Lower limb care in general practice: ‘It’s about giving people their lives back’

At the Adam Practice in Dorset, the work of nurses in lower limb care reaches well beyond the boundaries of the consulting room, shaping not just individual health journeys but the structure of care. This article is part of the Nursing in Practice How Nurses Count campaign.

Clare Mechen, nurse manager and advanced nurse practitioner, has been at the forefront of this shift for a decade, using nurse-led innovation to make lasting changes for patients, colleagues and the wider community.

Ms Mechen manages a large team of nurses and allied healthcare professionals across five sites, responsible for more than 41,000 patients. Her remit extends further as the professional nurse lead for Dorset General Practice Alliance and the Primary Care Training Hub.

‘I’m mainly non-clinical now,’ she says, ‘but that’s given me a bird’s-eye view of how nursing teams work, where the pressures are, and where we have real opportunities to do things differently. I’ve got the team leadership, but also the chance to influence at system level, which is so important for nursing right now.’

That elevated perspective didn’t come easily, though – it was earned through confronting those mounting pressures at ground level. Positive thinkers insist there are no problems, only opportunities – and they could easily point to the Adam Practice for validation of that theory.

Over half our nurse clinics were being taken up by people with lower limb wounds. Chronic leg ulcers, cellulitis, dressings, recurrent infections

Recalling the situation of a decade ago, Ms Mechen describes a practice ‘drowning in demand’. She explains: ‘Over half our nurse clinics were being taken up by people with lower limb wounds. Chronic leg ulcers, cellulitis, dressings, recurrent infections. The volume was unsustainable, and it meant we were struggling to see other patients for things like diabetes checks, asthma reviews, or prevention work.’

The statistics told their own story. ‘Our audit showed over 50% of clinical time in nurse clinics was lower limb work, and cellulitis rates were high. There were huge cost implications – not just for dressings and appointments, but for hospital admissions that could have been prevented.’

It was this challenge that led Ms Mechen to the Lindsay Leg Club model, a concept that puts wound care into a social, community environment. She visited a leg club in a neighbouring county with a GP colleague and was immediately impressed.

‘The minute we walked in, we were buzzing,’ she recalls. ‘The atmosphere was amazing. We looked at the evidence, and from that moment, we felt we needed to see if this would work for us.’

Related Article: Career change to GPN: ‘I wish more people knew what a great place it is to work’

Adam Practice’s Best Foot Forward leg club was born, opening in Poole, Dorset, in October 2015.

It offers care with a difference – not in a clinical sense, because everything follows national guidance and best practice. ‘The way it’s different is predominantly the environment,’ Ms Mechen explains. ‘People come to the club as members, not just patients. It’s open access, so they can drop in when it suits them during the session, rather than waiting for an appointment. And crucially, it’s not just nurses – they’re supported by volunteers who provide refreshments, run activities, and simply offer company.’

People stop going out, they don’t want anyone to see their legs or their dressings

Ms Mechen is passionate about what this shift means for patients who may otherwise be isolated or stigmatised. ‘We know that loneliness and shame go hand in hand with leg ulcers. People stop going out, they don’t want anyone to see their legs or their dressings. For some, it’s the only time they leave the house all week. The social aspect is just as important as the medical care – being able to talk, to have a cup of tea, to realise you’re not the only one going through this.’

She has seen lives change as a result. ‘Some of our members say it’s given them their life back. They might not see family, they might have lost partners, and suddenly they’re part of something again. They celebrate each other’s progress – when someone heals, the whole club cheers. That kind of encouragement is something no clinic can offer.’

The clinical results have matched the enthusiasm. An audit after the first year found the club had saved the equivalent of two full-time nurses’ worth of clinical time in the practice.

‘That’s not just a number on a spreadsheet,’ Ms Mechen observes. ‘It meant we could see more patients for other conditions, and that the time saved could go back into prevention and health promotion.’

The outcomes for healing and re-ulceration improved, too. ‘We hardly ever see long-term leg ulcers now, and if people do have a recurrence, they know exactly where to come for early support.’

Attendance at the club has grown steadily: ‘We started with 22 people at the first session. Now we have 55 to 60 every week.’ The success meant the club had to move to larger premises to accommodate demand.

Not everyone is there for wound care. ‘A lot come for maintenance, to check on their “well legs”, or just for the company,’ Ms Mechen explains. ‘Some will bring friends or carers, and it’s become a fixture in the community.’

The effect has been felt across the whole practice. ‘Our GPs noticed that some patients they used to see frequently, for all sorts of things, suddenly needed fewer appointments. Their overall wellbeing improved.’

When you deal with loneliness and anxiety, people feel more in control, and it reduces their need for crisis appointments, Ms Mechen observes.

She recalls: ‘One GP said to me, “I don’t see Mrs X anymore – what’s changed?” And it was the leg club.’

It’s not just about the patients – nurses benefit too

So while specific clinical outcomes are crucial, the true impact of the club reaches far beyond wound healing, in ways that are difficult to describe – but Ms Mechen makes a brave attempt at articulating it. ‘It’s prevention; it’s mental health; it’s social prescribing in action. It’s integration before it became a buzzword.’

Related Article: Nurse-led innovation: ‘I think nurses need to take the initiative’

And it’s not just about the patients – nurses benefit too, she insists. ‘General practice nurses are very autonomous, but that can also mean isolated. The club gives them the chance to work together, learn together, and support each other. We can bring in nurses who are developing their competencies, and there’s always someone experienced to discuss cases. It’s a space for sharing and growth.’

The multidisciplinary approach has expanded as the club has developed. ‘We’ve brought in social prescribers, people who support carers, and we’re starting a new project with podiatrists to offer preventative foot care advice, especially for people with diabetes. We’re also setting up a regular multidisciplinary team for more complex lower limb cases, with vascular and specialist input.’

The aim, says Ms Mechen, is to get quicker answers, and more joined-up support, so members don’t need to bounce between services.

While clinical skills such as wound care, compression therapy and the ability to spot red flags are obviously essential to the care model, the so-called ‘soft skills’ are just as important. ‘It’s about communication, about building trust, about listening,’ explains Ms Mechen.

Which leads us to another dynamic at play within the club: learning gets passed on. ‘Members share advice with each other – how to manage dressings, how to shower, how to get out and about again. That peer support is something we as professionals can never fully replicate. But we can create the environment where it happens.’

The demand isn’t going away – if anything, wound care is only going to grow as the population ages and more people live with diabetes and vascular disease

Looking ahead, Ms Mechen sees even more scope for nurse-led, integrated approaches. ‘The demand isn’t going away – if anything, wound care is only going to grow as the population ages and more people live with diabetes and vascular disease. The only sustainable way to cope is to build teams that can work across boundaries, with the nurse at the centre.’

Ms Mechen believes that pivotal role exemplifies why nurses count. And she insists the difference they make is ‘absolutely essential to the future of general practice’.

She explains: ‘We deliver holistic care for people at every stage of life, and we help them live the best lives they can. It’s not just about treating illness – it’s about prevention, about support, about building healthier, more connected communities. If the NHS is serious about shifting care out of hospital, then it needs to be serious about valuing the nurses who will make it possible.’

The difference Ms Mechen has made through her leadership has been recognised nationally: she was awarded the title of Queen’s Nurse in 2017, primarily for developing the leg club and supporting innovation in primary care nursing. ‘That was a real highlight for me, but also for the team,’ she reflects. She has since supported another team member to achieve the same recognition and is encouraging others to put themselves forward. ‘Recognition matters,’ she insists. ‘Nurses need to feel valued for what they bring, because it’s specialist work.’

Related Article: GPNs: Recruiting but not always retaining

For Ms Mechen and her team, the legacy of the leg club is seen not just in healing rates or cost savings, but in changed lives. ‘It’s about so much more than wounds,’ she says. ‘It’s about dignity, connection, and giving people their lives back.’