The Atlas of Shared Learning

Case study

The Centipede Club, a community hub for older people with leg ulcers

Leading change

Nurse leaders at Cornwall Foundation Trust in Penwith launched The Centipede Club. This was a new community hub for older patients with leg ulcers. The club has been positively received by the patients and is achieving good outcomes and delivering efficiency savings.

Where to look

Community nursing services in Penwith were under pressure. Senior nurses conducted a caseload audit, which showed high workload levels related to leg ulceration visits and patients had slow healing rates. Many were however ambulant with support and could have attended a group.

A review of care plans identified unwarranted variation in the use of compression therapy; this was linked to inconsistent Doppler testing due to time pressures. There was also unwarranted variation in treatment plans and dressing use. Nursing leaders recognised there was too much emphasis on a reactive response, rather than preventing patients declining into greater health and social care service dependency.

What to change

Time and workload pressures were causing unwarranted variation in clinical practice. Often nurses changed treatments because the correct dressings were unavailable. Discussion with patients showed that they were low in mood and many experienced feelings of loneliness and isolation.

In Penwith alone, monthly leg ulcer dressings were costing more than £30,000. A one-week audit of community nursing showed 127 visits were made to patients’ homes, consuming more than 60 hours of clinical time and a further 15 hours in travel. Nursing leaders resolved to create a community hub model, releasing additional time to care and creating new social networks with patients.

How to change

Senior nurses conducted audits into their own service and visited and scoped clinical and social models used elsewhere in the South West. They explored the concept of a hybrid model – mostly social, with an initial assessment in a clinical environment. They then held a local conference to engage support from strategic partners who after considering the outcomes of all the models agreed on the Hybrid model for implementation.

The result was The Centipede Club. Patients referred into the leg ulcer service are asked to attend an initial clinical assessment which includes Doppler ultrasound and blood tests. They are invited to also attend weekly group meetings in a relaxed café-style setting in a community location. If more frequent dressing changes are required then attendance later in the week is arranged in the health clinic or at home.

At the club, no appointments are required. Patients are treated whilst they sit together, with a separate room for those wishing to be seen privately.  People continue to be seen even when their legs are healed. Tissue viability specialist nurses attend the group, updating the knowledge and skills of all the staff involved and the therapy services on offer.

The Centipede Club has a wider prevention remit too. Group members are offered an invite to a monthly healthy ageing clinic. Here, support is offered by a team led by a Frailty Nurse to empower them to understand and manage their long term conditions. Community matrons also run a weekly wellness café, providing for guided conversations and the informal sharing of health-related information for those who need further assistance to manage their conditions.

The club has brought care closer to home, in line with the principles of the Five Year Forward View. Similar groups are now developing in other parts of Cornwall in a variety of settings.

Adding value

An audit of patients was carried out as a benchmark at the start of the Centipede Club and followed up several months later. Further audits will be undertaken to assess clinical outcomes and impact on issues such as social isolation.

Better outcomes – Regular auditing at The Centipede Club is showing leg ulcer healing by six months, now reaching rates up to 25%, compared to national rates of 9% (Guest et al, 2012).The first healed ulcer occurred 14 weeks after opening. The patient’s previous ulcer had taken two years to heal. .Another patient said: “This is the closest I have ever been to healing”. The reoccurrence rate of leg ulcers in the first six months of The Centipede Club running is 3% compared to the National average of 46 % ( Vandongen and Stacey 2000)

Better experience – Patients have provided positive feedback about the relaxed and friendly nature of the group meetings, compared with more formal clinical encounters. Staff say they love working at the group and are more confident in applying compression bandaging.

Better use of resources – The Club has led to fewer home visits and significant efficiencies in workforce deployment. A reduction in such interventions and staff travel time has released quality time for both nurses and patients.

Challenges and lessons learnt for implementation

Starting something new takes time and requires learning and patience. Using a conference format proved a good way to get the message out county-wide, and patient stories are especially powerful in this regard.

Challenges have centred around securing equipment, encouraging volunteer involvement and sourcing transport, to bring patients from their homes to the group. When setting up a new group, it is important to research these issues and to find out how many people cared for at home would want to attend.

Find out more

For more information contact: