Peer review of diabetes foot services in the South West

Summary

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.

Challenge

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.

Objectives

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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