2020 Workforce Vision
Contact name, number and Board:
Examples of Service Change in Action
Lynne Douglas
AHP Director
NHS Lothian
Waverley Gate
Waterloo Place
Edinburgh
01314655658
The service being delivered

In January 2012 NHS Lothian launched as part of a multidisciplinary approach the
Surgical Podiatry service. We employed a Consultant Podiatrist- surgical podiatry to
work as part of an integrated team alongside Orthopaedic surgeons to undertake
forefoot surgery. This is strongly supported in the literature around safety and efficacy
yet in Scotland it has taken many years to get this integrated model up and running at
service level. This is a spend to save model and currently the only such service in
Scotland
The changes that have taken place in the
service in the last 7 years

7 years ago it would not have been possible to integrate a surgical podiatry service into
mainstream orthopaedics in Scotland- In Lothian as part of our commitment to
modernise and advance the role of the podiatrist to their maximum capability we had
the opportunity to develop this, following the retiral of a number of key individuals who
until that point had blocked any modernisation in the service. We worked at a national
and local level to get this change embedded and to date although a long time in coming
we have a fully functioning qualified Podiatrist undertaking fore foot surgery as part of
the multidisciplinary orthopaedic team.
The impact on patients

The impact on staff
The impact on the wider public sector

The demand for forefoot surgery is rising as the demography changes and integrating
the service in the way we have enables orthopaedic surgeons to focus more on the
complex cases. This enables the surgical podiatrist to undertake all of the routine fore
foot operations (14 standard operations within competency) that used to be delivered
by the orthopaedic surgeons. Once the referral is received by the orthopaedic team the
MSK podiatrist triages whether the patient needs to be seen by a MSK podiatrist,
Consultant podiatrist (podiatric surgery) or an orthopaedic surgeon. Patients are seen
before surgery by the Consultant Podiatrist are given patient information which clearly
states the operation is being conducted by a podiatrist and they receive both telephone
and individual face to face follow up in clinic by the same Consultant podiatrist- The
patients therefore have a more timeous intervention, which is patient centred. This
work is undertaken as day case and often can be completed using local anaesthetic..
Our experience to date is that patients have a positive experience and suffer no ill
effects from having a surgical podiatrist as opposed to a orthopaedic surgeon
undertake their procedure.
This has been a significant development for the profession of podiatry in Scotland and
we have the ability now to enable this group of staff to work to their full range of
competency in NHS Scotland. It has also helped the multi and interdisciplinary working
in the orthopaedic directorate and the value of what a podiatrist brings to this service is
better understood and also very much valued.
This approach demonstrates a spend to save model in practice. This is a major
redesign within our public sector advancing the roles of AHP’s and truly embracing
quality driven innovation. This service redesign enables staff to work to their full
potential and fosters clinical integration. Economically the model is cost effective and it
promotes patient centred care and use of day case surgery it demonstrates significantly
the contribution of AHP’s in the elective care objectives.