Another NICE Disappointment

14 December 2015

I read NICE Guidance (NG19) – Diabetic foot problems: prevention and management. It comes after attending a diabetes meeting in which I had to walk past 135 single shoes to get to my seat. That is a powerful message to identify that we must try and reduce the number of amputations.

Everyone knows that prevention is better than cure and a good routine foot care program is essential for everyone with diabetes. I thought it would say – ‘let’s get sorted early’ – catch people before they have problems and get them into a routine. A simple routine – check your feet, wash and dry, moisturise daily and attend your routine foot check appointments.

The Society of Chiropodists and Podiatrists wrote a guide to maintaining healthy feet for people with diabetes. It is very clear and helpful and I would recommend it. It says ‘check your feet, wash with warm water and soap and moisturise. It recommends that the patient should ask their pharmacist for a moisturiser.

Many patients do not maintain the routine for more than a couple of weeks. There are simple issues coming into play here – the greasiness of the product (time to put socks and shoes on, risk of falling and staining of bedlinen) – the ease of application and what you do between the toes. It is not rocket science – just takes a little time and thought.

So, I expected a small reference to pharmacists – in the choice of product with the patient, emphasising the importance of routine care and some monitoring – you know – ‘how are you getting on with that cream?’

We know of over three million patients with diabetes in the UK. It’s a big job. So I saw an important role for community pharmacists – you know the guys that have a pharmacy on the high street or in the shopping complex or the supermarket – the ones that see patients with diabetes that are treated with medicines 13 times a year – the ones that have had a relationship with these people before and during their diagnosis – a common threat in patients’ lives.

But no – not a mention. In a time when integrated care is a buzzword – commissioners are expected to commission a bigger and better service ignoring the community pharmacists who already have a relationship with the patients.

I do ask myself why. But I look at the ‘expert reference group’ – is there a pharmacist – obviously not. Was there reference to the work of community pharmacy in the stakeholder comments – well no. Isn’t it a sorry state of affairs?

However, you will be pleased to know that many community pharmacies offer routine foot care advice to their customers. They may sell nail clippers and appropriate moisturisers and emphasise the importance of checking feet, attending routine appointments and contacting an appropriate healthcare professional if things change. They will be supporting self-care, offering advice and encouragement and matching products to patient’s experiences and needs.

We should be changing just a small part of our focus to prevention and creating health – rather than only focusing on illness and salvage. At least community pharmacists understand this.