Helping people access diabetic foot services during Covid-19

With outpatient appointments reduced due to the pandemic, the South East London Diabetes Foot Network which covers seven London boroughs and a population of two million, had to continue high-quality, intensive diabetes foot care. The Diabetes team have supported the network to help the coordination of urgent diabetic foot care while maintaining high-quality pandemic response planning.

Project overview

People attending diabetic foot clinics require regular close surveillance to achieve optimal foot health and reduce the risk of amputation (nationally 20 amputations happen daily due to diabetic foot problems).

During Covid-19, it was essential that:
a) Access continued to a diabetic foot service for patients with acute or limb threatening problems (current and new).
b) All new referrals were reviewed within 24 hours.

In mid-March 2020, an interim diabetic foot navigator role staffed by two project managers from the Health Innovation Network (HIN) and supported by a network of diabetes foot specialists was introduced. They had a remit to connect hospital multidisciplinary diabetes foot care team (MDFTs) and community teams. This was followed by the formal commencement of a substantive navigator in mid-April 2020.

Key elements of HIN’s support included:
• Implementation of virtual support, operated by specialists using Pando™ (a secure communica-tion tool for healthcare professionals) and Mi-crosoft Teams software, accessible by all mem-bers of the network.
• Daily capacity conference calls to match ap-pointment needs with capacity across the net-work.
• A proactive primary care pathway for high-risk diabetes foot problems.
• A proforma for telephone triage.
• An information governance (IG) agreement across organisations covering the use of virtual tools.
• Production of process flow diagrams and guid-ance explaining the proposed new model.

This project has enabled the rapid adoption of modern technology tools to facilitate access to expert diabetic advice. Data is currently being collected by the Diabetes Foot Network to clarify if this new model of care reduced amputation rates.

“This is a fantastic example of how clinical collaboration across the Trusts, community and primary care services in south east London ensured patients at high risk of diabetic foot complications still received a high-quality service and positive experience.”Dr Natasha Patel, Diabetes Consultant Guy’s & St Thomas’ NHS Foundation Trust & Dr Prakash Vas, Diabetes Consultant King’s College Hospital NHS Foundation Trust Diabetes Clinical leads for the South East London Diabetes Foot Network

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Key achievements

  • Analysis of one group of seven patients who have had virtual reviews shows they were reviewed by an expert clinician within five minutes of requesting one on Pando. .
  • four were upgraded to a hospital clinic for urgent review and one was admitted to hospital on the same day.
  • • The South East London MDFT COVID-19 plan was signed by all seven boroughs and the regional NHS England and NHS Improvement team.

By Rita Mogaiji

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