the right time using  telephone consultations, virtual and face to face (with appropriate PPE and social distancing  measures for patient and staff safety) .

For staff and colleagues and other health professionals we have continued to use MS Teams,  chat apps and emails to keep in touch. We are encouraged to use the resources for mental  health and wellbeing.  

Learning and Education has also been achieved through the use of online webinars and  conferences so we are able to keep up to date with the latest guidance and evidence related  to Covid19. 

We developed a public facing website to signpost people to the most up to date self management advice on topics such as MSK, Diabetes and Personal foot care. The site gave  patients and staff the confidence to be able to access suitable treatment where they were  unable to attend clinics.

Are there changes that seem to be lasting longer term and are there things that have slid  back to old ways of doing things?  

The new systems are sustained and we confident that this will continue rather than reverting  to ‘old way’. The focus is on how we move to a digital approach that improves access and  information for patients and staff.  

Virtual working is now more efficient than before as patients can be offered support using  multiple platforms rather than always face to face. Patients have reported feeling more  involved in decision making and appreciate not having to spend time travelling to clinics, look  for parking or ask family members to bring them to a clinic base. 

In wound care we have developed leaflets for shared care and wound diaries to help chart  the healing process. Family members have worked well to support dressing changes and take  photos for the virtual clinics.

What difference has this made to people? 

We have sought patient feedback on our virtual clinics at various points throughout Covid 19:

Podiatry staff report feeling more engaged and rewarded in their job role. Staff are also  taking the time to appreciate each other more. 

Further data show the website has also made a difference to people as a source of  information and engagement for patients and is something we will continue to develop. 

NHSGGC Podiatry website activity (April 20 -Oct 20)

How did this make you feel?  

It has been a good experience to be involved in shaping the future of our service through the  use of technology. We have also tried to share our share our experiences and learning widely  and as a service we were lucky enough to have an article published which may be of help to  other services.

Ultimately technology has provided us with the reassurance that patients can be triaged and  managed safely throughout Covid 19.

What difference has it made to you to tell your story as part of this project?  

It has helped us to increase awareness of the role of podiatry and how our activity has  changed during the pandemic. It has also joined us to a really useful network of people.  Connection has been key throughout this experience.