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April 2019

This newsletter covers Cambridgeshire and Peterborough, please read the correct section for your area.
  • Updates in blue are from CPFT and cover practices in Peterborough, Fenland and Huntingdon.
  • Updates in green are from CUHFT and cover practices in Cambridge and Ely.

For practices in Peterborough, Fenland, Huntingdon

Update from the Advanced Podiatry Service (APS)

Advanced Podiatry Service – Who we are

The APS service helps to deliver diabetic foot care service for Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) .

The APS clinicians are Advanced Diabetes Podiatrists with highly specialist knowledge & skills in assessing, diagnosing and treating diabetic foot pathology.

We provide gold standard diabetic foot care which is vital in order to reduce rising NHS costs of ulceration and amputation.

  • Peterborough - Alex Guinee, Karen Halliday, Mohammed Ellahi, Alison MacNally

  • Huntingdon - Clare Dean, Sarah Burgon, Rena Dobbie

  • Fenland – Helen Moakes

To contact us: cpm-tr.aps@nhs.net

Clinics

  • Podiatry Outpatient Clinic, Hinchingbrooke
  • Diabetic Foot Clinic, Healthy Living Centre, Peterborough

Patients Who Will Benefit from Urgent Referral to Advanced Diabetes Podiatrist

High-risk diabetic patients with an active diabetic foot problem. When assessing the risk of developing a diabetic foot problem it is important to examine the feet of the person with diabetes, remove their shoes, socks, bandages, dressings, examine both feet for evidence of Neuropathy, Limb ischaemia, Diabetic foot ulcer, Infection and/or inflammation, Deformity, Gangrene, Charcot arthropathy.

Referral Pathway & Criteria

  1. SystmOne Choose and book emergency slots direct to APS clinic in Peterborough Healthy Living Centre on daily basis - 8:45am slots
  2. 2. The APS referral email address for GP surgeries not on SystmOne: Refer every new diabetic ulcer (infected/non-infected, gangrene, suspected Charcot) to the Advanced Podiatry Service: cpm-tr.aps@nhs.net

Referral Criteria

  • Diabetic foot ulcer
  • Infection and/or inflammation
  • Gangrene
  • Charcot arthropathy

As per NICE Guideline Diabetic Foot Problems: Prevention and Management NICE NG19 active foot problems should be referred within 24 hours. Link toguidance: https://www.nice.org.uk/guidance/ng19

Aims of the APS team

Main aims:

  1. Amputation Prevention (lower limb)
  2. Prevention of Death by Sepsis
  3. Hospital Admission Avoidance
  4. Promote Wound Healing
  5. Management of Charcot Foot
  6. Rapid Access into Foot MDT
  7. Education of primary and secondary care sectors
  8. Stream lining referral pathways

How we achieve this:

Patients referred to APS to be assessed within 24-48 hours with plan:

a) Diabetes Control

b) Neurovascular status

c) Imaging/ investigations

d) Off-loading management plan, we provide weekly Total contact casting clinics in both sites

e) Microbiological management

f) Wound treatment including sharps debridement

g) Consultant led diabetic foot clinic

h) Rapid Access to Foot MDT

Education Packages

We offer Training packages ‘The Foot in Diabetes’ tailored to fit & topic requests available.
 
Subjects covered:

  1. What does the High Risk Foot Need
  2. How Diabetes Affects the Foot
  3. The Ipswich Touch Toe Test
  4. Spotting the High Risk foot
  5. Is it Charcot?
  6. Dressings & Offloading
  7. Diabetic Foot Screenings (annual reviews)
  8. Basic Education Skills
  9. OTC foot products

More topics available on request!
 
Training packages are tailored to fit, we offer our education to inpatient ward staff, GP Practices including GPs, Practice Nurses, Health Care Assistants, Diabetes specialist nurses, district nurses, all nursing teams.
 
We offer quick succinct 10 minutes presentations if time is of the essence, or longer 20-30 sessions lunch breaks, AM or PM - whenever suits you!
 
Our training can be either educational talks, or hands on approach, such as with dressings & Ipswich Touch Toe Test  demonstrations.

Anything foot related, any queries, or topics you would like to know more about, or simple revision package as part of your Continued Professional Development CPD - please get in touch:

Contact APS: cpm-tr.aps@nhs.net

Leaflets and Useful Links

CPFT leaflets - these can be downloaded & printed for staff to give to patients, put together by the APS team:

  1. Footcare Advice for Patients with Ulcers
  2. Charcot Foot Advice
  3. High-Risk Diabetic Feet
  4. Footcare Advice for Patients with Diabetes

Diabetes UK: Reduce your Risk of a Serious Foot Problem.

For practices in Cambridge and Ely

Update from the Diabetes Foot Team 

Who we are and what we do

The diabetes foot team provides assessment, diagnosis and treatment for patients with active complex diabetic foot disease. Diabetic foot disease affects the skin, blood supply, nerves and bones of the foot and requires a multidisciplinary team approach in order to be managed successfully.

Active diabetic foot disease can present as an ulcer, pain, swelling, deformity or a combination of all. Many of these problems are driven by poor circulation, neuropathy and infection and are made more complex by other medical, social and personal issues. We try and treat all of our patients in a holistic way, as problems arising in the feet are so often another manifestation of wider systemic problems.

Referrals can be made by any healthcare professional. We also accept patient self-referrals.

We run a reactive acute diabetes foot service and our aim is to see urgent referrals within 24 hours during our opening hours (see below). Often we can see patients the same day during working hours if required/appropriate.

Outpatients clinics

We run a multidisciplinary outpatient foot clinic working closely with a multi professional team in order to give timely and appropriate intervention and help improve outcomes for patients with active diabetic foot disease. 

The diabetes foot clinic is based in the Addenbrooke’s treatment centre, and is open Monday-Thursday 8.30am-5.30pm and on Fridays, 8.30am-4.30pm. 

We run twice weekly consultant led clinics, which involve the following members of the team:

  • Diabetes specialist podiatrists
  • Diabetes consultants
  • Specialist Registrars
  • Orthotist
  • Prosthetist
  • Plaster technicians
  • Diabetes specialist nurses
  • Dieticians
  • Health Care Assistants
  • Access to vascular scientists and non-invasive vascular imaging
  • Microbiology and radiology advice
We also run a monthly outpatient joint vascular and orthopaedic clinic for those needing surgical planning or review.

Inpatient diabetes foot service 

We also run an inpatient service with a specialist podiatrist and consultant to review the diabetic foot admissions and patients who perhaps have active diabetic foot disease as a secondary problem during their admission. We run a weekly joint vascular and orthopaedic ward round for our inpatients with active diabetic foot disease needing surgical input.

Examples of patients suitable for referral to the diabetes foot clinic

  • All patients with active diabetic foot ulceration.
  • Suspected Charcot neuroarthropathy or neuropathic fractures. e.g., patient may present with a painful (or more often painless) red/hot/swollen foot. Patient may report some change in shape in the foot.

Early referral from other healthcare professionals is vital. We try not to be prescriptive and would much rather see someone once, reassure and discharge rather than see them late in the disease process, especially when a more timely intervention would have made a big difference to outcome.

As an MDT diabetic foot service we can offer 

  • Expert assessment from experienced podiatrists in diabetic foot disease
  • Consultant/doctor review for “S.O.S.” patients Monday- Friday during our opening hours
  • Same day access to X-ray
  • Same day access to plaster technicians to provide total contact casting, an important tool for treating neuropathic ulcers, fractures and Charcot neuroarthopathy
  • Close working with vascular studies to access important arterial scans either on the day if emergency or within 2-3 weeks if non-urgent
  • Twice weekly consultant diabetologist-lead clinics
  • Diabetes specialist nurses and dieticians on hand to offer support in clinic with glycaemic control
  • Access to specialist footwear and insoles for the treatment and prevention of foot ulcers

Referral Criteria 

  • Patient diagnosed with diabetes.
  • Anyone with suspected active diabetic foot disease such as ulceration, infection, active red/hot/swollen foot. However please be aware that pain may not be present, due to neuropathy, so do not take this as a sign that it is not a problem.
  • When you see a foot problem in a person living with diabetes ask “Why has that problem occurred on that foot at this time and what processes have contributed to what I see in front of me?” It is not good enough just to say “because they have diabetes”- that offers no solutions. If in doubt, please ring and ask us.

Please note we do not provide a leg ulcer service. We also do not provide a routine service for general routine podiatry care i.e. callus debridement and toenail cutting. We are an acute service for active diabetic foot disease.

How to refer 

For all referrals or advice please call 01223 216706 and follow up with an email to diabetes.footclinic@nhs.net with patient details, medical/drug/foot history and details of current problem.

We are also more than happy to have visitors to the clinic to see what we do. Diabetic foot disease is particularly complex and it needs a team approach. Seeing the team in action is often the best way to get a grasp of the scope of what is involved in the management of these vulnerable patients. Please contact us on the above number or email address and you would be more than welcome to shadow one of our clinics.

We can also give education sessions at GP practices. Contact on the above email and number to arrange.

Produced by Cambridgeshire and Peterborough CCG
For queries please contact:

Jo Fallon
Programme Manager - Diabetes
Cambridgeshire and Peterborough Clinical Commissioning Group
Email: joanne.fallon@nhs.net

Diabetes bulletin April 2019