Diabetes patients ‘having to rely on GPs’ - Warns Review

A report from the NHS Resolution has said that following a referral to see a specialist, follow up is irregular and patients are having to rely on general practice for ongoing care.

After 2013/14, there have been 92 cases of lower limb complications from diabetes in England which have been settled by 2018/19, but the number of claims continue to grow as the years go by.

Almost 66% of the cases under review involved compensation for below knee amputation and 22% for amputation above the knee.

Interestingly, more than half had never had input from a multidisciplinary foot care team at any point even as the report says that persons who are high-risk are not identified and so do not receive adequate preventive care.

High-risk patients were often not identified and had received very minimal preventive care, the report said.

Furthermore, when the patient was identified, about 68% of them experienced a delay in being referred to the specialist team instead they were seen by different clinicians with ‘at least two clinicians and two episodes of care seemingly necessary to generate one referral’,

The report also said that most times and unsuccessfully, GPS and nurses try to reach out to specialists in order to facilitate the review but that referral notes had to be sent multiple times before the patients are finally seen.

Additionally, Patients who had been seen by a foot protection service or multidisciplinary foot care team most times do not have ongoing consistent review, as they require. Some of them wait for months while others are lost to follow up.

GPs were often needed to prescribe antibiotics, refer to the vascular or orthopaedic team, arrange for patient admission, and to see patients on an emergency basis, the report said. The report also highlighted that there is a need to vary the standards of care that patients with diabetes and lower limb complications receive and recommended a less complicated patient referral pathway in addition to a review of how diabetic foot care services are commissioned.

‘The model of care that patients did receive appeared to be one which was resource-heavy, yet outcome-light,’ it said.

Consultant diabetologist at King’s College Hospital Professor Michael Edmonds, who contributed to the report as part of a clinical advisory group wants the report to be a compulsory reading for all those caring for patients with diabetes.

He said; ‘There must be learning from the diabetes-related lower limb amputations analysed in this report and a thorough appreciation of why they occurred.’

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