Improving Diabetic Foot Care: A Guide for Commissioners
Almost 20 years ago, London North West Healthcare NHS Trust established a multidisciplinary specialist foot care service (MDFS) to serve the population of Brent. The MDFS operates two consultant-led clinics a week, a fortnightly vascular clinic and an emergency service five days a week. There are close links with the foot protection service in the community, which can refer patients directly to the specialist service, and with the vascular surgery team at the outer North West London vascular hub. Patients with recurring ulcers can self-refer to the service.
Wing May Kong is a consultant diabetologist at London North West Healthcare NHS Trust.
For many years, Brent has had one of the lowest diabetes amputation rates in England.
Between 2014 and 2020, there were 10 fewer major amputations and 22 fewer minor amputations per year in Brent than the expected level. (2020 is the last year for which discrete data are available for Brent, owing to the merger of CCGs and the establishment of ICBs. The expected level is calculated from the rate across England, adjusted for age and ethnicity.)
To establish the MDFS, increased HCP time was funded:
Consultant diabetologist 0.4 WTE
Podiatrist 0.4 WTE
Diabetes specialist nurse 0.05 WTE
Consultant radiologist 0.05 WTE
Consultant vascular surgeon 0.05 WTE
Plaster technician 0.05 WTE
The estimated cost of these extra inputs is £102,000 a year (in 2022-23 prices).
Savings from averted amputations are estimated at £306,000 a year, three times the cost of the improvements to the service.
Antonio Guerreiro is a patient at London North West Healthcare NHS Trust. He believes the integrated and multidisciplinary care he's received has made a crucial difference to keeping him ulcer-free.
Brent is now part of North West London ICB. Commissioners and providers from North West London have been working together for several years to improve diabetic foot care across the entire area.