Diabetic foot complications are recognised as one of the most common reasons for diabetes-related hospitalisation and lower extremity amputations.   Multi-faceted strategies to reduce diabetic foot hospitalisation and amputation rates have demonstrated success across the world.  These strategies commonly include multi-disciplinary foot teams, clinical pathways, clinical training and data reporting.  However, the majority of services that have employed these strategies have been based in tertiary hospital settings, rather than community settings where the majority of people with diabetic foot complications present.  Furthermore, guidelines advise primary healthcare professionals that all people with diabetes require an annual foot screen.  Yet, this then presents primary health professionals with the common problem if they do detect a foot complication of, “where do I send them for what …. hospital?”.

This paper aims to report on the Queensland experience of implementing these and other multi-faceted strategies in community or secondary settings across the state.  To date Queensland has a network of over 50 community based high risk foot services routinely following standard evidence based clinical pathways, meeting defined clinical indicators and collecting standard diabetic foot data annually; including 20,000 occasions of service, over 4,000 total patients, and nearly 1,000 healed ulcer patients data last year. The paper will finally discuss whether these secondary services have had any impact on tertiary hospitalisation and amputations.  This network runs under the auspices of the multi-disciplinary Queensland Health Statewide Diabetic Foot Working Group and Statewide Diabetes Clinical Network.