Letters

Foot morbidity and exposure to chiropody

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7144.1608a (Published 23 May 1998) Cite this as: BMJ 1998;316:1608

Purchasers still need to decide about investing in foot health care

  1. Quentin D Sandifer, Consultant in public health medicine,
  2. Jan Davies, Manager
  1. Iechyd, Morgannwg Health, Swansea SA1 1LT
  2. Podiatry Department, Barry Hospital, Barry CF62 8HE
  3. Lifespan Health Care Cambridge NHS Trust, Cambridge CB1 5EE
  4. Centre for Applied Medical Statistics, Department of Community Medicine, University of Cambridge, Cambridge CB2 2SR
  5. Department of Social Medicine, Canynge Hall, Bristol BS8 2PR
  6. Department of Dermatology, University of Wales College of Medicine, Cardiff CF4 4XN
  7. Centre for Applied Public Health Medicine, Temple of Peace and Health, Cardiff CF1 3NW

    EDITOR—The paper by Harvey et al shows that the organisation of chiropody services in many parts of the country requires greater consideration by purchasers.1 Unfortunately, foot health problems remain of low status. Even in 1995, four years after Harvey et al carried out their study, over half (52%) of those needing chiropody in South Glamorgan had waited over 12 months for treatment after having received an initial assessment by a chiropodist and been assigned to a waiting list. Of these, nearly 12% had severe foot disease.

    South Glamorgan (now Bro Taf) Health Authority responded by extensively reviewing chiropody services and is currently implementing radical changes to the delivery of care. Key features of the service change since 1995 are:

    • Referral from primary care only

    • Introduction of packages of active care

    • Improvement in skill mixing

    • Increase in patient and professional education and training

    • Reorganisation of clinics to realign the service with primary care and reduce the requirement for domiciliary care by developing transport arrangements for patients

    • Abolition of priority groups and opening of the service to all patients on the basis of clinical need

    • Introduction of surgical podiatry, supported by orthopaedic surgeons interested in forefoot surgery.

    Access has improved (measured by waiting times), and the types of problems referred indicate that foot disease rather than patient demand is starting to drive access. For …

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