Reduction of lower limb amputations as a result of diabetes has
been a main priority of the South West (SW) Cardiovascular (CV)
Strategic Clinical Network (SCN). National statistics have highlighted
high lower extremity amputation rates in diabetes (LEAD) in South
West England. Improvements in care processes in other parts of
England with similar ethnicity and rurality have resulted in sustained reduction in the
LEAD. A standardised Peer Review of foot care services for diabetes patients across all
14 acute trusts and 11 Clinical Commissioning Groups (CCGs) within the South West SWSCN has evolved over
four years. Its aim was to understand the variation in practice, establish compliance with NICE standards,
identify and share good practice and make recommendations for change and improvement. Provisional
data shows a significant reduction in the number of major amputations across the South West in 2015.
The population of South West (SW) England is of more than 90% white British ethnicity with good longevity
and a legacy effect of retirement to much of the area. These characteristics are associated with high
prevalence and incidence of diabetic neuropathy and its consequences. Currently 6% of the population in
the SW are living with diabetes which amounts to 169,444 persons and the numbers are increasing due to
obesity and an ageing population. 768 amputations took place in the SW as a result of diabetic complications
over the last year with amputation twice as likely for patients in the region as in London - it is estimated
80% of amputations are potentially avoidable. The commissioning of the care pathway is fragmented.
To reduce major and minor lower extremity amputation rates in the SWSCN footprint to below the average of
demographically similar areas in England by 2018. To deliver a peer review programme involving local clinicians
expert in their fi eld to review the care pathway for diabetic patients at risk of a foot amputation across all CCGs.
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