Commissioning toolkit launches to improve diabetic footcare

Clinical Commissioning Groups (CCGs) are being urged to make diabetic footcare a major priority across England.  

The College of Podiatry has published a commissioning toolkit to help encourage change and share good practice among local services.

The website features evidence on the human and financial cost of diabetic foot disease, information on the elements required for good care and a six-step process to help reduce costs in the local are area.

Data for each CCG and sustainability and transformation partnership (STP) on current diabetic foot services and the potential for improved outcomes and savings is also provided, in addition to lessons learnt by other CCGs that have improved diabetic foot services and reduced costs.

It is thought about 9,000 people with diabetes in England have legs, feet or toes amputated on an annual basis, although experts believe that at least half of all these major amputations are avoidable.

Both amputation and ulceration are associated with high mortality and only around half of people survive for two years after major amputation in diabetes.

​Dr Wing May Kong, a consultant diabetologist at Imperial College London, said: “Footcare is very easy to underestimate. We don’t think about our feet, we take them for granted. They just get us from A to B, but when they go wrong, the impact is huge.”

It is thought that if the prevalence of severe diabetic foot ulcers were reduced by a third, the average CCG would save around £1 million a year.

​Professor William Jeffcoate, Chair of the NDFA Advisory Group and Clinical lead for the National Diabetes Footcare Audit (NDFA), said: “The audit shows clearly that there is a link between the time that it takes before someone with a new foot ulcer has an expert assessment.”

Delays in access to specialist care are associated with poorer outcomes and higher costs. This means, the longer a person has to wait to be assessed by an experts means they are more likely to have a severe ulcer when eventually seen. 

Severe ulcers account for the bulk of diabetic foot care costs. Most severe ulcers last many months, and some never heal and some eventually lead to amputation.

Expert care, delivered early, can improve outcomes for patients and reduce NHS costs.

Photo by Frank Vessia on Unsplash

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