Foot In diabetes UK

Paul Chadwick

Clinical lead for the high -risk foot team, Salford

I qualified in 1990 from the Northern College of Chiropody and was fortunate to have in my cohort such luminaries as Martin Fox and Louise Morris and was lectured to by Louise Stuart (some things never change!).
Most of my work around diabetes has been carried out in Salford. I started work here in 1995 as a Senior 1 in high-risk liaison that involved developing care pathways and integrated working across the hospital and community trusts.
Through the ongoing implementation of a patient held record, audit and foot care guidelines a whole system approach to the management of the diabetic foot has been achieved.
I am now a clinical lead for the high -risk foot with a team of 9 band 7 pods working in this area.
I completed a Masters degree in 2000 looking at patient’s knowledge around foot ulceration and I am half way through a PHD looking at the construction of painful diabetic neuropathy.
I chaired the group that developed the North West Clinical Guidelines. I have published articles in a number of journals about the management of diabetic foot disease

Describe your typical work day

No day is the same. In my role I have to attend a lot of meetings and I am also undertaking my non- medical prescribing course as-well as my PHD so I spend a lot of time studying.
I do 4 clinical sessions a week at the moment and these involve complex limb threatening conditions.
I run a small neuropathic pain clinic.

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

My first day as a podiatrist in Great Yarmouth somebody's toe fell off into the bandage.
I must have impressed the senior 1 so much he asked me to cover his clinic two weeks later when he was on leave. It was a disaster! I was running two hours late, knocked over the treatment trolley and smashed glass over the floor. I did biomechanics and mental health for a couple of years after that. I was working in Sheffield and again I was asked to cover at the acute hospital working with Prof John Ward he complimented my work, I was encouraged and my interest was developed.

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

The complexity and the fact everyday and every patient brings new challenges. The team at Salford including my management team from the past ie Clive Brown and present Victoria Gould helped by giving me support and guidance to change systems that had been established and were set in stone.
Dr Bob Young has been instrumental in supporting guiding and educating me over the years.

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

Worst moment was receiving a phone call saying that someone was suing me from beyond the grave- a feeling that I had done a lot for the patient and I knew he was happy with my management but that a family member who never met me felt it was worth a go! No specific good bits but I have had a lot of good moments with patients who have appreciated the work of the team

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

From the answer above my documentation saved me- the use of a standard assessment sheet meant that the patient’s risk assessment and management plan were well described. The use of collegues and particularly non podiatry collegues e.g. district nurses for clinical supervision.

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

The main developments are around the use of a computerised patient record which can be accessed by patients, my phd takes up a portion of my time and the equipping of staff with skills to become the “guardians of the foot” e.g radiology prescribing

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

The need to embrace whole system working and improve access for patients to tertiary services such as vascular surgery. The need to look at working practices such as 9 to 5 for pods – we need on call pod working 7 days not dumping on to A +E