In England, the development of sustainability and transformation partnerships (STPs) and the bids for NHS England Diabetes Fund for multidisciplinary diabetes footcare team (MDFT) transformation with its focus on foot disease has led to development of innovations in practice and new ways of working. However, there was no robust mechanism for sharing these new ways of working across England and the wider UK. Consequently, developments and duplication of work have occurred at regional level among the 12 NHS England clinical networks, without their benefit being felt more widely. Therefore, a scoping exercise was carried out by The College of Podiatry and Diabetes UK, and a wish for a national network was identified.
Following this, a group of interested diabetes foot champions (Paul Chadwick, Mike Edmonds, Alistair McInnes, Richard Leigh and Christian Pankhurst) developed a steering group to establish a network across England. Funding was secured from an unrestricted educational grant from the URGO foundation. The aim of the steering group was to develop an English-wide network to provide a focus for strategic developments, share best practice and advise relevant stakeholders, for example the Department of Health, NHS England, NHS Innovation, Strategic Clinical Networks and Diabetes UK, on all matters relating to service delivery and improvements in England for diabetes-related foot disease. The network then feeds into the national programme and supports Foot in Diabetes UK in its wider UK role. The network is currently a coalition of the 12 local Strategic Clinical Networks (SCNs), relevant multidisciplinary health professionals and academics led by podiatrists under the banner of the College of Podiatry.
A first meeting was held in London at the College of Podiatry in March 2019. There were representatives from nine of the 12 SCNs and other attendees included representatives from Foot in Diabetes UK, Association of British Diabetologists and academic institutions.
The meeting was dedicated to the sharing of individual SCNs workstreams, their metrics and the sharing of good practice and learning. From this, common themes emerged in areas in which the group could develop a shared strategy. These themes included data (what is collected, how it is collated and how it is used), education of staff and patients, and issues related to the recent vascular reconfiguration and ‘workforce’, with a particular focus on the impending acute shortage of podiatrists. Discussions on these issues were fed back to the wider network.
Next steps
The steering group will meet to evaluate the day and review the workstreams, with the aim of producing a report to go to the National Clinical Lead for Diabetes and Obesity, the All-Party Parliamentary Group (APPG) for Diabetes, the APPG for Vascular and Venous Disease and NHS Right Care.
Several recurring themes from the SCNs were identified as priorities. Workstreams for each priority will be developed and divide between the SCNs to pilot. Feedback on each priority to the England Network will enable uptake of unified systems across the country, ensuring consistency of approach and country-wide performance measures to develop strategy in reducing variation of patient outcomes. including rates of major amputation, which have not significantly fallen over the past six years according to recent figures from Public Health England.
The hard work is just beginning, but the enthusiastic collaborative approach from all the participants augurs well for the future of care delivery in England and hopefully impact on the sub-optimal outcomes for diabetes patients.
We hope the group will eventually have representation from all 12 SNCs/devolved districts. If you are a member of your local NHSE network or devolved district but were not represented at the inaugural meeting of the England Network, please contact Stephanie White, email stephanie.white@cop.org.uk
