Make Change Happen

Six Vital Steps

Step 5: Measure the impact of change

Commissioners need to know if services are delivered as they are commissioned, and whether service changes are delivering improvements to outcomes and NHS cost reductions.


The National Diabetes Footcare Audit enables commissioners and providers to measure the performance of their diabetic foot services against NICE clinical guidelines. The audit produces annual reports looking at structures, processes and outcomes.  


If your footcare service has not yet registered to take part in the NDFA, instructions for participation are provided by NHS Digital at

Information on the quality of care at CCG and STP level can be found in the 'Your Local Area' section of this website. Further information is available in the diabetes footcare profiles published for each CCG by Public Health England at and in the National Diabetes Audit at

Local areas will often need additional data, and service change can offer the opportunity to introduce Key Performance Indicators for robust data collection along the pathway.



In North West London, 8 CCGs are working together to develop a foot care dashboard that will provide weekly data at patient-level from all providers of diabetic foot care. The aim is to enable commissioners and providers of care to monitor quality, to identify and solve problems in the pathway, to understand the financial impacts of diabetic foot problems, and to introduce outcomes-based payments systems.

Dr. Raquel Delgado is a GP and diabetes commissioner at Hounslow CCG.