Inside Southwark’s new lower-limb clinics: from “just dressing” wounds, to healing them
This guest blog – written by Jade Roberts, former Community Tissue Viability Nurse Specialist for Guy’s and St Thomas’ NHS Foundation Trust – is part of a series on our programme about transforming lower limb wound care across south east London. Read about the programme for background context.
The Southwark model aligns with the National Wound Care Strategy Programme (NWCSP) as well as our three pillars of change (people, processes, and technology).
Leg ulcers are painful, frustrating and often embarrassing. Patients tell me their wounds leak through dressings, making even short bus or Tube trips feel impossible. The isolation and loss of mobility take a real toll on mental health, leaving patients with chronic leg ulcers fearing that life will never feel normal again.
Before the clinic hubs, too many Southwark residents bounced between practice nurses, Urgent Treatment Centres (UTC) and Accident and Emergency (A&E) department, often without compression (the gold standard treatment for venous leg ulcers). Not through lack of care but because of a lack of funding, time and training in primary care, so compression simply wasn’t happening. By the time patients reached us, many had already been to A&E multiple times or had had repeated antibiotics for cellulitis, with wounds still unhealed.
People had been floating between wherever they could get a dressing change – or doing it themselves at home, really poorly.”
The idea behind the hubs was simple: bring specialist lower limb care for ambulatory patients into primary care, delivered by trained clinicians with the time and competencies to assess properly, start compression promptly, and review regularly.
We piloted the model in South Southwark at Tessa Jowell Health Centre, then opened a second clinic hub in North Southwark at Artesian Health Centre. Together, they now cover the whole borough.
How the model works (and how it’s different)
Integrated care, led by primary care
The primary care led clinics have shared governance between the Primary Care Network (PCN) and community services at Guy’s & St Thomas’ NHS Foundation Trust (GSTT). Our tissue viability nurse team works with the primary care nurses, supports and trains them and escalates to secondary care when needed, but all day-to-day care happens in the primary care clinic hubs. A local integrated team – GSTT tissue‑viability specialists, PCN multi-disciplinary team (MDT) staff and social prescribers, with council and voluntary community services links – keeps care close to home and connected to the community.
One shared record
We document on the EMIS electronic patient record so that GPs can see everything we do, and refer seamlessly. That visibility has sped up decisions and made escalation safer.
Right treatment, the first time
Everyone gets a full lower limb assessment (including Doppler) and, where appropriate, full compression from the outset. It’s not a “new” intervention, we are just consistently applying evidence-based treatment.
Smarter prescribing
We use a digital system, Online Non Prescription Ordering Service (ONPOS), and an optimised formulary to cut waste and ensure best value dressings.
Giving primary care capability
My job isn’t only to treat, it’s also to train others. Practice nurses and nursing associates complete eLearning and supervised competency signoff so the skills are maintained in primary care.
The results we are seeing
Faster healing
Pre‑pilot, the average healing time in local services was about 22 weeks. In the first clinics hub (South Southwark), that has dropped to around 7.6 weeks, and in the second hub (North Southwark) early data show about 4.1 weeks. The national ambition according to the National Wound Care Strategy Programme (NWCSP) is 12 weeks, so we’re performing ahead of that.
Compression as standard treatment protocol
Before the pilot, only around 25% of suitable patients were in compression. In the hubs, 96–100% of suitable patients are now in compression.
Better value for money
Average dressing cost per wound fell from around £836 pre‑pilot to around £145–£342, depending on site and period—reflecting faster healing and consistent formulary use (ONPOS).
Right care in the right place
Previously, patients often attended A&E or Urgent Treatment Centres in the absence of an appropriate service. Since the pilot began, South Southwark patients haven’t needed to attend UTC at King’s College Hospital (KCH) for lower limb wounds, with care managed in the clinic hubs.
Patients (and staff) thriving
Patients have described these clinic hubs as transformational in their feedback – these are people who had felt stuck with lower limb wounds for years that are now seeing weekly progress. Similarly, staff have fedback that working in the clinic hubs has been “the most rewarding” part of their nursing careers.
Addressing inequalities
The hubs serve a high proportion of Black and minority ethnic residents and improve access to a broader set of interventions: wellbeing, prevention, mental health, long‑term condition, and frailty support – all which can be built into the average run of clinic appointments.
We weren’t doing any magic… just the proper assessment and putting people into compression. And they were healing within 6–8 weeks.”
Building something sustainable
The work in the clinic hubs started as a pilot in November 2023 and is now transitioning to business as usual across both hubs with recurrent funding agreed. We’re expanding education offers (including to social care) and exploring the use of digital wound apps to support patient self-management and remote monitoring. We’re also using the EMIS dataset to understand demand, capacity, and outcomes in real time.
Next on our list: extend the model to care homes and housebound residents (where care is provided by neighbourhood nursing or care home nurses), and improve the prevention offer by early identification of skin changes, swift management of cellulitis, and links to social prescribing, long term condition (LTC) reviews, nutrition, and falls prevention.
Recognition – why it matters
Our work in the clinic hubs was shortlisted for an HSJ Independent Healthcare Providers Awards 2025, for Primary and Community Care Project of the Year. Awards aren’t our main goal of course, but they help shine a light on a model that’s working and encourages it to spread to neighbouring boroughs where patients deserve the same offer.
It does feel like a postcode lottery… someone in Southwark can access this lovely service and someone just across the road in Lambeth can’t.”
Two years ago, I was shocked by how little compression was happening for people who needed it. Today, Southwark’s clinic hubs show what’s possible when primary care and community services partner effectively: consistent assessment, prompt compression, shared records. It leads to faster healing that restores confidence, independence, and joy in patients and their carers. These are the results of teamwork, training, and doing the right things early and every time.
Get involved
If you’re a healthcare professional in south east London providing care for people with lower limb wounds, we’d love for you to be part of this work. Patients and carers can also contribute their insights to shape lower limb wound care services that reflect local needs.