November 2019 Blog: Pharmacy Quality Scheme – Foot and Eye Checks Audit

Pharmacy Quality Scheme – Foot and Eye Checks Audit

DIABETES FACTS; The NHS now spends around £10 billion a year – 10% of its entire budget on treating diabetes, there are currently four million people in England with the condition, someone is diagnosed every two minutes, and the numbers have doubled in the last 20 years.

Health checks for people living with diabetes are vital and we are all aware of the consequences of ignoring those early signs of problems. Diabetes UK encourages patients to have regular check-ups to prevent serious complications with feet, eyes, heart and kidneys but only 57% of Type 1 and 41% of Type 2 patients get even eight of the 15 basic health checks every year¹ outlined below on an annual basis.

Full list of checks and support services:

1. Blood glucose test (HbA1c test)
2. Blood pressure check
3. Cholesterol check (for blood fats)
4. Eye screening
5. Foot and leg check
6. Kidney tests
7. Advice on diet
8. Emotional and psychological support
9. Diabetes education course
10. Care from diabetes specialists
11. Free flu jab
12. Good care if you’re in hospital
13. Support with any sexual problems
14. Help to stop smoking
15. Specialist care if you’re planning to have a baby.

In a bid to address this issue a few changes have been made to the Pharmacy Quality Scheme (PQS), which replaced the Quality Payments Scheme (QPS). In particular, a Diabetic Foot and Eye Audit is now included in the “Prevention Composite Bundle”:

 We must now: “Check all patients aged 12 years and over with diabetes who present with a prescription from 1st October 2019 to 31st Jan 2020 have had an annual foot and eye check (retinopathy). Make a record on the PMR or appropriate form/patient record and signpost/refer as appropriate. The total number of patients who have had this intervention, the number that have not had one or either check in the last 12 months and where they have been appropriately signposted/referred should be recorded and reported as part of this criterion.”

Having foot and eye checks is clearly important and by participating in the audit you will raise the importance of the checks with your diabetic patients. Those who have not had their checks should be encouraged to get them and appropriate signposting will be an important element of the audit.

Foot complications are particularly common, because of either diabetic neuropathy (nerve damage or degeneration) or peripheral arterial disease (poor blood supply in the legs). In 2014-15 the cost of healthcare for diabetics related to foot ulceration and amputations was estimated at £1 billion in England, with two thirds of this spent on treating foot ulcers in primary, community and outpatient settings. In addition, there are 8,500 leg, toe or foot amputations every year (i.e. >160 per week). Yet it is thought around 1 in 4 Type 1 diabetics and 1 in 6 Type 2 diabetics miss their foot checks².

Diabetic retinopathy is the leading cause of preventable sight loss in the UK. It is a major problem and around 1,600 people every year are certified as visually impaired or with seriously impaired vision. If blood glucose levels are not well controlled high levels damage the back of the eye and the longer the condition is left undiagnosed or untreated the greater the damage (possibly even causing blindness). Other factors involved are blood pressure and cholesterol levels, which should also be checked as part of the diabetic annual review process. It should be noted that diabetes increases the likelihood of glaucoma by 1.5x and cataracts by 2x – both of these can lead to blindness if not spotted.

The audit requires that you check every diabetic patient who presents a prescription from 1^st October 2019 to 31^st January 2020. Fortunately, each patient needs to be spoken to only once, but this will require you to have systems in place to facilitate this and record the interventions that have been made. I estimate that the average pharmacy will have about 350 diabetic patients (28 Type 1, 315 Type 2 and 7 other).

For more background information have a look at the VirtualOutcomes’ Diabetes Foot and Eye Audit – PQS webcourse. It only takes 10 minutes and gives a good insight into why it’s important that diabetic patients get checked annually. It also helps you understand what information you need to collect and provides some examples of forms that might be helpful when collating the required information.

Finally, to help you get ready for the audit, check out “PSNC Briefing 043/19: Pharmacy Quality Scheme – Foot and eye screening (retinopathy) checks for patients with diabetes”. It’s a comprehensive guide and includes helpful resources such as small flyers for prescription bags, GP practice briefing points, a template letter for GP practices, a data collection form and a suggested process map for conducting the audit.

N.B. The Foot and Eye Check Audit is one of five elements you will need to complete in order to claim the 25 points associated with the Prevention domain bundle (worth between £1,600 and £3,200).

¹ Diabetes UK Tackling the crisis: Transforming diabetes care for a better future”

² NHS Digital (2018) National Diabetes Audit, 2017-18 Short Report: Report 1: Care Processes and Treatment Targets