In 2011, commissioners and providers in Somerset established a county-wide integrated diabetes foot pathway.
Local emergency clinics were established, offering appointments within 24 hours for people with active foot disease, and direct referral to the MDFS where necessary.
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.
The cost of the service improvements was £189,000 a year plus one-off set-up costs of £35,000 (all in 2022-23 prices).
In 2008-11, before the service change, there were 16 major amputations a year for every 10,000 adults with diabetes in Somerset, which was 60% above the England average. The rate fell to 13 in the first year after the service change, and it has continued to fall since then. In the most recent data, for 2018-21, there were 5 major amputations a year per 10,000 adults with diabetes in Somerset, 30% below the England rate.
The annual gross saving from averted amputations is more than twice the cost of the service improvement. Local data indicate that there were additional savings from reductions in inpatient bed days for foot care.
Rachel Rowe was the lead diabetes commissioner in Somerset when the service improvements were made.