REMEDY : BNSSG referral pathways

Diabetes Foot Pathway

Checked: 03-04-2017 by Rob.Adams Next Review: 03-04-2018

Overview

The risk of foot problems in people with diabetes is increased, largely because of either diabetic neuropathy or peripheral arterial disease, or both. Peripheral arterial disease affects 1 in 3 people with diabetes over the age of 50.

Foot complications are common in people with diabetes. It is estimated that 10% of people with diabetes will have a diabetic foot ulcer at some point in their lives. A foot ulcer can be defined as localised injury to the skin and/or underlying tissue, below the ankle, in a person with diabetes.

Diabetes is the most common cause of non-traumatic limb amputation, with diabetic foot ulcers preceding more than 80% of amputations in people with diabetes. After a first amputation, people with diabetes are twice as likely to have a subsequent amputation as people without diabetes.

Mortality rates after diabetic foot ulceration and amputation are high, with up to 70% of people dying within 5 years of having an amputation and around 50% dying within 5 years of developing a diabetic foot ulcer. This high mortality rate is believed to be associated with cardiovascular disease, and emphasises the importance of good diabetic and cardiovascular risk management.

Foot problems in people with diabetes have a significant financial impact on the NHS throughprimary care, community care, outpatient costs, increased bed occupancy and prolonged stays in hospital. A report published in 2012 by NHS Diabetes estimated that around £650 million (or £1 inevery £150 the NHS spends) is spent on foot ulcers or amputations each year.

Diabetic foot problems: prevention and management (NG19)

 

Referrals - Bristol

Podiatry

For details on services in Bristol including how to refer to a podiatrist please go to the Bristol Community Health website. For more immediate concerns see Red Flag section below.

Referrals to podiatry should be sent on the completed proforma to:

Podiatry Department, Administration Office, Knowle Clinic, Broadfield Road, Knowle, BS4 2UH

Tel: 0117 919 0275        

Fax: 0117 919 0259

The management of patients with diabetes by the podiatry service is based on the following pathway:

pod pathwa.png

Diabetes Foot Clinics - Bristol

UHB - The Combined Diabetes Foot Clinic at UHB can be accessed via email referral:

ubh-tr.dfc@nhs.net

Telephone: 0117 3422175 (for advice - available on Tuesdays and Fridays only)

NBT - The Diabetes Foot Team can be contacted by telephone or fax:

Telephone: 0117 4146422

Fax: 0117 4149402

 

Referrals - NS

Podiatry

For details on how to refer to a podiatrist please go to the NSCP website. The website includes a link to the joint clinic booking page.

Diabetic Foot Clinic

Active diabetic foot problems which are non-life or limb threatening to be referred to a multidisciplinary foot care service within 1 working day, for triage within 1 further working day.

The local services are as follows, so refer accordingly to available services, or to the acute on-call medical team if appropriate, to meet the need of the patient;

Weston General Hospital;
Emergency and Urgent referrals:-

  • Refer non-vascular life/limb threatening foot problems to the medical team for direct admission.
  • Refer vascular life/limb threatening foot problems to the Vascular Hub at Southmead Hospital (see red flag section below). 
  • Weston General offers a weekly MDT every Tuesday to treat diabetic patients with active foot problems that are not life/limb threatening.
  • Urgent referrals (those needing to be seen within 48hrs of referral) will need to be referred to Southmead hospital as below if unable to get to a Tuesday clinic appointment within this time span.

Other referrals to be made via e-referrals using the same process as that used for 2WW referrals:-

  • Create the UBRN, select the speciality ‘Diabetic Medicine’ and clinic type ‘Podiatry and Foot’ and then select Weston Hospital and BOOK a dummy appointment.
  • Ensure you attach the new Diabetic Foot form at the same time so the trust can contact the patient. This form is available as an EMIS template.
  • Where possible, please attach a photo of the condition of the foot to the referral form in order to help the service priorities the patient’s care.

 Southmead Hospital; Has an MDT foot care service that operates every day, between the hours of 8 –  4pm. Staff usually see booked patients between 8 – 12am.
 

There is also a vascular hot clinic which runs Monday to Friday. (See red flag section below)

 

Referrals - SGlos

Podiatry

For details on services in South Gloucestershire including how to refer to a podiatrist please go to the Sirona website

Diabetes Foot Clinic at NBT or UHB

See Bristol section above for details.

Red Flags

There is a vascular hot clinic at NBT for more urgent concerns (e.g. infected diabetic leg or foot ulcers with vascular compromise) . Urgent patients can be referred via the vascular network office telephone 0117 414 0798 or by discussion with either the General Surgery/Vascular Surgery Registrar on call.