The College of Podiatry's response to Diabetes GIRFT Programme National Speciality Report

Response to the Getting It Right First Time (GIRFT) review of diabetes, led by Professors Gerry Rayman and Partha Kar.

The College of Podiatry broadly welcomes the Diabetes GIRFT Programme National Speciality Report, published on Friday 13 November.

We would, however, urge them to address the diabetes footcare issues on a more granular level to ensure that people receive a greater level of care and input and thereby reduce their risk of developing a foot ulcer and foot or leg amputation. Whilst we agree with the learning from the South West and particularly the North Devon NHS Trust, where the ulceration and amputation rates have been drastically reduced, we would urge GIRFT to go further.

We call for standardisation of diabetes foot screening training, and standardisation around the information that is provided - both, written and verbal; but this information should also be tailored for those for whom English is not their first language, or if they have educational needs.

The College backs their calls for Multi-Disciplinary Foot Services (MDFS) as part of all acute services, as set out in the NHS Long Term Plan. These MDFS need to be fully integrated with Primary and Community care to ensure the flow of patients in and out of the MDFS, and that people receive the right care at the right time, by the right healthcare professional. We wish to see the introduction of the “Check, Protect, Refer” for feet programme1 as part of an integrated admission process to reduce the risk of developing a pressure ulcer. We fully appreciate the added expertise an orthotist brings to a MDFS. Access to timely appropriate bespoke footwear is vital to help reduce patient’s risk of re-ulceration. Urgent vascular opinion is a vital component at any aspect of the pathway. We would urge that where the MDFS are the spoke service, in the hub and spoke model, that the clinicians are developed to be able to recognise and treat vascular complications to a high level.

The College’s Clinical Director, Dr Paul Chadwick said, “Better education is needed to empower people with diabetes, to increase their knowledge and understanding to recognise problems and know who to contact in an emergency. Regular foot checks and appropriate rapid referral are essential to ensure these otherwise preventable foot ulcers and subsequent lower limb amputations are reduced. But we also need standardisation across the pathway to ensure that everyone has an equal opportunity of reducing their risk of ulceration and amputation.”

Notes to Editors

The College of Podiatry is the academic authority for podiatry in the UK, and an independent charity dedicated to foot health research, education and public awareness. In short, they’re the UK’s experts for everything and anything to do with the foot and lower limb. Podiatry is the assessment, diagnosis and treatment of diseases and other disorders of the foot, lower limb and associated structures.

For further information about The College of Podiatry please contact: Martin O’Connor, Senior Communications Manager, The College of Podiatry, at martin.oconnor@cop.org.uk


[1] Pankhurst C, Stang D, Cawley S et al (2020) Tools to improve inpatient foot checks. Journal of Diabetes Nursing 24: JDN124