DIABETES & VASCULAR FOOT REFERRAL GUIDANCE 2013 Ver4.0 With keys points adapted from NICE Guidelines - The Prevention and Management of Foot Problems in People with Diabetes: a tiered structured approach to ensure that people with diabetes receive timely, appropriate and effective surveillance and treatment to reduce foot complications. Foot ClassificationReferral CriteriaTeams & RolesContact Information Normal Sensation & Normal Perfusion, +/- Palpable Pulses Primary Care Team Examine feet to detect risk factors & classify risk, agree a management plan including foot care education with each person. Arrange annual recall as part of ongoing care and refer to foot specialists as appropriate Practice Surgery The general practice where the patient is registered Neuropathy, Deformity Callus, Corns, Nail Pathologies Foot Protection Team Provide specialist assessment and regular review as appropriate. Podiatry treatment for skin and nail care, including provision of protective insoles and their renewal. Agree management plan including intensified foot care education (further details available on GP Gateway under Podiatry) City of Coventry Health Centre – Community Podiatry Service Stoney Stanton Road Coventry CV1 4FH Referrals via Choose and Book or faxed pro-forma to Queries please tel: IF NEW ♦ulcer (wound) ♦swelling ♦discolouration Ulcer (Non healing: 4 or more weeks), Infection, Necrosis / Gangrene, Charcot, Painful Neuropathy Multidisciplinary Diabetes Foot Team Highly specialised management of complex diabetic foot & lower limb conditions, with access to advanced investigations & working closely with other hospital specialties-VIA CHOOSE AND BOOK---RSS or WISDEM FAX [In severe cases where admission to A&E is being considered Refer to [GPAU] GP Assessment Unit TEL— OR or Please FAX LETTER AFTER DISCUSSION Also Contact Bleep on call Diabetes SPR via UHCW switchboard ( )] WISDEM Diabetes Foot Clinic WISDEM Centre UHCW Clifford Bridge Rd CV2 2DX Tel Send referrals to CHOOSE & BOOK --RSS or following discussion with bleep 1698 Diabetes SPR WISDEM Fax Critical Ischemia, Digital Ischemia, Rest Pain, Wet Necrosis Vascular Surgery The department at UHCW offers advanced vascular investigation and revascularisation procedures for patients with occlusive peripheral vasculature. Referral form available on GP Gateway [In severe cases where admission to A&E is being considered please ring UHCW switch board ( ) and ask for the on-call vascular consultant– available 24/7] University Hospital Vascular Department University Hospital Clifford Bridge Road Coventry CV2 2DX Via switchboard: Send referrals to RSS At any time Acutely Unwell or Foot Emergency: EXTENSIVE ISCHEMIA or INFECTION, the patient should be directed to the nearest Accident & Emergency Department & Please inform Bleep 1698 via UHCW switchboard ( ) This guidance was developed by a multi-disciplinary team including: Dan Higman, Vascular Surgeon UNCW, Michelle Horn Coventry CCG Narasimha Murthy, Consultant Endocrinologist UHCW & Gurdev Singh Deogon, Chief Podiatrist in Diabetes UHCW Low Risk High & Raised Risk Vascular Ulcerated/Active & Reduced Perfusion

AT RISK FOOT INTEGRATED CARE PATHWAY FOR COVENTRY 2013