Introduction

We launched Botesdale Leg Club on Monday 13 May 2002 and are delighted with its success. We have on average 15-18 patients attending each week. The Leg Club is a unique partnership between ourselves (district nurses) patients and our local community. We have integrated working with our practice nurses, who join us bimonthly and the GPs drop in on an regular basis.

We rely on our kind volunteers to organize refreshments, raffle, setting up chairs and banking the money. As we function as a club the volunteers have set up a committee with a secretary, treasurer and chair lady and we have a meeting bimonthly. The accounts are audited yearly by an external auditor. The Club is self funded through a weekly raffle and donations towards refreshments. A friendly and happy environment has already developed in the Club.
 

Reflections

The setting up of the Leg Club has given me a wider knowledge of the community that I work within. Exploring resources and services available both voluntary and statutory. It has been interesting and a challenge organizing a group of volunteers to help run the Club. It has been interesting seeing relationships between the volunteers develop and the way they have taken on responsibility and ownership of the club. This was reflected in the wonderful Christmas lunch that was organized by them for the patients and nurses and the kind words that were shared. Obviously it has not come without some difficulties but I feel the bimonthly meeting has been very important opportunity to discuss any issues before they have become problems.

I have also found it challenging having to make sure that the Club became self funded, this was one of my greatest concerns as I did not know where the money would come from it we ran at a loss. We were cushioned by Friends of Botesdale Health centre who gave us the money for the first 6 months, this took the pressure off. It has also been a good experience for me applying/ bidding for resources in the community. I was delighted to receive a cheque for £500 from Suffolk County Council. I feel having support from the community has changed the ownership of the Club and I feel that ` health care has been taken to the heart of the community'. I feel that I have been innovative in providing a primary care services which `ensures that the patients receives the right care from the right person, in the right place and at the right time' (Liberating the Talents 2002) Although initially the patients were apprehensive about the Leg Club I was fortunate that they were prepared to support me, even if at the first session one patient came as it was my birthday! I felt it was difficult to explain to them how a Club environment could be achieved without a compromise on the professional service provided by the district nurses. There were also issues and traditions around the fact that we had been visiting them at home, same for many years and were now expecting them to get to a village hall. If it had not been for the British Red Cross transport we would have never got over the first stumbling block. As a result of the Leg Club and the empowerment of the patient with transport same of the patients who traditionally expected the GP to visit at home now come up to the surgery using the transport. It has also made the GPs reflect on which patients they visit at home.

We worked well together as a district nursing team before the Leg Club, but it has enhanced further our commitment to work together as a team, improving our knowledge of wound care and Doppler assessments. It is an excellent learning and controlled environment for the Students of nursing. It allows me to have a greater overview of all patients. The environment is easier and takes less time to complete a comprehensive assessment and Doppler than often in the patients house.

It is difficult to quantify the benefits to the patients but is has addressed the social isolation, rebuilding patients self-esteem and self-respect by destigmatising their condition. Relationships have developed in the Club, sharing telephone numbers and knitting patterns! This is an area I would like to audit. I have asked several patients to complete a patient satisfaction questionnaire. I feel the comments are very positive: ,

"I've met more people and I go out at least once a week"
"Made me talk for myself more"
"I can't see how it can be improved; because the nurses and helpers are kind"
"I enjoy coming-the company"
"Helped my ulcers to heal. I've met people"
"To spend a lovely friendly morning with friends and get my ulcer treated"
"Got one of my ulcers better and given me a morning to look forward to make new friends"
"It's better than the surgery"
"I met a rich widow"
"Made me realize that others are suffering also"

'Many of the most innovative developments rely on a combination of nurses' skill, knowledge, close relationship with patients and an understanding of the community' (RCN document Primary Care April 2002). 1 feel this combination is why the Leg Club has proved to be so successful. The way forward in District Nursing is the working across professional boundaries, forging new links with other health care professionals and colleagues and ensuring that the services provided reflect the needs of the patients.
 

Transport

Botesdale Health Centre covers a rural area approx 200 sq miles and 52 villages and the transport of patients to the club has been an issue. We are fortunate to use the Suffolk County Council Wheels within Wheels which is run by the British Red Cross. We have to ask the patients for a financial contribution towards the cost of the transport, which they appear happy to give. For a few of our patients their weekly trip to our Leg Club is their only trip out of the house
 

Funding

I was successful in putting forward a bid towards our local Suffolk County Council locality budget and received a cheque far £500 towards establishing the Leg Club and to help subsidise the transport. The cheque was presented by Charles Michell our local County Councilor to me on behalf of the Leg Club at Christmas lunch we organized for the patients at the Leg Club.

The Friends of Botesdale Health Centre have also supported the Leg Club and helped us financially with buying equipment and giving us the money for the first six months rental of the Hall. I was also successful in getting £336 from the Health Authority money which the Department of Health had targeted for setting up new initiatives. We also have a good rapport with our Scholl and Activa representatives who have given us a supply of hosiery, plus finance and products from the healthcare industry.
 

Referals

The Leg Club is open to anyone who has problems with their legs. These problems include leg ulcers, which need regular dressings, skin lacerations, eczema and treatment of varicose veins, assessment with the Doppler, measuring and fitting of support hosiery.

There are no appointment times and new patients can refer themselves by just dropping into the session- which they do with problems that they would not have felt necessary to make a GP or practice nurse appointment.
 

Treatment

With our patients that have leg ulcers we 3 monthly Dopplers and monthly check blood sugars, weigh and take blood pressures and photograph wounds.

We have a 6 monthly recall system for our patients who wear support hosiery when we Doppler and measure for before supplying them with 2 new pairs of support hosiery. We do have some patients that come on a weekly basis, to have their legs soaked in a bucket of water and support hosiery changed. These patients would otherwise be unable to wear support hosiery as they are unable to reapply the stockings. This obviously is very effective towards patient compliance, and prevention of and reoccurrence of leg ulcers . We put these patients into Class 1 hosiery, which is safe compression for them to wear for a week.
 

Audit

The Leg Club is audited every 3 months by an independent auditor Alan Davies. We are able to see how much the dressings are costing, who the patient is initially referred by, number of patients with infections, types of compression warn, age and sex of patients attending Leg Club and of patients healed.

Over the first 6 months period we heated 8 patients leg ulcers. We had 24 patients registered on our book; 9 active leg ulcers and 15 non active, of these 11 patients were in support hosiery.
 

Health promotion / extra activities

Pam Butcher community dietician came to speak to the Club this was well received and agreed would take place on a 6 monthly basis.

Christmas meal was organized on Monday 9'h December for all patients at the Club. This was very well received Aim when we have a full time community chiropodist to also invite them to provide same health information on good foot care, would like to see them involved with joint work.

Our community physiotherapist has also put together an exercise sheet for all patients and the Leg Club group has asked for an exercise session.

To find out more, please contact us.