Shropshire Star

Dr Mary McCarthy: Putting best foot forward – together

At a medical meeting this week when discussing examples of healthcare professionals coming together to tackle a problem, I was reminded of a project that Shropshire initiated some years ago - the foot-screening programme.

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Using the nursery rhyme ‘for want of a nail the shoe was lost’ to publicise the programme, the screening was designed to encourage intervention of diabetic patients who have already or were likely to develop foot problems.

The programmed was devised out of a need for more consistent methods of detecting early foot problems in our diabetic patients with the aim of developing secure pathways of which to refer them.

Prior to this, chiropody services in Shropshire had been unevenly distributed and patient referrals were taking longer than they should.

We pointed out that for those with diabetes, nail loss, injury or infection can have far reaching consequences and an infected diabetic foot may result in an amputation of the foot or even of the leg – the “for want of a nail” effect.

My time working as a hospital practitioner in the local hospitals’ diabetic clinic gave me greater exposure to the excellent work that hospital podiatrists were doing, and I came to realise the value of the service they provide.

We organised a foot service meeting involving the diabetic consultants, diabetic nurse specialists, managers and podiatrists and discussed setting up a screening programme for the diabetic patients of Shropshire practices.

A pilot study was funded by the trust where practices were invited to enrol a patient by gaining their consent and informing the podiatry department. With the podiatrists, we developed a template, which was downloaded onto practice computer system. This recorded peripheral (foot) pulses to check on circulation and peripheral (foot) nerve function by checking sensation.

It also calculated a risk profile of diabetic foot problems allowing us to keep a register of those patients who were more likely to run into trouble. The podiatrist then visited the surgeries to examine the feet of their diabetic patients on a yearly basis, making sure everyone was expertly assessed.

The Foot Screening Service, as it came to be known, was instantly popular and eventually rolled out to all 66 practices in Shropshire, each serving thousands of patients.

The merits of the programme speak for themselves, providing an expert means of assessment near the patient’s home, within their local practice. The patient feels valued since the podiatrist is spending time talking about foot care as well as assessing their feet. It is commendable both for its educational benefits and success in the detection of high-risk patients affording swift referral to diabetic foot clinics where necessary.

The diabetic consultant, lead podiatrist and myself presented the programme in Europe at a medical meeting (EASD – Rome). We were surprised to find that this was apparently the first foot screening programme reported and remains a shining example of how a range of healthcare professionals, in this instance, podiatrists, GPs and diabetic consultants, can work together to improve care for patients.

* Dr Mary McCarthy is chair of the local medical committee and represents Shropshire, North Staffordshire and South Staffordshire on the General Practitioners Committee of the BMA. She has worked at Belvidere Surgery in Shrewsbury for more than 20 years.