Faster treatment for diabetic foot patients could slash £650m NHS costs

Speeding up target treatment times for patients with diabetic foot disease could significantly cut NHS costs, a clinical audit suggests.

A total of 62% of patients with diabetic foot ulcers are seen within two weeks of a GP referral, according to the first National Diabetes Foot Care Audit (NDFA) – a new branch of the National Diabetes Audit (NDA).

But the audit's findings suggest that the £650m annual cost to the NHS of diabetic foot ulcers could be reduced if all patients were seen this quickly.

It also found that nearly half of CCGs and local health boards did not have all three of the basic NICE recommended systems in place to care for people with diabetic foot disease.

Diabetic foot ulcers

NICE guidance suggests patients should be seen within 2–4 weeks for people who are at high risk of developing a diabetic foot problem, and within 6–8 weeks for people at moderate risk.

But the audit showed rapid treatment significantly improved recovery. Patients were 50% likely to be ulcer-free after 12 weeks if they were seen by an expert within two weeks of initial presentation with their GP.

Patients seen between two weeks and two months were 43% likely to be ulcer-free at the 12-week benchmark, while only 34% of patients seen over two months later were ulcer-free at 12 weeks.

Around one in 10 diabetes patients will have a diabetic foot ulcer at some point in their lives, costing the NHS an estimated £650m a year – equivalent to £1 for every £150 it spends.

More than 5,000 patients presenting with diabetic foot ulcers in England and Wales between July 2014 and April 2015 were included in the audit.

GP referral

Around three quarters of these patients were referred on to specialist services from their GP or other health services, while the final quarter presented without a referral.

A survey included as part of the audit found that almost half of CCGs and LHBs do not have all three of the basic NICE recommended systems in place to care for people with diabetic foot disease.

NICE guidelines state it is necessary that staff involved in routine care of diabetes should be sufficiently skilled to undertake annual foot risk assessments, a foot protection service is in existence to assess those at high risk of foot ulcers and there is a pathway for referral of people with diabetes with an active foot problem.

The NDFA is managed by the Health and Social Care Information Centre (HSCIC) in partnership with Diabetes UK.

Dr William Jeffcoate, clinical lead for the audit, said: ‘This first report from the NDFA highlights the importance of early expert assessment of all people presenting with a new foot ulcer in diabetes.

‘The results show that when the time to expert assessment exceeds two weeks, the condition of the ulcer is on average more severe.

‘Whilst future audits will no doubt provide further insight, this report will make a valuable contribution towards improving services, and is an important first step in measuring the quality of care provided for diabetic foot disease in England and Wales.’

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