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Too many patients!

Discussion in 'Australia' started by Backdoorpod, Oct 1, 2010.

  1. Backdoorpod

    Backdoorpod Member

    Members do not see these Ads. Sign Up.
    Just looking for some ideas to create a better service directory/priority tool for seeing patients.

    I am currently employed in a regional healthcare facility. We also have 2 allied health assistants podiatry. We are currently overbooked into 2011 and I am constantly fielding angry calls from patients that have been on the waitlist.

    Alot of my time is spent on doing the initial assessments for people who would just like to see the AHA for routine nailcare. I feel like I spend more time doing this than treating my high risk priority patients.

    We have a priority tool in place based on the NHS model, but it is not proving ineffective. I would like to make better use of my time and see patients in a more timely manner.

    Bad day on the job....
  2. Stirling

    Stirling Active Member

    I know the regional podiatry health clinic I have recently started to work for had a very similar history to your current working conditions. An overworked podiatrist with allied health assistants overbooked with routine care.
    They are now in the process of restarting a "full" 1 FTE podiatry service after being reduced to .1 FTE for a year and implementing a new service model. Reducing down to only half a day a week (for high risk patients only) helped clear a lot of the RNC from the books and created a lot of (initially) disgruntled patients. Most, if not all of the previous RNC patients are now on Care Plans and are able to see a private podiatrist regularly, given them a more reliable service.
    To summarise the new service model, NO RNC, NO newly diagnosed T2DM assessments, referrals accepted from GPs, Podiatrists and a select group of health professionals only. Focusing on high risk patients initially (with views to expand into paeds soon). Our model of care will hopefully encourage local GP's to initially refer to the local private podiatrists (on care plans) stopping RNC and routine diabetes assessments from being seen by our limited resource community clinic.
    Educating the referring parties is our next step.
    I would be happy to forward a copy of the Service Model once it is finalised. However I believe that each region requires their own Service Model depending on what resources and funding they have available to them.
  3. Backdoorpod

    Backdoorpod Member

    Thank you very much. That is quite helpul. If you do not mind sharing, I would like a copy of the Service Model.
  4. Lab Guy

    Lab Guy Well-Known Member

    You can see a lot of patients if trained Podiatry assistants working under the license of the Podiatrist is allowed to do routine foot care. The Podiatrist comes in after the assistant is left but most of the time consuming work is done and the Podiatrist can check for any new pathology, educate, et. Just as Dentists do not clean teeth, we should be able to have trained competent assistants to help us.

  5. twirly

    twirly Well-Known Member


    I am unsure how regional care provision in Australia is allocated & funded. The wording indicates this is perhaps a government/healthcare funded scheme?

    If this is the case is it not possible to press for further funding to expand & employ more podiatrists & assistants? Even on a temporary contract until the situation is resolved.

    I appreciate funding is a never ending problem.....:bash:

    (Could always sack some bosses to create some revenue) ;)

    It is so demoralising trying your level best to juggle an already overwhelming existing case load + squeeze in new patients!

    In reality one pair of hands can only possibly do one job. If you & your colleagues are spread too thinly then staff morale becomes none existent.

    Good luck. I know locally our NHS waiting list for new patients once exceeded 2 years!

    Kind regards,

  6. Backdoorpod

    Backdoorpod Member

    Yes, it is a community healthcare facility. Sadly, we have been advertising for a new pod for a year and no applications! Fingers crossed there are some new grads looking for a job!!

  7. pgcarter

    pgcarter Well-Known Member

    Community health service in Aus was never intended to provide service like routine nail care. It was meant to be for people with real health problems who could not afford to access private practice. Due to philosophical cowardice it is evolving into "access for all" and due to funding issues it has degenerated into community health services poaching clients from private practice because they now want/need to make money out of DVA gold card, health insurance or workcare/TAC patients. It is just plain weakness on the part of your intake section if lots of routine footcare people are left with the impression that they have a right to service.
    None of our governments ever said that they would provide toe nail cutting service for people without major health care problems, podiatry provided to those people was meant to save money by heading off worse problems before they occur. Everyone else was meant to look after themselves.
    regards Phill Carter
  8. Tkemp

    Tkemp Active Member

    I sympathise. I arrived at my job to find no podiatrist had been there fore almost 18 months. Clinics had to be started from scratch, waitlists had been suspend, etc.

    I started by allocating 2 mornings to ulcers and nail surgery, then had to put all new clients into other slots for 2-3 months until the review periods came round again.
    Then I allocated 3 mornings to reviews and 4 afternoons to new clients. The friday afternoon was kept for orthotic manufacture and admin.
    Once I had been working for 6 months and the original waiting list addressed the books were opened for new clients.... and rapidly filled.

    In the meantime there is a EPC service GPs can use to refer to private podiatrists and the client is eligible for 5 free treatments a year. You need check if local podiatrists are willing to accept EPCs though.

    Then one AHA was trained for RNC and double chair clinics started. This reduced the wait for review appointments. Now I run two double chair clinics -15 mins appointments with the trained AHA, and 20 mins with the other AHA who gets them in the chair, cleans their feet and sees them out after.
    This has drastically helped.
    So now i have reveiws monday, wednesday and thursday all day. Monday and wednesday afternoon are new clients, tuesday and friday morning are ulcers and nail surgery, and tuesday afternoon is rural clinic.
    Every month I take thursday morning for an Indiginous foot health clinic.

    This system has taken refining but now works a treat and our waitlist has reduced to point that we are only booked 2-3 weeks ahead and new clients are booked straight in.
    Review clients have to call 2 weeks before their next appointment to book. So we have room to adjust for emergencies, sickness, etc and not have a backlog of appointments to adjust.

    We dont take Gold cards, or veteran cards, we only take Health care card holders. Those who have gold cards or private insurance have to go privately as they can afford to do this. Intake ensures the correct clients are put on the list and advise accordingly.

    We dont do home visits and had to stop nursing home visits as these take too much time and there are private clinicians willing to undertake this work.

    So its adapting your clinics for the clients and surrounding area and adjusting as required. it wont fall into place straight away but once its sorted it'll be a weight off your shoulders... and always keep one afternoon for the admin, etc as you'll be snowed under and end up with burn out if you dont.

    Good luck and I hope you get it all sorted
  9. Backdoorpod

    Backdoorpod Member

    I agree. We are a HACC only funded service only. So, technically all the patients we curently see are on a healthcare card and/or have a disability. We do not treat anyone with private insurance, DVA or TAC. Unfortunately, it is the definition of disability that has been up for much debate.

    I am trying to evolve the clinic into a chronic disease model. Just trying to have a concrete tactic before I present to the powers above...

    You have provided some food for thought. I am just trying to find a diplomatic way of presenting it...


  10. Backdoorpod

    Backdoorpod Member

    I like your idea of having the patients call for a review. I think that is where we are falling down, we are booked too far in advance. I work at a different site everyday so, it makes it a bit tricky.

    Thank you for your insight. I am going to collaborate some of these ideas to find a model that works!!

  11. Tkemp

    Tkemp Active Member

    you're welcome. I am willing to be a sounding board for any ideas.
    Good luck with presenting your case and if all else fails remember the adage that a Podiatrist with a short waiting list and a breakdown is worse than a longer waiting list and a happy podiatrist :) ....... that was my final reasoning and it worked
  12. Backdoorpod

    Backdoorpod Member

    Hahaha! You described it perfectly!

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