There are a number of risks to health that people with diabetes face. One of these is foot ulceration which can lead to limb amputation.
According to an All Party Parliamentary Group report (APPG 2014) the South West has the highest rate in the country of lower limb amputation in people with diabetes. This is double the rate of London which is the lowest. The exact reasons for this variation are unclear, however there are a series of actions that primary care need to take to address this situation. These are:-
1. Education - of primary care staff in the performance of standardised foot checks, involving visual inspection of the feet for skin damage and deformity plus tests for circulation and sensation; helping people with diabetes to understand the importance of foot care and annual foot risk status assessment.
2. GP appointment systems – practices should ensure they have an effective call up system and follow up for non-attendance.
3. Foot checks – provision of annual foot checks for all patients with diabetes (and more frequently for those in amber and red risk categories) with standardised assessment and identification of patient foot risk status.
4. Patient information – provision of written leaflets which describe risk status and back up verbal advice. These contain advice on daily skin care, prevention of injury and who to contact and what to do if a problem occurs.
5. Referral pathways for primary care – having and consistently using clear flow charts for your local health system on when and how to refer to foot protection services (Podiatry) and for hospital admission
6. Post amputation case reviews – undertaking with secondary care colleagues case reviews in order to better understand the reasons leading to amputation and action any prevention lessons learned for the benefit of all your patients with diabetes
7. National Diabetes Audit – sign up to the national audit to help the whole system learn and do better http://www.hscic.gov.uk/nda
Diabetes annual foot checks
Foot checks for people with diabetes
The following links will take you to screening, patient education and referral resources in your locality to help you offer the best service to your patients with diabetes.NORTHERN- covering North Devon EASTERN- covering East and Mid Devon, and the city of Exeter WESTERN- covering West Devon, South Hams and the city of Plymouth NATIONAL- resources available for all