Foot In diabetes UK

Who: Louise Morris
Where: Trafford Primary Care Trust

After graduating from Salford University in 1990 I began my career in Podiatry in Trafford, near Manchester, where I am now Lead Diabetes Specialist for Trafford Primary Care Trust. I work across both primary and secondary care leading the specialist podiatry team and developing diabetes services. I also sit on the executive committee of FDUK and I am Vice Chair/Secretary of the Northwest Podiatrists’ Clinical Effectiveness Group for Diabetes. In May 2006 I became a Supplementary Prescriber and I am part way through a Masters Degree.

Describe your typical work day

I don’t have a typical day as such. Because my role has several different aspects to it each day can be quite different to the next. My working week tends to be split between my clinical and strategic work and I therefore either have clinical days spent devoted to patient care, office based days spent working at my desk and in strategic meetings or days where I am out and about training and educating patients and professionals.

In my lead specialist role I lead the specialist diabetes podiatry team and influence the development of podiatry diabetes services. Since becoming a non-medical prescriber I have developed my role within our foot ulcer clinic to work alongside the consultant, this involves setting clinical management plans, prescribing antibiotics and the general monitoring of the patients that we treat. Our foot ulcer service runs across both primary and secondary care and therefore I manage patients in both hospital and community settings.

I am very proud of our service and strongly believe that our strength is our integrated approach – we are one team providing (more often than not) seamless care!

I also manage my own case load of patients with foot ulcers and I am involved in all aspects of their care including management of infection, pressure offloading and so on.

Strategically, I work with PCT leads to influence the development of diabetes services. I have a remit for training the multidisciplinary team in diabetic foot management including the podiatry department, GP practice teams and District nurses.

I also work as part of a specialist multidisciplinary team with a diabetes specialist nurse and diabetes specialist dietitian to develop diabetes services across the trust to deliver the Diabetes National Service Framework standards. A great part of this work involves supporting GP practice teams to manage diabetes in primary care and this has led us to develop our own structured patient education programme.

That sounded rather like a job description I think!

What I do enjoy about my job though is the variety that it provides for me.

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

My interest in the diabetic foot began whilst I was studying podiatry, although we did not really get to see or treat any very interesting cases the theory and complexity of it all fascinated me and I was instantly attracted to this area of work. This interest was enhanced further by my student placement to Hope Hospital in Salford where I saw how their high risk foot ulcer clinic was run and the types of patients they routinely treated. I was hooked and knew this was what floated my boat.

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

I do like blood and guts – doesn’t everyone who works with the diabetic foot? - so this it is a perfect niche for me. I also get a lot of satisfaction from the challenge of managing the diabetic foot particularly in my prescribing role, and when things go well this is especially rewarding. The likes of Mike Edmonds and Ali Foster have been truly inspirational to me as they have led the way for the multidisciplinary foot management teams that we now work in.

What have been your best and worst moments working in this area and why?

I don’t really have specific examples because there are so many of each.

The best bits are always when your patient heals and stays healed and everyone is happy!

The worst bits are when your patient rapidly deteriorates and there is very little that can be done. I despair when patients do not understand the full magnitude of their problems and often see it as a personal failure. I also get upset when patients blame you for their problems when you know that you have gone that extra mile to help them. But the worst moments have to be when I see a foot that has badly deteriorated because it has been mismanaged in some way and I know that it could have been avoided.

Do you have any coping strategies you can share with us that get you through the worst bits?

Although working in this area is often rewarding, it can be very difficult to cope at times. Anyone who works in this area knows that you do not switch off from this kind of patient at 5 O’clock every night and that you do take the job home with you and worry about the patients and the decisions you have made for them. Unfortunately we do also experience a fair bit of death working in this area and these are people that we have spent a lot of time with and get to know quite well – so it can be very hard.

The important thing is to have a team of people around you and for you all to support each other in making management decisions. It is important to talk to each other about the good bits and the bad bits and to generally share each others experiences and be there for each other. I feel very fortunate that I work with a great team of people where we are open and supportive.

Do you have any new related projects in development at the moment?

Yes I have a few projects on the go at the moment. I am currently working on formally setting up and promoting our Podiatry Foot Protection Service. I am also working with our medicines management department to set up and implement patient group directions to support our foot ulcer service and I am working with my dietitian and nurse colleague to develop our home grown structured patient education programme.

What do you feel are currently the most challenging issues for people working with foot in diabetes in 2007/8?

I think just working in the NHS is quite challenging in itself at the moment! There are obviously changes on the horizon for all of us over the coming months with, for example, practice based commissioning which no-one seems to fully understand.

But as far as working with the foot in diabetes I feel that the challenges here are mostly around patient motivation and education, which are paramount for any management interventions to succeed. Unfortunately these are the areas that we as clinicians are least skilled in!