Re-issue of the summary of the Open Meeting July 2013 regarding podiatry services

At the 9 July 2013 DUKRT meeting Etienne van Niekerk, from Hounslow and Richmond Community Healthcare (HRHC) Podiatry Dept. gave us an update on changes within the podiatry services serving the borough of Richmond.

 The GP commissioning group has opened up podiatry services to both NHS and private practitioners by introducing the concept of AQP - any qualified provider. They must undergo a rigorous approval process by demonstrating that they meet the relevant standards and criteria.

There are now potentially four organisations providing podiatry services to patients registered with GP practices in LB Richmond. All will compete for referrals from GPs. Patients can choose which one to go to.

Patient choices within Richmond Borough are:

Health share Ltd,

Sheen Lane Health Centre

East Sheen, London, SW14 8LP

Hampton Hill Medical Centre

94-102 High Street, Hampton Hill, TW12 1NY

Hampton Wick Surgery

26 Upper Teddington Road, KT1 4D. 

Hounslow and Richmond Community Healthcare Trust,

Centre House

68 Sheen Lane, East Sheen,SW14 8LP

Richmond Rehabilitation Unit

22 Evelyn Road, Richmond, TW9 2TF

Ham Clinic

Ashburnham Road, Ham, TW10 7NF

St Johns Health Centre

Oak Lane, Twickenham, TW1 3PA

Teddington Memorial Hospital

Hampton Road, Teddington, TW11 0JL

Whitton Corner Health Centre

Percy Road, Twickenham, TW2 6JL


Ravenscroft Physiotherapy Centre,

Cross Deep Surgery

2-4 Cross Deep Surgery, Twickenham, TW1 4EA


Queen Mary’s Hospital,

Podiatry Services Admin

Queen Mary’s Hospital, Roehampton Lane, SW15 5PN

Annual check

Feet should be checked annually by a suitably trained healthcare professional e.g. GP, practice nurse, to assess risk. A referral to an AQP podiatrist may follow, either simply for advice and discharge or if there is a foot problem then you will be offered up to three follow-up appointments then discharged back to your GP, with a summary of your treatment. This AQP process repeats if further treatment is needed.

If you are at increased risk because of, for example, circulation problems or nerve ending problems you will remain under HRCH specialist podiatry care i.e. AQP is not applicable. You too should get a copy of the summary of treatment.

If the podiatrist feels that continuing treatment is required the GP will be informed by letter, copied to the patient, that the patient is still being seen and if they are discharged in future.

Low risk people with healthy nails will no longer be able to access a nail cutting service under AQP and they will be directed to other local paid for services e.g.  Ellery and Linden Halls day centres, Age Concern Kneller Hall if they are members.

(Ellery and Linden Halls membership is £25pa and £12 and £13 for treatment respectively. Age Concern is £15 pa and £19 for treatment.)

HRHC staff may be seeing both AQP and patients at higher risk at their clinics.

The appointments system is not changing and cards are still being sent out as in the past.

Risk Stratification

Patients should be told at their annual assessment what their risk level is. Ask for this information it if it is not forthcoming.

Checks for the following should be carried out

  • Nerve endings (pin pricks)
  • Sensory check with tuning fork
  • Two pulses in the foot
  • Visual inspection of the foot’s skin e.g. untreated hard skin, other skin changes  (darkness under the skin could be signs of ulceration or bleeding].
  • Foot shape or deformity (hammer toes, bunions)

Check out   on DUK’s website for more information

Low Risk

  • No neuropathy
  • Intact pulses
  • No deformity
  • No other risk factor

Moderate risk

One risk factor present e.g.

  • Some loss of sensation
  • +/- some compromised blood flow to the feet
  • +/- deformity
  • and/or other risk factors

High risk

More than one risk factor present such as loss of sensation or signs of compromised blood flow with callus or deformity.

  • Previous history of foot ulceration, minor amputation or Charcot foot

Active Foot Disease

Presence of active ulceration, spreading infection, critically poor circulation, gangrene or unexplained hot, red, swollen foot with or without the presence of pain, painful peripheral neuropathy, acute Charcot foot. Once these complications have been resolved the patient will go back to High Risk.