HNY Policy and Pathway Repository - York

From 1 May, the local Community Podiatry service will be provided by Harrogate and District NHS Foundation Trust. The new contract, which was shaped following consultation with local patients in Scarborough and Ryedale and Vale of York, will be delivered by highly skilled podiatrists, trained in the prevention and diagnosis of lower limb issues. They will provide assessment, advice and treatment for patients across 38 community sites in North Yorkshire.

The services available include general core podiatry, nail surgery, management of high risk feet and muscular or skeletal imbalances and injuries.

The service will not provide simple foot care procedures, (defined as toe nail cutting and skin care, e.g. callous and corns), unless clinically appropriate for high risk patients such as high risk patients with diabetic or vascular pathology. Podiatry treatment will not be available to patients who can self-care or have social / family support who can provide care. The Harrogate District Hospital Podiatry Service website includes self-care information and signposting to other sources of podiatry support.

This is a re-award of a contract to Harrogate Hospital. Please continue to refer to the service as previously – however, all relevant documentation have been added to the RSS.

1. Referral form PDF version
2. Referral form Word version
3. Referral acceptance and exclusion criteria (below)
4. Podiatry Decision Trees
     o Biomechanics triage and assessment
     o Community triage and assessment
5. Referral pathway for Diabetic foot

For further information about the service and access to patient leaflets / information guides please go to the provider's Podiatry Service website.

None provided

None provided

Acceptance Criteria

Any person may be referred into the service but they must possess a specific medically related problem identified below highlighted on the referral OR they must fit one of the following categories:

• School children of 18 years or under (Excluding treatments for of simple verrucae but include verrucae with complications, i.e. painful lesions requiring sharp debridement that would otherwise significantly impact on a patient’s quality of life or ability to work);
• Domiciliary visit to patients assessed as housebound within agreed protocols;
• Any person requiring nail surgical procedures for removal of part or a full nail to treat:
  • Fungal infections of nails
  • Bacterial infection of nails. (Adolescent ingrown toenails)
  • Involuted or abruptly curved nails.

Specific medical related access

Access will be available for the following classifications of patients irrespective of age classifications:

• Diabetics with complications or risk related to the feet as defined in the NICE Guideline on Diabetes management
• Rheumatoid arthritis
• Severe peripheral vascular disease including Raynaud’s syndrome
• Blood disorders whereby the immune status of the patient is compromised
• Neurological dysfunction affecting the feet
• Medications affecting vascular or neurological state
• Children with pain resulting from deformities of the foot abnormal gait
• Connective tissue disorders
• Dermatological disorders (small simple areas of hard skin / corns are not classified as Dermatological disorders)
• Patients requiring nail surgical procedures
• This is based on the at risk status rather than medical diagnosis alone

Exclusion Criteria

• The service will not deliver simple foot care procedures, defined as toenail cutting and skin care unless specifically for those patients, who are otherwise eligible for referral to the service. (Such as high risk patients with diabetic or vascular pathology).
• Patients who do not have a podiatric need in line with the agreed access criteria.
• Patients that do not fit into the specific groups outlined above. These include:
  • Verrucae treatment requests.
  • Expectant mothers.
  • Patients who can provide self-care, i.e. toe nail cutting and skin care (unless clinically appropriate for high risk patients)
  • Patients who do not comply with agreed treatment objectives
  • Patients with social / family support who can provide care. (This includes signposting to private podiatry support) based on clinical need
  • Low risk diabetes presentation in line with NICE Guidance
  • Patients with small amounts of callous and corns that have no medical presentation and hence are non-limb threatening – impact on quality of life and ability to work to be taken into account
  • Patients with fungal infections of skin.
  • Patients with mild / asymptomatic biomechanical problems

• HDFT service website
• Direct Access Leg Ulcer Clinical Assessment Services - York & Malton Hospitals