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How do you motivate patients with stubborn leg wounds to comply with treatment regimes?

Clare Mechen describes how her GP practice engaged patients and freed up practice time.
leg club

Clare Mechen describes how her GP practice engaged patients and freed up practice time.

At the Dorset GP practice where I work as a nurse manager such a high ratio of patients had lower leg ulcers or legs that would not heal that half of the clinical practice time was devoted to these problems.

Our figures reflected national data indicating that 55% of patients have had leg ulcers for longer than a year, but with treatment rooms full daily and practice nurses struggling to keep up, we needed a rethink.

We knew about well-established Lindsay Leg Club Foundation, which enables patients to become partners in their own care. To get further information about how it works we visited an established leg club at Bradford upon Avon in Wiltshire, the first leg club in the country led

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Clare Mechen describes how her GP practice engaged patients and freed up practice time.

At the Dorset GP practice where I work as a nurse manager such a high ratio of patients had lower leg ulcers or legs that would not heal that half of the clinical practice time was devoted to these problems.

leg club
Leg club in action. Photo: Chris Balcombe

Our figures reflected national data indicating that 55% of patients have had leg ulcers for longer than a year, but with treatment rooms full daily and practice nurses struggling to keep up, we needed a rethink. 

We knew about well-established Lindsay Leg Club Foundation, which enables patients to become partners in their own care. To get further information about how it works we visited an established leg club at Bradford upon Avon in Wiltshire, the first leg club in the country led by primary care nurses.

Our visit inspired us to set up our own leg club. With the support of GP partners, a business plan was developed and we secured set-up funds from our clinical commissioning group.

Over the next few months we liased with the founder of the Leg Club Foundation, Ellie Lindsay, who provided support and advice.

Paving the way for patients

We agreed on a vision for an integrated and collective approach to care with the local district nursing team. It was felt that patients being treated at home are isolated and would benefit from being treated in a community based leg club.

As several patients, who were being cared for by the district nurse team, were unable to leave home without assistance and appropriate transport, we sourced a minibus with disabled access facilities.

This transport proved essential as without it these patients would have stayed at home.

When last October we opened our club, by now called the Best Foot Forward Leg Club, we felt like rabbits in the headlights.

Some clinicians and patients wondered if treating people in a non-clinical environment where they were sitting next to each other would work. 

Dispelling doubts

But these doubts were dispelled in the first couple of weeks as we began to see members sitting happily together, offering each other an understanding only someone with personal experiences of lower leg ulcers could. Witnessing their willingness to support and advise each other was rewarding.

It was soon apparent that the club was changing many of its members’ lives, not just demonstrating good clinical care but addressing the social wellbeing of members too.

One older woman, who had been walking with the support of a frame, had not left the house for three months. Thanks to the support of the minibus driver, she began attending the club every week.

Instead of being isolated at home, she was able to sit for a couple of hours with her new friends.

£400 million

Venous leg ulceration is estimated to currently cost the NHS

Soon we were seeing members’ improved compliance in treatment care plans. In particular members with long-term ulcers’ healing improved. Initially some patients turned up in pain, struggling to look after themselves and feeling desperate because of their lower leg problems. 

Addressing the social isolation often associated with lower leg ulceration meant we were able to support patients to self-manage their condition.

There were benefits for staff too as the nursing team were able to work together, discussing ideas or suggesting changes with each other and members to aid healing. Nursing staff gaining competence in leg ulcer management have been able to work alongside experienced colleagues.

And there was an impact on surgery treatment room demand, with time freed up for other nursing needs with a significant reduction in time spent in treatment rooms across the practice.

Growing pains

Just eight months after opening we have more than 120 members. The club is growing so fast that new, larger premises are being sought. Once we are in our new home we hope to be able to introduce weekly armchair exercise and health education classes.

In future we hope to take part in a research project on improving compliance and wound healing and reducing low mood/depression and the need for medication. 

With continued investment we hope to evolve different elements of the club focusing on needs of our members and the local community.

We have shown how a GP partnership and integrated working with our district nurse team can take the leg club model and develop it to meet the needs of the community – and already our local clinical commissioning group is discussing setting up another leg club in the area.

The Lindsay Leg Club Foundation

Former district nursing sister Ellie Lindsay came up with the innovative concept of wound management through community social groups in 1995.

The Lindsay Leg Club Foundation started in 2004 and received charitable status the following year. Set up for patients with leg ulcers and associated conditions, patients are encouraged to take ownership of their own care.

For more information on the Lindsay Leg Club Foundation go to www.legclub.org


About the author

Clare Mechen

Clare Mechen is a nurse manager and advanced nurse practitioner at the Adam GP practice in Poole, Dorset

 

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