Quality Assurance

Foot Pain Consultant Birmingham - Podiatric surgical services at Spire Little Aston Hospital

Standards – evidence of quality and safety

“Knowing that your clinician is safe to practise”

So how do we go about ensuring that we are safe? The best way is to seek evidence. In this section you can look at key areas where we have to submit evidence to remain in practice.

The HCPC – national regulator for allied health professionals

All professionals acting within healthcare have to register to practise. Their probity (record of suitability to practise and responsibility in actions) is judged by independent people through the government regulator. In the case of podiatry this is the Health Care Professions Council or HCPC. Any person not certified to practise cannot work in the NHS or at a hospital such as Spire. You can check the register for current status of professionals. www.hpc-uk.org/check 

Care quality commission

Spire Little Aston Hospitals comes under a regulator of its own called the CQC or care quality commission. All staff who work at the hospital providing patient care must lodge their current certificates which includes CRB (police checks). www.cqc.org.uk/

Data Protection for patients when using information

It is important to protect patient data. I am registered with I.C.O a data protection register which requires annual retention. Quality assurance uses PASCOM-10 registered to The Society of Podiatrists and Chiropodists.

The Society of Podiatrists and Chiropodists*

Each professional body also provides internal regulation and ensures that training is offered on a regular basis through continuous professional development. The Society has a Professional Conduct Committee which can arbitrate for patients. Podiatrists are expected to maintain their skills. www.feetforlife.org

*Chiropody is the old name for modern podiatry and was used as far back as the 18th century. Chiropody today is used more for the commercial sector of foot maintenance care rather than medical management of the foot. There are no institutions training toward Chiropody since 1990’s when degrees in Podiatry replaced the older diplomate qualification.  

National data base PASCOM-10

Our clinical and surgical practise data base was first established in 1997. In 2010 this was set up as a national database to hold clinical activity for podiatrists practising surgery. Today the website is accessible to anyone although only trained members can look at patient data which is also accessible on request by individual patients. Some national reports are included and your podiatric surgeon is fully registered and audits his patient data each year. The information and fact sheets used on this website are taken from the database called PASCOM-10. www.pascom-10.com On the home page select information pages and see the latest reports posted by the College of Podiatry, Directorate of Podiatric Surgery.

Appraisal

Unlike medically trained surgeons who now have to satisfy the GMC by appraisal from 2012, the HCPC does not mandate that Podiatrists have to follow the same process. Spire Hospital Little Aston now require all podiatric surgeons have an appraisal meeting the same standards as medical practitioners at their hospital. Mr Tollafield has to submit a 360 report to the hospital every 5 years (last submitted July 2013) as evidence that his patients and those working with him can comment on his performance every five years. His last submission was in 2013. His last appraisal was 26th August 2014 carried out by Mr Simon Mellor FRCS.

Manchester-Oxford Foot Questionnaire – MOXFQ

This is a patient measure of improvement in walking, social impact and pain associated with their foot complaint and is recorded at the beginning of your treatment, then again later on. The values show high is the problem and impact is poor or worsening or low if there is improvement. The MOXFQ is known as a Patient Related Outcome Measure and is now a national standard for foot surgery, especially bunion surgery.

Patient satisfaction (PSQ-10)

Patients satisfaction is a term that might seem rather evident. Yes or no might be appropriate. We go further and ask 10 questions about your (surgery) treatment. At Spire I  randomise my audit annually and look at meeting you aims, success of your treatment, pain control, management of any problems, would you be prepared to have surgery again? The pascom website information pages will provide the questionnaire in full on the home page www.pascom-10.com

Scoring the PSQ-10

Under normal circumstances we all believe that 100% is the best score. PASCOM-10 does not work like this although 100 as a mark can be attained. 70 is a benchmark score for all treatments.  Any mark over 70 is considered satisfactory. The bigger the surgery the longer the recovery and return to footwear so marks are deducted for this reducing the score. We can liken this to a speedometer. A speedometer may read 140 mph on the gauge but of course the speed limit varies for each road we drive on.

Negative Performance Indicators (NPI)

This are conditions that arise following surgery, such as pain, swelling, numbness, scar line pain, deep vein thrombosis, delayed healing, complex burning pain, further surgery. The risks are written onto the consent form and information fact sheet 40 is issued to highlight the risks.Copy and paste to see full paper. Select Page 24, Section 14. https://www.pascom-10.com/assets/content/PASCOM-10%20User%20Guide%20v1.02%20August%202014.pdf

Post operative expectations and problems (40)

Many conditions are expected but have low impact. Some arise very infrequently and have a high impact. These are measured for all patient activity and can be provided to any patient or agency for this practice as part of full transparency. The information is held on our database PASCOM-10

Thanks for reading: Quality Assurance. Consulting Foot Pain – David Tollafield, Birmingham