Martin Fox
Please say who you are with a brief biography to date of your work with the foot in diabetes
I qualified from Salford in 1990 and have spent most of the last 19 years in NHS clinics in Tameside (east Manchester), developing an interest and podiatry career in diabetes, wound management and more recently peripheral arterial disease. My NHS work has been split by periods in Calcutta, India, working in a small leprosy clinic for a year, working as a Clinical Associate at Huddersfield University and more recently a year in Cork, Ireland working in a hospital diabetes foot clinic. I have recently moved to NHS Manchester to work as a Vascular Podiatrist
Describe your typical working day
I ride over the Pennines every morning on my motorbike (Fazer 600), come rain or shine, which clears my head and gives me about an hour to calm or exhilarate myself, depending on mood.
Until 3 months ago, I held a Clinical Lead post and was a PEC member, in a neighbouring PCT. About 30% of my time was clinical work, the other 70% being chairing / attending meetings, project management, communication and supporting other staff around me. My clinical work was mainly in the Consultant-led Diabetes Foot Ulcer and Vascular clinics, Podiatry-led Vascular assessment clinics and Casting Clinic.
I now work in a small NHS team (Consultant Podiatrist, Vascular Nurse Specialist and myself as a Vascular Podiatrist), with a remit to identify, assess, diagnose and manage people with peripheral arterial disease in North Manchester. We are running and promoting peripheral arterial disease clinics in 4 community locations across North Manchester. I spend about 60% of my time in clinics and the rest developing the service and drumming up business. It feels like a good balance. It’s a great opportunity to focus on providing and developing further a new service model, for a local population with a high level of cardiovascular disease related mortality and morbidity.
How did you become interested in working with the foot in diabetes?
Early successes and failures, in particular with people who had diabetes- related foot ulcers. Then following on from working with leprosy for a year in Calcutta, it was a natural direction to go in, back in the UK.
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 spent time with my colleague Judith Gibbons in a hospital diabetes foot clinic and remember being hooked by attending Ali Foster’s conference presentations in the early 90s. My current Clinical Lead Louise Stuart both stimulated and challenged me in various clinical meetings around Manchester and both Neil Baker and Paul Chadwick have played their part. The Diabetic Foot Conferences fronted by Matthew Young and co also hooked me.
However I had a growing realisation that too much of the focus was on hospital based MD foot clinics and the real solution was to create integrated diabetes foot frameworks with specialists firmly embedded across community settings too. This came from my experiences with another challenging long-term condition – leprosy. We are still a long way off from this ideal, but now 15 years on it seems less alien as a concept … I hope.
What have been your best and worst moments working in this area?
Best moments have been when connecting with patients, changing their understanding of their health situation, hooking them into choices that produce better clinical and health outcomes. Practically this usually involves; facilitating better wound care and offloading of foot ulcers, getting the penny to drop around modifiable risks like smoking and exercise and getting health care colleagues who work in isolation to work better together. Conquering shyness and fear to present what I think are key, important issues at conferences / study days.
Worst moments have been litigation, lack of support from some colleagues, communicating badly with patients and ending up with more resistance at the end of consultations, avoidable amputations and work-related stress.
Do you have any coping strategies you can share with us that get you through the worst bits?
Talking to key colleagues. Listening to what they say. Stepping back, giving myself a break and investing in self-study and training around leadership. And reminding myself that a reasonable work / home life balance is essential for sustainability. Playing with my son and daughter, in their worlds.
Do you have any new related projects in development at the moment?
I’m very excited by my current post focussing on peripheral arterial disease. Just as the foot in diabetes has been the Cinderella of diabetes, PAD is the Cinderella of both the foot in diabetes and cardiovascular disease. I aim to change that locally and hopefully influence others regionally and nationally. I need help from like minded people …
What do you feel are currently the most challenging issues for people working with foot in diabetes in 2010?
Getting integrated service frameworks commissioned that give us the opportunity to really start to improve outcomes for people with diabetes, cardiovascular and peripheral arterial disease.
Martin Fox
Vascular Podiatrist
FDUK Committee Member
January 2010