Improving Diabetic Footcare Faculty (DIFF Model)


The Improving Diabetic Footcare Faculty (IDFF) was formed following the 2012 publication of high South West diabetic amputation rates. A voluntary, podiatry-led network of healthcare professionals (HCPs), IDFF focuses on structured education and service development. The faculty meets outside working hours to develop free, innovative education packages, which help to standardise education provision for HCPs and patients, encouraging timely referrals and a multidisciplinary approach. The IDFF model has now been replicated by other HCPs within the South West.

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This is a voluntary MDT network development, where effectiveness develops from drawing on the experience, strengths and interests of the individual group members. The goal is to reduce the diabetic foot amputation rate to below the national average within 5 years, while improving outcomes and quality of life for patients. The IDFF considered this goal to be specific, measurable through repeated audit and use of Likert scoring systems and achievable within the time proposed by implementation of educational tools.


In November 2012, a voluntary group of HCPs who work within and manage diabetes services in Devon came together to develop a network that also included patient representatives. More recently, the IDFF has expanded to include colleagues from South Devon and Torbay NHS Trust, as well as colleagues from primary care, Diabetes UK and support from a pharmaceutical company to develop a diabetes group educational programme. Actions include:

  • To audit current practice, identify barriers, challenges and gaps in service, examine existing research, gather baseline data, develop educational tools and standardise packages for education, deliver the former, evaluate effectiveness and ultimately share good practice
  • To work proactively with primary care clinicians to ensure diabetic foot care outcomes improve with year-on-year improvement
  • To measure and continually improve and adapt the standard of education delivered through audit and research
  • To develop competencies and certification for NHS providers who work with or care for patients who have diabetes
  • Ensure that access to diabetic foot care and education is equitable across Devon providing peer support and advice
  • To link with the national networks and share learning.

The IDFF has made driving down the rate of amputation a key priority as a result of action learning. By bringing peers together in a supportive environment, best practice is shared between HCPs involved in the network and a range of resources and tools have been developed to promote consistency and standardisation of practice across Devon. The following range of educational tools for HCPs have been developed: a 10-step prompt poster series regarding education, wound care, caring for feet in hospital and provision of antibiotics; and an e-learning education package (launched in Nov 2015) to provide HCPs working for the NHS Trust with an annual update in diabetic foot assessments. The IDFF education tools have also been extended to patients via a structured education package in accordance with NICE guidelines ensuring that each time a patient is seen in clinic he or she is exposed to NICE-compliant education. This is supported by advice and recorded on the treatment plan. Examples of these materials are presented in Appendix 2. The patient educational tools include:


Amputation rates in Eastern Devon were 1.4 per 1000 diabetic population in 2012 and have fallen to 0.6 in 2016, which is now less than the national average. Within just six weeks of launching the online e-learning resources to community nurses, 117 (26%) HCPs had accessed the e-learning compared to 73 (8%) HCPs who accessed face-to-face training in the previous two years. Delivery of patient education has improved with 100% of 100 consecutive podiatry notes in East Devon having structured education recorded against just 25% in 2012. Of the patient notes audited, 78% had education delivered via the 10-step prompt poster series and 98% had been issued with an Emergency Access Card. Amputation data collected between November 2012 and November 2016 indicated that there were 27 major amputations in 2012 compared to an average of 14.6 per year, 2013-2016. Based on estimated costs per amputation of £12,000, it would suggest that there are potential savings of approximately £150,000 per year. If our local population of community nurses (450) required a four-hour face-to-face training this would cost approximately £25,020 less travel expenses (450 x £55.60 (£13.90 ph)) against £6,255 which is the cost of providing one hour to complete the e-learning - a cost saving of £18,765.

Sustainability and Spread

We have recently promoted the e-learning to GP practices and resources and learning are now being shared across the South West region through the South West cardiovascular network. The team is liaising with higher educational bodies regarding use of e-learning proactively as part of undergraduate programmes. The IDFF in conjunction with Plymouth University are in the process of applying for a research grant to test the efficacy of the education tools they have developed.

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QiC Diabetes Finalist 2017
Diabetes Team Initiative of the Year – Adults
Improving Diabetic Footcare Faculty (DIFF Model)
by Royal Devon & Exeter Trust


Sue Pyle

Job title:
Place of work:
RDE Exeter foundation Trust

Quality In Care Diabetes

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  • 2022 KEY DATES
  • Open for entry:
    Monday 28 March 2022
  • Entry Deadline:
    Friday 1 July 2022
  • Judging day:
    Tuesday 6 September 2022
  • Awards ceremony:
    Thursday 13 October 2022