“You have to understand GP practices are businesses, and have to operate in that way as making money is one of their priorities.”
This may sound obvious, but it wasn’t until Carol Hedger, a tissue viability nurse specialist, showed me the effect this has on some practice nurses and their patients, that I realised the true impact of this statement.
GP practices receive funding for treating asthma among other conditions and for the number of flu jabs they administer, very little funding is allocated to wound care. Patients with chronic wounds are unlikely to be referred to a specialist clinic and tend to be managed in the community.
Frustrating for a nurse like Carol who is desperately trying to make people see that long-term wounds are both avoidable and treatable. Once you find out why a wound isn’t healing, the patient’s quality of life can be improved considerably.
Like most specialist nurses, Carol’s caseload is simply too large for her to offer individualised care herself. Her priority has to be on educating nurses and patients. Carol visits practices and works with practice nurses to identify the causes of chronic wounds and teach them to assess why wounds aren’t healing.
When a woman attended Carol’s clinic with painful cellulitis, she discovered that both the doctor who had originally seen the patient, and the nurse at the follow-up appointment, had not assessed for oedema – a high risk factor for cellulitis. Luckily for this patient Carol did assess and was able to plan care appropriately.
Similar patients attend some practices week after week with little or no change. They are offered alternative dressings but the underlying problem is not assessed.
As Carol puts it: “It isn’t the dressing that heals the wound, it’s the body. If a wound isn’t healing you need to be asking why and treating the problem, not the symptom.”
Sound advice, but is this possible in a 10 minute appointment? And with funding diverted elsewhere, do practice nurses receive enough training to confidently assess the underlying conditions of chronic wounds?