Around 6,000 people with diabetes undergo leg, foot or toe amputations each year in England. The NHS across the UK spends £600m a year treating foot ulceration alone.
The analysis by Miss Vig and colleagues looked at data on 124 patients aged 37-90, who underwent 82 minor and 42 major amputations at 27 institutions across London.
They found that 24% of these patients were not previously known to foot care services – despite some of these patients having had a previous amputation.
Two thirds had neuropathy and a quarter had gangrene. Only 39% were aware of foot complication risks before entering hospital.
Miss Vig said GPs in her area were hitting QOF targets for diabetic foot care in around 70-90% of patients.
But she said services were breaking down after this point. ‘They are people in the service who want care, who don’t know where to find it, who are struggling to get the right person, and finally do, but are losing their toes or feet,’ she said.
‘We are failing our patients. We are failing to deliver excellence, despite the fact that we care so much.’
CCGs must improve screening, referral and the signposting of patients to multidisciplinary teams, and give patients better information on the risks of complications, she said.
But Miss Vig warned the situation could worsen and lead to more amputations if competitive tendering of foot services fragments care.
‘The landscape is changing unbelievably quickly and we also have to engage and embrace any qualified providers, private providers and CCGs,’ she said.
‘We need to join up, and not find that pathways put together are being disjointed and we’re suddenly back to where we were five years ago. That’s a real risk at the moment.’