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Taking a team approach to diabetic limb salvage

Discussion in 'Diabetic Foot & Wound Management' started by LER, Apr 5, 2012.

  1. LER

    LER Active Member

  2. DTT

    DTT Well-Known Member

    Very interesting and similar to may I have seen the NHS implement in the UK.
    I would like as an independent Private Practitioner ( IPP) direct access to a multidisciplinary team which at the moment would appear to be impossible as the referral can only come from the GP. Unfortunately some GP's and "specialist" diabetic medical staff working in the GP practice are so clueless about the urgency of a new diabetic ulcer / necrosis of digits and make it all but impossible.

    I had 4 patients last year 3 of whom died that waited weeks for referral to specialist care because I couldn't get past the GP. In one instance I got the patient to the NHS podiatry clinic and the podiatrist there agreed with my Dx and the follow up but still had to get the actual referral via a disinterested GP and incompetent nurse ( who's idea of multidisciplinary care was between her dressing the ulcer and sending the Pt back to me:mad:)

    As a generalist I am in the front line of primary care and IMHO many more amputations and lives could be saved if DIRECT access was made available with clear defined pathways so we ALL know how to get the Pt to the proper care QUICKLY.
    Just my thoughts
  3. kitos

    kitos Active Member

    Hi Richard,

    Maybe instead of various hospitals launching new ideas and procedures maybe it would be better if all diabetics were eligble to see a Pod on a regular basis or even at all?

    Increasingly in the SW it would appear that more and more are not 'eligble' for treatment. They have to rely on paying or a very quick check by a nurse maybe once a year.

    Just a thought - being a diabetic myself as well !

    Best wishes

  4. DTT

    DTT Well-Known Member

    Hi Nick

    Out of interest , I know you are an IPP, do you have the same problems as me in London getting direct access to multidisciplinary teams ??

    Unless you are a "proper" high risk patient you have no chance of direct routine footcare on the NHS up here but I know in the SW there has always been a more " community approach" to healthcare and in more modern hospitals in many cases.

    And thats from one DM2 to another :D

  5. kitos

    kitos Active Member

    Hi Derek,

    >>access to multi etc<<

    What access?? There is none as such unless through the NHS and that can be rickety at best.

    Does that answer your question? :(

    I talked to the Diabetic nurse the other day at my local clinic. They have access to a phone number to a diabetic specialist Pod and a person 'should' get seen quite quickly! Probably not within the 24 hrs as NICE recommends though. I have numerous anecdotal stories of people trying to get seen but 'deemed' as low catergory and can't be seen!!

    Guess what? They probably then get in patient care if they are lucky and / or potentially amputation

    I have a patient who was being seen every 16 week for nail cutting on his one leg and was told that every other time they would cut his nails. He said that even his artificial leg nails were growing in that time and the Pod didn't know that he had an artificial leg!

    I probably now have more diabetic patients (especially those that have been refused NHS care) than the NHS in my area...and yet they have one of the highest rates of amputation????

    I saw the Diabetes UK figures for N Ireland amputations and it was around 1000 for a year and one guy said if he had had access to a Pod then it probaly wouldn't have happened.....

    Makes you wonder where the priorities have gone

    Where are the basic skills of the NHS and care procedures?

    Why does everyone seemingly in the NHS have to be an 'expert' and where are the core skills??

    The 'Community approach' down here in the SW seems to be ...take your chances as I see it.

    Luckily the diabetic nurse locally and I have structured an 'at risk' foot criteria and my assessment and 'at risk element' is accessible and highlighted to both her and the GP and I can ensure as much as possible that the patients plight is highlighted and actioned.

    I work a great deal with Diabetes Research Network and locally we are all worried about the recent figures and discussion.

    I regularly have a go at specialists and ask how and why we are treated as almost second class patients......I mean who else gets harangued over their HbA1c results as we do?

    I guess the only way of looking at it, is that we...the Type 11's will soon out number those without.

    I wish I could smirk - but I can't

    Take care and may your sugars be low :)


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