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Bevan Exemplar Cohort 8 Projects

Phone first –Diabetic Foot Emergency Early Triage (DFEET) service within Cardiff and Vale Podiatry

Helen Golledge, Morgan Jones and Vanessa Goulding

Cardiff and Vale University Health Board

The growing burden of diabetes and its complications is acknowledged by Welsh Government in the Diabetes Delivery Plan for Wales (2016) which has identified preventing and managing diabetic foot disease as a key priority. In 2019 it was estimated Wales had nearly 200,00 people diagnosed with Diabetes and evidence demonstrates between 2-2.5% of the diabetes population has a diabetic foot ulcer (DFU) at any given time. The cost of diabetic foot disease in England is almost 1% of the health service budget, which would be comparable in Wales.

Since 2018 Cardiff and Vale (CAV) has offered a ‘Walk in clinic’ (WIC) for patients with diabetes and a foot emergency. However, audit and feedback from patients and staff has identified that the current set up of WIC is not equitable or sustainable

The aim of this project is to change to a community based ‘phone first’ Diabetic foot emergency early triage (DFEET) system where patients living with Diabetes and have a ‘foot emergency’ contact CAV Podiatry, speak to a triaging Podiatrist and be offered advice and an appropriate appointment.

The triaging system would be supported by telephone and video consultations and urgent access face to face clinics.

Patient outcomes and experience will be at the centre of this project and the aim will be to provide early access to equitable, appropriate and sustainable health care.

Anticipated outcomes of the project will include improved wound healing times and reduced limb amputation. Early access triage will reduce waste and duplication in primary care and unnecessary A&E access and hospital admission.

The idea is to provide the right care, at the right time, by the right person. We hope to offer a ‘one stop shop’, introducing patient group directives (PGDs) to facilitate timely access to antibiotics for mild infections and to offer phlebotomy one site.

 The hope would be to spread and scale this model of care to include not only DFUs but foot wounds of all aetiologies such as peripheral arterial disease and pressure damage, ultimately providing equitable care across CAV and eventually Wales.

This project supports the direction of travel within the NHS for Allied Health Professional (AHP) ‘First Contact Practitioners’ integrated within primary care. Currently there are no First Contact Podiatry Practitioners working in Wales.