Jacob Maxwell

Page 1
SSC3A

An Audit of Diabetic Foot Care in Cranham Village and Little Gaynes Surgeries
Tutor Name: Dr Muhammad Akhter
Audit Objectives:
1- Understand the importance of auditing within a general practice environment.
2- Gain the ability to carry out the initial research and follow-up patients that would
provide useful information for the audit.
3- Gain the ability to analyse the data collected and to draw conclusions from it.
4- Gain the ability to present an audit in a written format in a clear and concise manner.
Audit Aims:
1- Discover how many diabetic patients receive annual foot check-ups.
2- Discover how many diabetic patients do not receive annual foot check-ups.
3- Discover why it is the case that some patients do not receive annual foot check-ups,
and if there are any changes to be implemented that could prevent this.

Introduction & Background

Jacob Maxwell

Page 2

Type 2 diabetes mellitus is often referred to as the ticking timebomb of the NHS. Globally,
it affects 285 million people and in the UK, diabetes (both diagnosed and undiagnosed) is
estimated to affect one in every 16 people, with roughly 90% of these cases being type 2
diabetes mellitus. While there is a large genetic component to diabetes (particularly type
2), lifestyle risk factors such as obesity and increased sugar consumption are known to
have a role in the aetiology of this condition. The incidence of diabetes is expected to
follow the increasing prevalence of these risk factors.
Because of the huge expense of treating the myriad of diabetic complications, it is
imperative that diabetes is not just well-controlled, but that diabetic complications are
caught early, for example, through screening programmes. The bulk of this workload is
carried out in general practice, where diabetic patients are annually checked for signs of
nephropathy, neuropathy and retinopathy, and have their blood pressure and cholesterol
levels monitored.
Diabetic neuropathy is one of the long-term complications of diabetes. It often presents
with dysesthesia and a loss of proprioception, sensation and reflexes that begins in the
toes and spreads proximally up the legs. This sensory loss can result in the ignorance of a
minor injury, which over time may progress to a more serious condition, such as an ulcer.
These ulcers may result in disability and death, and are responsible for more hospital
admissions than any other diabetic complication.
A diabetic foot check-up is performed by taking a history of any foot-related problems,
followed by visually inspecting the feet for ulcers and changes in shape, then testing for
sensory loss using a monofilament. The Quality and Outcomes Framework sets a
standard for GP surgeries of carrying out an annual foot check up on 90% of their
diabetic population. These check-ups are a very simple method of screening for a very
serious problem, so ascertaining how well the practice was performing in this area
seemed to be a practical and potentially enlightening audit to complete.
Methodology
The method of data collection used in this audit was generally very simple. The first step
in gaining information about diabetic foot care was to ascertain the number of diabetic
patients shared between Cranham Village and Little Gaynes surgeries. Of these 11,296
patients, 575 were on the diabetic register.
Of these, 525 patients were judged as needing to have their feet checked annually. The
next step was to discover the proportion of these patients that had received their foot
check-up within the previous year. This was completed using the search function on the
practices online patient records with the guidance of Dr Akhter.
To further delve into the issue of why some patients dont receive these check-ups, I
decided it would be important not just to collect the data above, but to talk to some of
the patients who did not receive the check-ups to ask them why they did not. Originally, I
proposed the idea of using an afternoon to telephone several of these patients to
interview them. However myself and Dr Akhter realised that this would raise concerns
about patient confidentiality and privacy, as I had never met these patients before. Dr
Akhter then kindly proposed that he would ring up the patients on my behalf. We agreed
that roughly 10 patients would constitute a sample size large enough to extrapolate data
from, without having too much of an impact on Dr Akhters normal workload.
Results

Jacob Maxwell
Conclusion
Recommendations

References

Page 3