Service transformation in Somerset

The major amputation rate fell from 16.1 per 10,000 adults with diabetes in 2008-11 to 5.9 in 2015-18.

The annual gross saving from averted amputations and fewer hospital bed days for foot disease is almost 4 times the cost of the service improvement.

Julia Thomas is a consultant diabetologist.

In 2011, commissioners and providers in Somerset established a county-wide integrated diabetes foot pathway.

Emergency clinics were established in eight locations, offering appointments within 24 hours for people with active foot disease, and direct referral to the MDFS where necessary. From 2020 these emergency clinics will be replaced by four central hubs of excellence. 

Community podiatrists received specialist training and strong links were established between the community and hospital services. Many community podiatrists worked on rotation in the hospital service.

A full time inpatient diabetes specialist podiatrist was  appointed.


Patient notes were shared electronically, including photographic images.


Training was provided for practice nurses and GPs. 

Patients have faster access to specialist care, and there is increased knowledge of diabetic foot problems in community and primary care.

Stephen Martin is a community podiatrist.