South West England

In 2012, the South West region had some of the highest amputation rates in England.

A team of local clinicians worked with all the CCGs and providers in the region to review their services.

They developed 10 criteria for commissioning diabetic foot services.

After 2012, major amputation rates fell substantially in the CCGs that changed their services to meet most or all of the 10 criteria. There was no change in amputation rates in those that did not increase their score against the 10 criteria.

Delays in access to specialist care can lead to more severe ulcers that last longer, and to more amputations.

Good quality services can reduce ulcer duration, prevent amputation, and save NHS money.

One of the CCGs that improved its foot care service was Somerset. Its major amputation rate is now below the England average. 


Somerset CCG invested £155,000 a year (plus one-off set-up costs of £32,000) to transform their diabetic foot care pathway. Major amputations and bed days for diabetic foot care have been reduced, reducing costs each year by nearly £600,000 - almost four times the annual cost of the service improvement.

Rachael Rowe is their diabetes lead commissioner.

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