Diabetes clinics across the country have been advised to follow the blueprint used by Newham Foot Care Clinic after it was named one of the top performers in England.

The National Diabetes Audit placed the clinic amongst the top 25 performing practices in the country after its high performance in reducing the amount of minor or major amputations needed.

Roz Rosenblatt, London Regional Manager for Diabetes, said the “rest of the country” should learn from the clinic’s example and follow its “outstanding work”.

The regional boss said the clinic, based at Newham University Hospital, was leading the field in reducing the amount of diabetes-related amputations.

Patients with diabetes are more than 20 times more likely to suffer an amputation than those without the condition. There are around 6,000 diabetes-related amputations across England annually.

The audit found that in the worst performing areas, people with diabetes are more than eight times more likely to suffer an amputation than patients living with the condition in Newham.

Michael Van Orsouw, the vascular nurse at the clinic, said the success of the practice was down to its multi-disciplinary team. “Our team includes a vascular surgeon, a consultant diabetologist, and a podiatrist, in addition to nurse practitioners,” he said. “The team is available for all diabetic patients whether visiting our day foot care clinic or as an inpatient requiring treatment.”

“We take a patient centred approach – so that at every step of the way in their treatment, the individual is involved. It’s definitely a ‘no decision about you without you’ approach.”

NHS Wales has launched a consultation document for a programme of service improvements to reduce the incidence of, and death rate from, heart disease.

The Cardiac Delivery Plan for 2013–16 focuses on prevention, early diagnosis and treatment, care plans and reducing hospital admissions.

The three-month consultation is in line with NHS Wales’ ‘Together For Health’ strategy to promote personalised and integrated healthcare.

Coronary heart disease affects 9% of adults in Wales (and 33% of adults aged over 65), causing 4,700 deaths per year.

The document points to causal factors such as smoking and obesity, but also notes the need for more timely and well-integrated cardiac care.

A major aspect of the proposed strategy is that Local Health Boards will work with social services to develop “a care plan for those with long-term cardiac conditions” to ensure that “care is co-ordinated between community and hospital”, meeting each patient’s “individual treatment and support needs”.

The care plan will be shared with the patient and reviewed on an ongoing basis, with the aim of ensuring that care services “are compliant with national standards and guidelines” and are “safe, sustainable and available as locally as possible”.

The document also states that cardiac services should be provided “increasingly” within primary care.

Three performance measures are proposed: the percentage of patients treated in line with the cardiac disease waiting time target; the number of emergency admissions, readmissions and bed days; and the percentage of patients who have a care plan.

The consultation will close on 26 October 2012.

CCGs in poorer areas of the country will have their targets adjusted to reflect the demographic of their patients, the NHS Commissioning Board (NHSCB) has said.

The decision comes after NICE published its recommended indicators for inclusion in the NHS Commissioning Outcomes Framework (COF) – the system by which GPs will be assessed and financially rewarded.

A spokesperson for the NHSCB said that a “robust approach to case-mix adjustment will be needed”.

The BMA backed the proposal and called for potential indicators to be piloted across the country in order not to discriminate against GPs based in poorer areas.

Dr Mary-Louise Irvine, BMA Council member, said that anything that “unfairly discriminates” GPs who need resources the most should be tested first. “If my resources are shrunk it’s more difficult to deliver good care,” said the south-east London GP. “I think the indicators should be piloted and evaluated to get them right.”

Indicators in the COF include reducing emergency admissions and providing care for stroke patients, plus ones for COPD, maternal care and access to mental health services.

Variations in the level of acute hospital admissions for elderly people point to a need for integrated care, according to the King’s Fund.

If admission rates and hospital stays for elderly people were standardised at the rates of the best 25% of PCTs, the NHS could save £500m per year.

The King’s Fund said no single change could bring major improvement: the only solution was better integration of acute care with primary and social care.

The think tank found that rates of emergency admission for elderly patients varied fourfold across the NHS, while average lengths of stay varied from 6–13 days for patients aged over 65.

If all PCTs achieved the same admission rates and stay lengths as the lowest 25%, the NHS could free 7,000 hospital beds and cut its annual costs by £500m.

The report recommended that acute trusts work with GPs to improve primary care of long-term conditions and work with local authorities to help keep patients safe at home.

Study author Candace Imison said there was no “magic bullet” to address the issue, but the answer lay in better integrated care: “The areas that have shown a long-term commitment to integration – for example through joint teams, shared records and joint budgets – demonstrate better results and much lower use of emergency hospital beds.”

Such an approach would be “far more clinically and financially sustainable” than the current model, she concluded.

The NHS Commissioning Board (NHSCB) has appointed five more managing directors for commissioning support units (CSUs) in the second round of recruitment – nine less than expected.

They include Nick Relph at South London CSU, Clodagh Warde Robinson at Surrey and Sussex CSU, Maddy Ruff for North Yorkshire and Humber CSU, Alison Hughes, West Yorkshire CSU and Daryl Robertson, Kent and Medway CSU.

The Commissioning Board said it will make further appointments in “due course”.

The appointments come after the NHSCB confirmed nine managing directors in the first round of recruitment.

Also, Andrew Kenworthy, Chief Executive of NHS South London, is set to join the Commissioning Board Authority’s Commissioning Development Directorate via an IMAS assignment as Director of the CSU Transition Programme.

Meanwhile, the Commissioning Board Authority has recruited three Very Senior Managers. Bob Ricketts joins as Director of Commissioning Support Strategy and Market Development, the DH’s Colin Douglas has been appointed Director of Communications and Ann Johnson has been recruited as Director of Financial and Corporate Performance.