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<p>NHS England and clinical commissioning groups (CCGs) have responsibility for determining
the overall approach to improving clinical outcomes from healthcare services for people
with diabetes. There are various actions at a national level to help ensure that all
patients with diabetes receive good quality care, including foot care.</p><p> </p><p>
</p><p> </p><p>The National Institute for Health and Care Excellence (NICE) has published
clinical guidance and quality standards on the treatment of diabetes and its complications.
The NICE Diabetes Quality Standard is clear that people with diabetes who are at risk
of foot ulceration should receive regular reviews by a foot protection team in accordance
with its clinical guidance. The Health and Social Care Act (2012) places a duty on
NHS England to have regard to the NICE Quality Standards. CCGs should also have regard
to them in planning and delivering services, as part of a general duty to secure a
continuous improvement in quality.</p><p> </p><p> </p><p> </p><p>As part of the Quality
and Outcomes Framework (QOF), general practitioners are remunerated for assessing
nerve damage and poor blood supply to the feet in people with diabetes on an annual
basis. Information is collected annually both through the QOF returns and through
the National Diabetes Audit (NDA).</p><p> </p><p> </p><p> </p><p>The new National
Diabetes Foot Care Audit, a module of the NDA, aims to establish the extent to which
national guidelines on the management of diabetic foot disease are being met. The
audit will provide local teams with the evidence needed to tackle any identified differences
in practice which will lead in turn to an overall improvement in management and outcomes
for patients. Local and national level results will be available in March 2016.</p><p>
</p><p> </p><p> </p><p>People with active diabetic foot disease should be referred
up to the hospital-based multidisciplinary diabetic foot teams and seen within 24
hours of referral. There has been an increase in the proportion of trusts with multidisciplinary
diabetic footcare teams, from around 60% in 2011 to 72% in 2013.</p><p> </p><p> </p><p>
</p><p>Diabetic foot disease is also a focus of the cardiovascular Strategic Clinical
Networks across England, with an emphasis on rolling out best practice.</p><p> </p><p>
</p><p> </p><p>The attached table gives a count of finished consultant episodes with
a primary diagnosis of diabetes and a primary or secondary procedure of amputation
between 2010-11 and 2012-13 as well as the number of diabetes patients from the 2009-10
and 2010-11 diabetes audits having an amputation the following year. The figures have
been divided by primary care trust as we do not hold this data in the format requested.</p><p>
</p><p> </p><p> </p><p>Reference should be made to the notes provided with the table
when interpreting these figures.</p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p>
</p>
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