MSK toolkit
Theme 4: Costing

Establishing a secure model for costing MSK podiatry services is a difficult task to create for a nationwide template. This challenge is driven by historial and geographical negotiated contracts and is limited by previous agreements in service provision. Additionally, management of funds often falls under the umbrella of podiatry as a whole service, making it harder to define MSK costing. Adding to this model of provision, the newer role of an FCP podiatrist working in MSK is funded by the PCN that they are employed by. This budget and costing can vary depending on the requirements of the group but is often set at an NHS pay scale band 7 with scope to negotiate this pay grade with the employee.

Community trusts adopted different models of funding and can be managed on a block contract to provide care for all patients with which the podiatry service manager decides on how to allocate the funds for the whole service. This leads to discrepancies to what is included for MSK podiatry, with MSK team leads competing against diabetes, nail surgerys and general care to obtain funds to support staff development, equipment and core services. Other models include negotiated fees for assessment and follow up appointments. On average this is a flat rate fee, with no consideration of skill level and expertise. An initial appointment can be charged at £32.11 - £55 and follow up appointment £29.90. MSK podiatrists working in the community can be on an NHS agenda for changed contract brand 5, 6 or 7 depending on skill level and expertise.

Applying this costing to a model of patient contact enables context to be put to the figures. Exploring data collected from Torbay and South Devon NHS Trust between April 2020 and February 2021. [Appendix 1 Service Provision, Torbay Data.] Over this time, 2676 New Patients were seen, using a cost figure of £42.11, this would generate £112,686. At the same time, 885 reviews were which would equate to £26,261. Total income for the service over this time frame could have been £139,147. It is not clear from managing a service how this money then is allocated. Wages for podiatrists to run the service would need to be factored in along with running costs of materials, equipment, training and access to other facilities.

MSK podiatry delivered in an MDT as an outpatient does not have its own treatment function code and is often included into the physiotherapy budget for the Orthopaedic service it serves. Podiatrists can be employed under a physiotherapy contract and are often lists as band 8 advanced practitioner. Fees for a consultant-led service can range from £163-£180 for initial assessment with a review appointment fitting to pricing of £65-£75 per contact.