Foot In diabetes UK

Who: Louise Stuart Where: North Manchester PCT, England Contact: louise.stuart(at)manchester.nhs.uk

Louise, tell us bit about how you became involved with the foot in diabetes.

I have a frenetic professional background. Up until recently I worked as a full time lecturer at the University of Salford. As part of the lecturers post I set up a secondary care multidisciplinary foot clinic in collaboration with Professor Wiles and North Manchester PCT. The foot clinic provides a clinical placement for final year podiatry and 4th year medical students.
I suppose we see on average 40 patients on this clinic each Wednesday.
Six months ago I applied for the first lecturer / consultant podiatrist post in the UK. The twist here is that the Consultant Post is based 2 days per week in the North Manchester PCT and for the rest of the week I run around like a headless chicken between the university and the hospital-based foot clinic. Working across the university, the hospital and the Primary Care Trust has been a vertical learning curve and has most definitely altered my view on the role and value of primary care specialist podiatrists.
I took the Consultant Post as 3 trusts were merging and most of my line managers where on redundancy lists. I have had to learn the new lingo of commissioning and business cases and strategically develop an integrated commissionable Diabetes Foot Service across North Manchester PCT. I have never networked so much in all my life and will never speak badly of any district nurse again! The whole service development has been driven by a group of dynamic primary care based nurses,
podiatrists and GP's, not to mention a very supportive diabetologist.
Our team have only scratched the surface so far but already we have a responsive foot protection team who work across both the community and hospital setting.
We have already shown a reduction in hospital admissions, reduced visits to out-patients, direct admission rights to the medical assessment unit as well as improved patient satisfaction. The gold standard now will be to aim for an enhanced multidisciplinary diabetes foot clinic based in the community.
We hope to write the business case for a community diabetologist. On saying all that though, ask me in a year if we are up and running!
The clinical side of my job is what I love most, but I am enthusiastic about providing better protocol drive care based on evidence based practice and disseminating good practice through undergraduate and postgraduate teaching as well a clinical
research via publication and presentation at national conferences. Three of us recently took the non medical prescribing exam, the dread of all courses to date, I now look forward to gaining some experience as a prescriber.
As Chair of Foot In Diabetes UK I am passionate about the care of people with diabetes and improving care of the diabetic foot. I feel that I along with other specialists am acting as a change agent in helping to pioneer landmark changes in the profession within diabetes and foot complications. There is still so much ignorance about diabetes and foot complications, which in my experience go across secondary care as well as primary care. My commitment is to provide the best service for patients regardless of where it is delivered.
Such a commitment can only be achieved by national and international networks and alliances with a similar vision. FDUK has already achieved a proven track record of providing a national support framework, as well as becoming a stakeholder voice engaging with NICE, Society of Chiropodists and Podiatrists, DOH and DUK. We now have more than 600 members and look forward to supporting, influencing and leading the management of the diabetes and related foot complications.

So, what's your typical working day?

Every day is different. The only consistent thing is that I always leave the house in a state of stress after leaving my 2 kids to go to school minus their swimming kit or some other crisis that they spring on me at the last moment.
On Wednesdays I work in the multidisciplinary foot clinic with 3 other podiatrists, an orthotist, a lovely diabetologist and a vascular specialist nurse. We usually have at least 5 students with us who spend 3 weeks with us on placement.
Clinics are the highlight of my week. The patients are there weekly with community follow up. A typical clinic involves the bread and butter of our work; risk assessment of limbs, appropriate medical assessment and history taking. Wound debridement and loads of medicine advice notes for antibiotics.
I suppose the thing which slows an already 'busting at the seams' clinic down is making pressure relief casts. We now use Softcast™ on the majority of our foot ulcers along with the usual commercial walkers, sandals and TCI's. Once the clinic starts it's a bit like a steam roller - you just keep going until the waiting room is empty. Often morning and afternoon clinics run into each other. (I bet by now some of you reading this are seeing your typical day!) After clinic or at lunchtime we may go onto the wards to see some patients who can't make it to foot clinic. I don't know about you but writing up notes seems to take forever at the end of clinic before going home to see my little angels!

How did you first become interested in working with the foot in diabetes?

Not sure why diabetes specifically but other areas like rheumatology and podopaediatrics never interested me.

Why does this speciality appeal to you as a career choice, and who, if anyone influenced / motivated / guided you in this area of work?

As a career I don't think I would choose a different option now. I have had a lot of people who have influenced and motivated me though.
Ali Foster, for me is iconic to the diabetic Foot.
Phil Wiles the diabetologist that I have worked with for the past 16 year has been hugely motivating and supportive.
The list is endless;
Matthew Young (Diabetologist in Edinburgh) has also been a support to me as well as to sustaining the development of FDUK, particularly in its early stages when it was known as PDUK.
Mike Edmonds and William Jeffcoate are an inspiration in what they have contributed to our knowledge of diabetes related foot complications. The list could go on for ever!

What have been your best and worst moments at work and why?

Best moments so far in the work sense have been getting countless ulcers to heal when amputation was expected. The 'highs' you get on a foot clinic when you know the team have done a good job and that obviously most importantly includes the patients.
Worst moments???? Being hit in the eye whilst draining an exploding abcess full of pus.

Do you have any new projects that you are trying to develop at the moment?

A new service development for management of the foot in diabetes across community and secondary care. Writing a successful business case for a community based multidisciplinary foot clinic.
A randomised controlled trial to compare Softcast as a means of offloading ischaemic foot ulcers compared with traditional methods of pressure relief.
My PhD!!! Arrrrgh
Putting non medical prescribing into practice.
Developing a work place based Clinical Management of the Foot in Diabetes module for all health care professionals involved in the management of diabetes related foot disease.
Delivering the Clinical Diabetology masters module.

What do you feel are currently the most challenging issues for people working with foot in diabetes in 2007?

Embracing patient centred care and not purely paying lip service to it!
Widening participation to more effectively manage risk factors such as hypertension, lipids, etc.
Embracing practice based commissioning and coming out the other side sane!
Improved audit of services.
Extending non medical prescribing and preparing for independent prescribing.

Thanks Louise.