Commissioning a foot care service for people with diabetes
Diabetes can have a profound impact on lifestyle, health and life expectancy, and has a significant impact on health and social services. The Diabetes national service framework (2001) reported that around 5% of total NHS resources and up to 10% of hospital in-patient resources are used for the care of people with diabetes.
Foot complications are common in diabetes, and are associated with peripheral vascular disease (the damage caused to large blood vessels supplying lower limbs) and neuropathy (damage/degeneration of the nerves).
The provision of appropriate foot care is an important component of the care of people with diabetes. It helps to avoid morbidity due to foot ulceration and amputation, thus helping those with diabetes to maintain their quality of life.
All people with diabetes require foot care examination and review, at least annually, to detect risk factors for ulceration. Examination involves a visual inspection of the feet and footwear, testing of foot sensation and palpation of foot pulses.
The potential benefits of robustly commissioning an effective foot care service for people with diabetes include:
- ensuring that all people with diabetes receive appropriate foot care in line with the NICE clinical guideline CG10 on type 2 diabetes - foot care and NICE clinical guideline CG119 ‘Diabetic foot problems - Inpatient management of diabetic foot problems´
- reducing the risk of foot ulcers, infections and amputations, which can release capacity in secondary care, and improve quality of care
- reducing inequalities in access to foot care
- better value for money, through helping commissioners to manage their commissioning budgets more effectively - this may include opportunities for clinicians to undertake local service redesign to meet local requirements in novel ways.
Key clinical issues
Key clinical issues in providing an effective foot care service are:
- accurately diagnosing all people with diabetes within primary care, maintain a register, and ensuring they receive foot care according to the NICE foot care guideline algorithm
- providing effective foot care for people with diabetes as appropriate
- developing and implementing a system for timely call and recall of patients based on their risk of foot ulcers
- providing a quality assured service.
National priorities and initiatives relevant to commissioning a foot care service for people with diabetes include:
- NHS Outcomes Framework
- The Operating Framework for the NHS in England 2012-13
- Liberating the NHS: legislative framework and next steps
- Commissioning Diabetes Footcare Services
- ‘National service framework for diabetes' and associated delivery strategy
- Six years on: Delivering the diabetes National Service Framework
- Quality Innovation Productivity and Prevention (QIPP) long term conditions workstream
- Using the Commissioning for Quality and Innovation (CQUIN) payment framework - a summary guide
- ‘Developing a Year of Care for diabetes'.
- ‘Improving chronic disease management'.
- Considering the impact of patient choice.
- Implementation of NICE clinical and public health guidelines. These are currently core standards, and performance against these standards will be assessed by the Care Quality Commission in line with ‘Standards for better health'.
Although many or all of these priorities may be relevant to the services nationally, your local service redesign may address only one or two of them.
This page was last updated: 03 April 2012
- Foot care service for people with diabetes
- Commissioning a foot care service for people with diabetes
- Specifying a foot care service for people with diabetes
- Determining local service levels for a foot care service for people with diabetes
- Assumptions used in estimating a population benchmark
- The commissioning and benchmarking tool
- Ensuring corporate and quality assurance