HNY Policy and Pathway Repository - Humber

HUTH Trust Orthotics Department accept GP referrals. It is not necessary to refer via a Consultant led pathway in order to access the orthotic provision.

Any referrals already made to Orthopaedics, Rheumatology and Neurology services to access Orthotic Service only will be redirected to the Orthotic Department for a period of 3 months. Any consultant referrals received for Orthotic access only will be rejected. 

This pathway was agreed as being an episode of care pathway with clear endpoint and discharge, GP to act as case managers for both adults/paediatrics with long term conditions.  Review of paediatric patients by GP with ongoing orthotic need required to ensure underlying pathologies not missed.

Consider directing to Lakelands (ERY only) or high street for simple off-shelf orthoses.

Open wounds that will prevent casting or not suitable for contact with prescribed orthoses

Cauda Equina Syndrome – Direct to Emergency Care  

Exclude red flag symptoms

If unsure submit advice and guidance request

No Guidelines on Management Listed

Do Not Refer

• Acute “Red Flag” symptoms e.g. cauda equine syndrome.
• Suspected fracture.
• Suspected infection e.g. osteomyelitis.
• Suspected cancer.
• Extensive open wounds that will prevent the application of casting materials and or orthosis.
• Patients requiring standard off the shelf hosiery (can be fulfilled by community pharmacy).
• Postiche / Wigs please see local CCG commissioning guidelines and refer to a local NHS registered wig provider (note prescription charges will apply). Limited local suppliers, patients may be required to travel out of area
• Pre-natal back pain / Pelvic Girdle Pain (PGP) should be advised to contact their midwife who will refer to HEYHT Obstetric/Women’s Health Physiotherapy Service as required.
• Already known to a community service orthotic provision e.g. Community Paediatric services.
• Patients requiring domiciliary visits.

Referral Criteria

Orthosis provision by the service (not an exhaustive list):

- AFO – Ankle Foot Orthosis.
- AFO & Footwear.
- Ankle braces.
- Collar.
- Elbow Orthosis.
- Fabric Supports.
- Footwear.
- HGO - Hip Guidance Orthosis.
- HKAFO – Knee Ankle Foot Orthosis.
- Hosiery – made to measure or adapted only.
- Insoles.
- Insoles and footwear.
- Knee Ankle Foot Orthosis.
- Knee Brace.
- Shoe Adaptation including raise.
- Shoes – modular.
- Shoes – made to measure.
- Shoulder Orthosis.
- Spinal Orthosis.
- WHO – Wrist Hand Orthosis.

Referrals

Direct referrals are accepted for all adults who are not already known to a service where the orthosis being referred for can already be provided such as Community rehabilitation / MSK service where provision certain appliances are available e.g. knee bracing, Basic WHO, epiclasps etc.

Paediatric referrals accepted unless already known to community paediatric services  including Paediatric Orthotics Service for Hull and ERY

Please complete the referral form and refer via NHS e-Referral's (Orthotics and Prosthetics)

Lakeland Orthotics - East Riding Only

Appliance annual allowances are used by the services and previously agreed with commissions, please check the patient is not known to any other NHS orthotic service.  Care can be transferred to HUTH Orthotics but patients cannot be under the care of 2 services for the purposes of increasing appliance allowances.  This may result in referral to the NHS Counter Fraud Authority