London Diabetic Foot Network
‘Striving Towards Reduction in
Variation & Implementation of an
Integrated Foot Care Pathway for
London’
London Diabetes Foot Care Network
June 2010: Proposal to NHS Diabetes
Stakeholder Meeting September 2010
London Diabetic Foot Network Meeting Feb 2011
London DFN Meeting Feb 2012
LDFN September 2012 and Jan 2013
Vision for London Diabetic Foot
Network
To reduce variation in diabetic foot care
through communication, shared
learning and implementation of
integrated pathways by 2014
Aims to implement a Clinical Network
Establish
1. Local Diabetic Foot Networks and Champions –
self-governing
2. A London Steering Group for DF disease
3. An Advisory Champion Group
4. A Directory of Services
5. A Research Network
6. A Patient Access Group
Aims to implement a Clinical Network
1. Local Diabetic Foot Networks and Champions – self-governing
– Variable implementation: No teeth!
2. A London Steering Group for DF disease – Clinical Advisory
Group for Diabetes – SCN
3. An Advisory Champion Group – Voice into the DSCN and DUK
4. A Directory of Services: Richard Leigh/DUK
5. A Research Network: Association with the AHSN
6. A Patient Access Group: Mike Edmonds, Christian Pankhurst
and DUK
7. Standard approach to diabetic foot care
8. Root cause analysis of major and minor amputations
Challenges?
• Align to the visions and objectives of partner organisations
• Three key deliverable objectives
• What teeth do you wish to gain?
• Meetings twice a year?
• Formalise cluster leads and strategies?
• Partnership with CLAG
Q and A
Workshop
• Further opportunities
Setting up a Diabetic Foot Registry
• Research proposal
on behalf of the London Diabetic Foot Care Network
Current problems
1. Varied assessments by
multiple individuals
2. Lack of unified descriptors
for DFU
3. Poor data collection on
diabetic foot complications
Research Proposal
‘The role of using 3D imaging
technology Improving Outcomes in
Diabetic Foot Care’
Why this technology is needed?
3D Imaging allows:
• Repeated accurate measurements of wounds
enabling trajectories of wound healing and prediction
of time to heal.
• A central database and development of a registry and
research resource.
• Photographic evidence for patient involvement with
diabetic foot management plans.
Describe the patient group and healthcare
setting
• Among people with diabetes, foot complications are
common.
• 2.5 per cent of patients with diabetes, approximately
59,000 people, are estimated to have a foot ulcer at any
given time.
• Diabetic foot disease accounts for 20% of the total cost
of diabetes care in the UK.
• Research to be undertaken within Acute and Community
Settings within the Foot Care Networks.
Why is this research important to the NHS
• Service improvement: Diabetic foot ulcers can lead to amputation.
50% of people who have a major amputation die within two years;
many of these amputations could be avoided with the right care.
• Cost savings: NHS spends £650 million dealing with foot ulcers
and amputations caused by diabetes.
• Currently the numbers of amputations are rising from 5,700 in
2009/10 to over 6,000 in 2010/11.
• Projected to be 7,000 by 2014/15 if urgent action is not taken to
reduce these.
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Proposal
• To utiilse 3D imaging technology as a Telehealth tool across
boundaries allowing development of:
1. Diabetic Foot Registry
2. Tracking of wound healing
3. Enabling timely discharge to the correct care setting
4. Enabling patients to be involved in their care
5. Prediction and time setting for wound care management
6. Reduction of amputation rate by improved wound care management
Benefits of Study
1) What are the benefits in terms of reduced uncertainty?
• Allow an understanding of real-time outcomes for patients with diabetic foot
complications
► (population-based)
• Assessment of cost-effectiveness to the NHS
► targeting of services
► methodological gains through performing the assessment.
2) How long before benefits could be realised, bearing in mind time take
to perform the assessment and affect a change in practice?
• Data collection for one year and then application of learning over the
following 18 months. A number of benefits maybe realised once the device
is implemented into normal clinical practice.
Benefits of Study
3) Would the assessment offer value for money?
Yes as this will impact on diabetic foot care.
4) How important is an early assessment?
Very important as potential usage across interfaces allowing an integrated
management plan for high risk patients.
5) Other factors including policy considerations, prevalence of the
condition and social/ethical concerns.
No overt concerns.
Going forward
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NHS Supply Chain Support for the proposal
•
Will supply the hardware
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Steering Group: Professor Homer, Natasha Patel and Gerry Rayman
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London wide (plus other key centres)
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First meeting Dec 2013
North East
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Cluster wide service restructuring is taking place
Cluster wide directory of services almost completed, any corrections to be
emailed to James Gotts – james.gotts@bartshealth.nhs.uk
Access: New patient open access variable
Email and share access and education protocols with everyone across the
North East
Diabetic Foot training for primary care - Zabeer Rashid and Abi Green will
lead on this
Latha Hapugoda will take Waltham Forest foot data to CCG board and WF
Diabetes Network meeting
North West
1. Directory of service almost complete
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8 PCT areas represented and commissioning
Integrated care needed: Flows of money: disparate groups
Bundles of care vs piecemeal or provider driven with single access to funding
Active commissioning lobbying needed for the pathway with detail to allow this to
be an easy process
Find the GP Commissioning Champion for cluster – Dr Raquel Delgado ??
2. Renal Disease:
•
Renal patients fast tracked into the hub but where are post discharge providers
to ensure collaborative approach
3. Vascular
•
As above: Plan patient pathway so that patients are discharged to responsible
appropriate provider
4. To be followed up by Trusha, Wing May and Gaytree.
North Central
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Have had cluster wide meetings – Richard Leigh is leading
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Directory of Service and mapping process almost complete
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Plan follow-up cluster meetings
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CCGs: Need to be able to influence in terms of commissioning as a group
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Local sector guidelines and process map as a care pathway plan to allow
signposting as well as a timeframe with contact details
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Single sheet: for circulation and back to meeting in September 2013
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Natalie will pull together a single sheet flow diagram
South West
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DOS discussed at length, there are some variations
Gaps identified and actions for change
Hotline to be unified
Competency for FPT need to be named and single sector without will be
supported to enable
Competency framework for podiatry
Foot education program for patients
Stakeholder meeting: 13th June Diabetes Week
Patient Education meeting to be confirmed
South East
1. Concern re vascular centralisation: delays into central hub and sub optimum
discharge. Pathway into the hub maybe erratic and sporadic
• Feedback to Andy Mitchell
2. Research re access to services: Prevalence study of ulcers, pressure sores
within a cluster within a time frame: September presentation snapshot audit
3. Screening: Assurance re screening and education
4. Assurance of services: Vascular podiatrist high-risk non-ulcerated foot
5. Mental health problems prevalent in cluster population and increase risk to
compliance and long-term health
6. Antibiotics: national problem and local guidelines exist but working towards a
community policy
Service Users
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Patient leaflets: Agreed to be done 1st June
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Health Watch Right information at the right time
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Structure and governance locally
Assurance from the Health and Well Being Board
Diabetes Voices involvement
Quality of service from the patient’s side:
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GP Education?
How to speak up when care is not good enough?
Next Steps
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Foot care mapping
Commissioning presentation
Cluster feedback importantly and sharing of best practice
Patients in cluster meetings
Next meeting Sept 19th
Commissioning document to go to NHS Commissioning Board via Andy
Mitchell and Stephen Thomas
The Foot Attack Centre
Prevention and Risk Stratification
Immediate local access to foot protection/multidisciplinary team and 48 hour
access target for endovascular and surgical treatment
London Diabetic Foot Network
‘success and challenges for the
future’
13/04/201
5
What have we learnt
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Excellent Champions already exist
Horizontal leadership and ownership works well
Create headspace for all!
Funding stream
Umbrella organisation
Partnerships essential
• Next meeting funded but where do we go from there?
Foot Attacks can kill!
Stop the
Foot
Attack!