Clare Mechen: Opening a great Leg Club

Initially in practice we we have a high proportion of patients with lower leg problems and it was taken we found that it was taking a large amount of our time in practice in our treatment room time to to treat these patients and when I looked it was about 50% of our workload and in general practice we have to do so many other things and so therefore it's sort of a light bulb moment of thinking How do we do something different? How do we, despite our patients getting excellent care in surgery, being seen by tissue viability, we didn't seem to be progressing very fast. It was how we could do something different. And with that, we came about the Lindsay Leg Club Foundation and found out about it. And I wanted to find out more, so I went to visit Bradford-upon-Avon Leg Club, and I took a GP colleague with me. And that was a really inspirational visit. It taught us a lot and gave us a lot of ideas of how we could develop our own leg club for our own community, looking at our needs. So we came back and put a proposal to our GP partners in the practice to say this is our idea, that we wanted to open one for our patients. And they were very supportive, really liked the idea of the concept and the model of care. So we then put in a proposal, business proposal to our local clinical commissioning group who thankfully were very supportive and again really liked the idea so they gave us some setup costs which mean that therefore we then had the backing and the funding so the next thing I had to look at was trying to get some volunteer committee which I've never done anything like that before that was probably I would say the most daunting part for me personally but actual fat turned out probably be the easiest. What we did was we had a couple of coffee mornings along with my nursing colleagues who were also very keen to look at opening a leg club and we got a couple of key really key volunteers and they themselves then found other volunteers went and spoke to their friends their families and the volunteer committee was formed and that really happened after a couple of just a couple of coffee mornings so that was quite quite good. Then the next role was we had to find premises and buy equipment. Finding premises was a little bit more difficult because it's a storage that was a bit of an issue but we found a lovely new church hall and they were very receptive to us coming in and helped us with the storage. So after then finding all of buying the equipment and then looking at all of the risk assessments infection control manual handling which a lot of people will always question about infection control in particular with the support from the LegClub Foundation which gives very thorough and informative evidence based risk assessment for you and guidance on infection control. We then liaised with our own local infection control nurse team for advice and we developed our own guidelines then. So in October last year we opened the doors. I think we're all a bit like startled rabbits in that first day but from within a few weeks we could see how the leg club was developing and very soon our members were calling it our club. They were forming friendships, people didn't know each other before, they were exchanging phone numbers and arranging to meet people the next week and you could really see the social aspect coming out and the improvement that was coming from that. And we found over the last 11 months the club has really developed hugely. We have on average 35 to 40 members each week and relationships have been formed, the buzz, the chatter that goes on, patients, the members there really get a lot out of it. Some say that whatever, whether it's rain and snowing, they will be there, whatever. We've had some really good success on both the clinical care, patients that were needing to have their legs treated virtually five days a week and now because they're coming along to the leg club, I've basically only been seeing once a week at the leg club, have legs that are now almost either healed or almost healed because they're compliant and their participation in their care. The social aspect is fantastic. Our volunteers are very proactive and they did a tea party for the Queen's 90th birthday birthday, which had a really big spread and Union Jacks all over the place. They've been out on, they've arranged harbour trips around Poole Harbour. They did two trips around Poole Harbour, which the members loved. They've been on a trip to a market and have a cream tea. And they've got lots of ideas that they want to do. Next plan will be hopefully for our one year anniversary, which will be, I think the volunteers are planning to do a fish and chip night, sorry lunchtime, and yeah with lots of other ideas of activities. The volunteers do a raffle every month which is an amazing raffle that they provide, one of our volunteers provides everything for the raffle and that raises good amounts of money. We have another volunteer who is undertaking planning a big concert for us in aid of the leg club which is hopefully going to run it which will be in October and all that money will come back into the leg club. So the fundraising as much as there's concerns about continuing the club and and how you fundraise is actually that the volunteers are absolutely key in there. I have to say since we've started the club not one of our members has asked to be in a private area they are very very generally very happy to sit next to each other and have their treatment because they actually find it quite therapeutic to be able to chat to other members but they are all given the choice and when they come along when they first come along we explain the setup that it is generally the clinical area is in a sort of open area but they they have the ability to have a screened off area if they choose to. With regards to data we collect all data of everybody that attends each week. We complete the Leg Club Foundations audit which is done as to why they've attended. So for example they've attended for a complex leg ulcer that's documented obviously which leg it is and it's documented on when their next visit. If they then are healing once they go they can go into the well leg regime and again that's documented on the audit sheet and then hopefully the idea of their next visit is recorded depending on their needs. And then that data is then sent back each is from the patient's information is put onto a master copy and none of the information has the patient's details and each patient is given a number. So it's completely anonymous. And then that information is put onto a form that is then sent back to the Leg Club Foundation so that we can monitor healing rates, we can monitor attendance, any indication of any infection and that helps provide the evidence for the continuation of the leg club and hopefully what it achieves. We also keep our own clinical notes and maybe slightly different to other leg clubs is we We actually use laptops via Wi-Fi, and we actually link into our clinical notes within our practice. So we keep very minimal handwritten notes so that we're not actually duplicating. So all our clinical notes for our patients go directly onto the patient's notes, which are in the system, the computer system linked in with the surgery. So that way we have continuity, so even if the patient is then being seen in surgery at a different time, we have complete continuity in that respect. So we find that works really well for us. I think if anyone was thinking of developing the idea of a leg club, then my number one thing would be go for it. You really can improve your patient care and the well-being of your patients. And I would say that there should be no barriers to it. My motto has been, if you don't ask, you don't get. So don't let there be any hurdles to developing a leg club. And in my view, I think every town, every area needs a leg club because it's so beneficial. We've seen such benefits from it. So one thing we're doing looking at the future is we've just got ethics approval to undertake a small study which is looking at the well-being of our members following this within this model of care which we hope will demonstrate the whole holistic approach that this model of care has because we've certainly seen that it has very much improved the overall well-being of our members. So hopefully that will be in the near future and then will be published.