GIRFT report urges hospitals to introduce multi-disciplinary footcare services

Hospitals are being urged to introduce specialist multi-disciplinary footcare services (MDFS), in a bid to reduce ulceration and amputation rates. 

The Diabetes GIRFT Programme National Specialty Report has also recommended that a community-based footcare protection service (FPS) to screen people and help prevent diabetes-related problems should also be introduced.

Getting It Right First Time (GIRFT) is an NHS improvement programme delivered in partnership with the Royal National Orthopaedic Hospital NHS Trust.

The terrible and unprecedented events of 2020 – and the extraordinary response from everyone working in the NHS – add greater significance to GIRFT’s recommendations, giving many of them a new sense of urgency.

Over the last year Professors Gerry Rayman and Partha Kar visited more than 100 hospitals  providing diabetes services across England. They have published their findings in the report which has identified the areas of diabetes care that need most attention and which offer the most significant opportunities for improvement. In addition to footcare, they also singled out type 1 diabetes and inpatient care.

Early prevention

They said: “The cost of care for diabetes-related ulceration and amputation is estimated at up to £1 billion – accounting for almost 1% of the total NHS budget in England.

“Much of this could be avoided with better early prevention and coordination of services. Of the 140 leg, foot and toe amputations performed each week in the UK, 80% result from earlier ulceration, which is largely preventable.”

The report has also suggested that vascular impairment must be focussed on as it is a “key contributor to diabetic foot ulceration and amputation.”

It has been suggested that those who are deemed at risk should have access to all vascular services.

However, Professors Rayman and Kar said some of the smaller hospitals they visited had mentioned they had experienced difficulty in obtaining urgent vascular opinion.

They write: “We recommend that everyone with a diabetic footcare emergency requiring admission should be assessed the same day by the MDFS, and if vascular impairment is identified, they should have same day access to a vascular opinion. If the MDFS is not available, they may need to be transferred to a vascular service.”

Professor Tim Briggs, GIRFT’s Programme Chair said: “This report comes at a time when the NHS has undergone profound changes in response to the COVID-19 pandemic. The terrible and unprecedented events of 2020 – and the extraordinary response from everyone working in the NHS – add greater significance to GIRFT’s recommendations, giving many of them a new sense of urgency.

“Recommendations in this report, such as systems to support virtual clinics, can help the NHS as it faces the substantial challenge of recovering services while remaining ready for any future surges, by operating more effectively and safely than ever before.”

To access the report, click here.

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