A different approach to community care 

Community podiatry services are managing growing numbers of patients with complex needs. Many people we see are living not just with foot problems, but with diabetes, vascular disease, frailty and other long-term conditions. 

Their needs do not always fit neatly within the boundaries of individual services. 

At Surrey Downs Health and Care Partnership, this led us to ask whether there was a different way of providing some aspects of community care. 

In July 2024, following six months of planning, we held our first Community Assess and Support Day (CASD). 

The idea was to bring different services together in one community setting, giving patients access not only to clinical assessment but to wider support that could help them manage their health. 

Podiatry, musculoskeletal and diabetes teams worked alongside community organisations to develop the model. 

Since then, we have held seven CASDs in venues including leisure centres, libraries and sports clubs. 

What happens on the day? 

Patients waiting for appointments in podiatry, diabetes and MSK services were invited to attend. Members of the public could also come along for advice and support. 

Each person received a patient passport and met a clinician for a "What matters to you?" conversation. 

Rather than beginning solely with the condition or referral, this gave us an opportunity to understand what was important to the individual and identify other factors that might be affecting their health. 

Depending on what emerged, people could then be introduced to other services and community organisations attending on the day. 

These included support for physical activity, lifestyle change, mental wellbeing and social prescribing. 

For patients who might otherwise have needed several separate appointments or referrals, some of those conversations could happen in one place.  

Where does podiatry fit? 

Podiatry has been part of the CASD model from the beginning. 

As well as assessing and treating foot and lower-limb problems, podiatrists could identify other health needs and, where appropriate, introduce patients directly to colleagues from other services. 

Working alongside diabetes and MSK clinicians also created opportunities for joint assessment. 

This was particularly useful where a patient's needs crossed traditional service boundaries. Rather than making another referral and asking the patient to wait for another appointment, clinicians could sometimes discuss the problem together on the day. 

It also gave us an opportunity to think more broadly about the role podiatry can play in prevention and management of long-term conditions.  

What happened to waiting times? 

Seven CASDs have now been delivered over an 18-month period. 

Across those events, 237 podiatry patients attended, with 39 discharged on the day. 

The service also saw its podiatry waiting time fall from 21 weeks to eight weeks. 

Among patients attending CASD, the follow-up ratio was 0.3, compared with an average of 2.04. 

Almost half – 47% – were subsequently managed through patient-initiated follow-up (PIFU), while 22% required a conventional podiatry follow-up and 10% completed treatment and were discharged. 

We also saw fewer onward referrals to physiotherapy because some patients could receive joint assessments during the event. 

These figures are encouraging, although they need to be understood in the context of the wider service and the relatively small number of CASDs delivered so far. 

Taking care into the community 

The location of the events has been important. 

Rather than holding CASDs exclusively in traditional healthcare settings, we have used community venues including libraries, leisure centres and sports clubs. 

Around half of the events have taken place in areas experiencing greater socioeconomic deprivation. 

This reflects a wider aim to make services easier to reach and to connect healthcare with organisations already working within local communities. 

The approach also fits with the NHS's developing neighbourhood health model, which places greater emphasis on prevention, care closer to home and multidisciplinary working. 

What have we learnt? 

Setting up CASD was not straightforward. 

The first event required six months of planning and depended on collaboration between clinical teams and community organisations. 

But seven events have given us an opportunity to see what works and where the model can improve. 

One lesson has been the value of having different professionals in the same place at the same time. A patient's needs do not necessarily correspond to the organisational boundaries between podiatry, MSK, diabetes and other services. 

We have also seen the value of asking what matters to the patient before deciding what happens next. 

And bringing community organisations into the model has allowed us to offer support beyond what an individual clinical service could provide alone. 

Where next? 

CASD is still a developing model. 

Our experience so far suggests that bringing services together can help some patients reach appropriate support sooner and reduce the need for routine follow-up. 

For podiatry, it has also provided an opportunity to work differently – alongside other clinical teams, closer to local communities and with greater emphasis on the wider factors affecting people's health. 

The next stage is to continue learning from the model and understanding which elements can be sustained and developed further. 

References and links 

Fit for the Future: 10 Year Health Plan for England 

NHS England Neighbourhood Health Guidelines 2025/26.  

About the authors 

Laura Price is a clinical lead podiatrist at Surrey Downs Health and Care Partnership and an operational manager.  

Nevena Hristova is a business support manager at Surrey Downs Health and Care Partnership and a CASD project manager.