The MSK Virtual Foot & Ankle clinic was established as a preferred means of escalation for MSK Podiatry patients with the intention that this would not only allow for rapid escalation for an Orthopaedic perspective, but also to provide opportunity for peer to peer and group learning. There is a further benefit to the service of a temporary pause of referrals at a vetting stage to more confidently ensure and implement a principle of 'getting it right first time' for the patient. 

Ultimately the intention of this clinic is to make for a more effective management of patients, allow greater efficiency in service provision regarding the patient journey, and create a learning environment that is psychologically safe, whilst being necessarily robust in its effective

How to presentation your patient at the virtual clinic

• Send any photographs to be presented ahead of appointment date,  sending them to our Extended Scope Practitioner podiatrists.  

• These can be brought up on screen when discussion takes place. 

• Pictures to include the specific area of concern, the specific foot, and the other  foot for comparison

• Introduce the patient with name, age and occupation  

• Discuss what they presented to clinic with, include date of initial  presentation and who initiated first referral (Gp, DM nurse, self referral)  

• Provide brief medical summary including history of DM, neuro issues, diagnosed OA, RA (clinical portal summary, discuss any links with current  condition)  

• Discuss any recent x-rays and results  

• Discuss recent vascular review include own checks and if any referral  and results from vascular/cardiology depts)  

• Discuss other service interactions, including orthotist, physiotherapy,  vascular, cardiology  

• Discuss what treatments have been attempted, include offloading, and  orthotics, and what the results have shown  

• Discuss why patient has been referred to orthopaedics and what your  thought are on what may be required  

• Have patient information (EPR notes ) to hand to answer any questions  regarding current podiatry care that has already taken place, and  remember you know the patient far better than the other members  taking part in the virtual clinic discussion. 

• Keep discussion brief for each  area, as there is only around 15 mins for discussion of each patient

Principle Operative Objectives of this clinic 

• MSK Podiatry Leads and ESP Podiatry staff will look to maximise the efficiency of escalation/de-escalation at the interphase between the Community Podiatry and Extended Scope Practitioner Services. 

• A weekly opportunity will be afforded to develop this strategic objective 

• Orthopaedic from the ESP Service will provide an Advanced Podiatry opinion in the context of musculoskeletal orthopaedic care 

• Orthopaedic staff will facilitate conversations around investigation, imaging and management of patients brought for discussion around suitability for Orthopaedic input 

• Education will be a key component of the clinic with every effort being made to ensure a psychologically safe environment 

• Discussion principles and format will follow those encapsulated by the acronym BRAN (Benefits, Risk, Alternatives, Nothing) to ensure the principles of Realistic Medicine are embedded in any subsequent shared-decision making interactions with the patient 

• Broader principles of MECC (Making Every Contact Count) will also be explored to ensure a holistic approach