In reply to Howards initial question,

In the UK a group of podiatrists from the North West have formed a
Clinical Effectiveness Group (CEG). These podiatrists all have
experience/ specialist posts in rheumatology and/or musculo-
skeletal diseases. The group came about following a CPD update
when an enlightened podiatry services manager caught on to the
fact that although we have many specialist services for patients
with diabetes there are few for patients with rheumatic diseases
and even less specialist posts.

The work of this group aims to support the global aim of improving
the care of patients with musculo-skeletal and rheumatic
diseases (The Bone and Joint Decade - Harris 2001). We use the
term rheumatic diseases as the broad term and this includes
auto-immune, metabolic and musculos-keletal disorders
The general aim of the CEG is to rationalise and improve the
quality of podiatry service that is provided to these patients
through the following objectives:
To  develop referral guidelines for patients with  rheumatic
    diseases.
To  review the assessment forms currently in use and
    design an assessment /screening form which includes the
    minimum requirements for podiatry assessment.
To  review the outcome measures available for the foot and
    incorporate outcomes as part of patient assessment and
    review.
To  develop standards of podiatry care for all patients with
    rheumatic diseases.
To  establish links with organisations such as British
    Health Professionals in Rheumatology, British Society of
    Rheumatologists and the Arthritis and Musculoskeletal
    Alliance.
To  identify the training and education needs of podiatrists
    working in this area and to link with educational providers
    (University of Salford, University of Brighton, PRCA, BSR,
    BHPR) to fulfil these needs. [The Podiatry Rheumatic Care
    Association is an independent organisation for podiatrists -
    currently with over 100 members and a very active committee-
     Cathy Bowen at the University of Brighton is the current
    Chair]
It is anticipated that through the above objectives,
Podiatristsof all grades within a service will have the
    framework, knowledge and confidence to screen and refer
    to specialist podiatrists in an appropriate and timely way.
    ( There is a very clear referral pathway chart which can be
    laminated for use in clinics)
The specialist Podiatrists in this area will manage those
    patients who have been screened as requiring their
    expertise and specialist skills
the specialist Podiatrist will be a recognised member of
    the rheumatology team
Consultantsand members of the rheumatology team will
    have clear guidelines for referring patients
The management of foot problems in this patient group will
    be based on available evidence and best practice.
The outcome of podiatry management for this patient
    group will be readily audited (locally and potentially
    nationally)
Since the group formed we have developed the guidelines which
have been subject to external review by members of PRCA and
BHPR and three consultants (who have been extremely supportive
and positive about the guidelines). The only negative comment was
that there is not much evidence for podiatry interventions apart from
the excellent work done by Jim Woodburn (and thank goodness for
his research and work in the early days establishing podiatry at a
national level)

The guidelines have been used by numerous trusts all over the UK
who are trying to instigate podiatry services for these patients and
will help to justify either diversion or new funds for these patients.

The guidelines are being embrased by BSR and BHPR and as a
result of the work by the PRCA podiatry will be represented on the
NSF working party for musculoskeletal diseases.

This is an extremely excting time for those of us who have been
working at both a local and national level to provide good services
for these patients.

Best Wishes

Anita Williams
Anita E Williams
Directorate of Podiatry
University of Salford
Frederick Road
Salford
M6 6PU
[log in to unmask]
0161 295 7027

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