Quality statement 5: Referral for adults at moderate or high risk of diabetic foot problems

Quality statement

Adults at moderate or high risk of developing a diabetic foot problem are referred to the foot protection service. [2011, updated 2016]

Rationale

Referring people at moderate or high risk of developing a diabetic foot problem to the foot protection service allows their feet to be assessed at an early stage and then reassessed at regular intervals. This can reduce the likelihood of them getting foot ulcers or other foot problems.

Quality measures

Structure

Evidence of local arrangements to ensure that adults at moderate or high risk of developing a diabetic foot problem are referred to the foot protection service.

Data source: Local data collection. Contained in the National Diabetes Foot Care Audit.

Process

Proportion of adults at moderate or high risk of developing a diabetic foot problem who are referred to the foot protection service.

Numerator – the number in the denominator who are referred to the foot protection service.

Denominator – the number of adults at moderate or high risk of developing a diabetic foot problem.

Data source: Local data collection.

Outcome

Incidence of foot and lower limb amputations in people with diabetes.

Data source: The National Diabetes Audit collects information on minor and major amputations in people with diabetes.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as GPs and community services) ensure that adults at moderate or high risk of developing a diabetic foot problem are referred to the foot protection service.

Healthcare professionals (such as podiatrists, GPs, practice nurses and district nurses) ensure that they refer adults at moderate or high risk of developing a diabetic foot problem to the foot protection service.

Commissioners (clinical commissioning groups and NHS England) ensure that they commission services in which adults at moderate or high risk of developing a diabetic foot problem are referred to the foot protection service.

What the quality statement means for patients, service users and carers

Adults with diabetes have regular foot checks, and if a check shows that they have a moderate or high risk of having a foot problem related to their diabetes, they are referred to see another healthcare professional in the foot protection service.

Source guidance

Definitions of terms used in this quality statement

Moderate or high risk of developing a diabetic foot problem

Assess the person's current risk of developing a diabetic foot problem or needing an amputation using the following risk stratification:

  • Moderate risk:

    • deformity or

    • neuropathy or

    • non-critical limb ischaemia.

  • High risk:

    • previous ulceration or

    • previous amputation or

    • on renal replacement therapy or

    • neuropathy and non-critical limb ischaemia together or

    • neuropathy in combination with callus and/or deformity or

    • non-critical limb ischaemia in combination with callus and/or deformity.

[Adapted from NICE's guideline on Diabetic foot problems: prevention and management, recommendation 1.3.6]

Foot protection service

A service for preventing diabetic foot problems, and for treating and managing them in the community. It should be led by a podiatrist with specialist training in diabetic foot problems and have access to healthcare professionals with skills in:

  • diabetology

  • biomechanics and orthoses

  • wound care.

[Adapted from NICE's guideline on Diabetic foot problems: prevention and management, recommendations 1.2.1 and 1.2.2]