foot care: reducing amputation rates and improving care · foot care: reducing amputation rates and...
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Foot care: Reducing amputation rates and
improving care
Professor Fran Game
Consultant Diabetologist and Director of R&D
Derby Teaching Hospitals NHS FT
Foot risk classification
Active risk
High risk
Increased risk
Low risk
Physician Orthotist
Microbiologist
Diabetes nurse
Vascular surgeon
Podiatrist
Multi-disciplinary team
Orthopaedic surgeon
Primary care team
Pharmacist
Splints/casting
Evidence suggests that, for
every £5m invested in Multi-
disciplinary Footcare Teams
(MDFTs) savings of around
£9m annually can be
achieved.
£650 million pa
East Midlands -Major amputations
in patients with diabetes
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
Major amp/ 1000patients
Where are the problems?
Diabetic Foot Pathway
Professor Fran Game
Consultant Diabetologist and Director of R&D
Derby Teaching Hospitals NHS FT
Peer Reviews:
1. Mansfield and Ashfield CCG, Newark and
Sherwood
2. Nottingham City Nottingham North East, North
West
3. Nene and Corby
Diabetic Foot Pathway
Professor Fran Game
Consultant Diabetologist and Director of R&D
Derby Teaching Hospitals NHS FT
No standardised training and
competency assessments of
foot screening for primary
care teams
Patient not informed of risk
and/or not appropriately
referred
Lack of access to MDTs
Lack of capacity in MDTs
Vascular re-organisation
Diabetic Foot Clinic Derby Teaching
Hospitals NHS FT - capacity
0
100
200
300
400
500
600
700
800
900
2011/12 2012/13 2013/14 2014/15 2015/16
Foot Clinic - New Appointment Trend
0
1000
2000
3000
4000
5000
6000
7000
8000
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17
Foot Clinic - Follow Up Trend
Diabetic Foot Clinic Derby Teaching
Hospitals NHS FT- capacity
Diabetic Foot Pathway
Professor Fran Game
Consultant Diabetologist and Director of R&D
Derby Teaching Hospitals NHS FT
No standardised training and
competency assessments of
foot screening for primary
care teams
Diabetic Foot Pathway
Professor Fran Game
Consultant Diabetologist and Director of R&D
Derby Teaching Hospitals NHS FT
No standardised training and
competency assessments of
foot screening for primary
care teams
Patient not informed of risk
and/or not appropriately
referred
Diabetic Foot Pathway
Professor Fran Game
Consultant Diabetologist and Director of R&D
Derby Teaching Hospitals NHS FT
No standardised training and
competency assessments of
foot screening for primary
care teams
Patient not informed of risk
and/or not appropriately
referred
Lack of access to MDTs
Lack of capacity in MDTs
Silhouette digital image solution
Foot care: Reducing amputation rates and
improving care
Professor Fran Game
Consultant Diabetologist and Director of R&D
Derby Teaching Hospitals NHS FT