"We had heard about Flo through Michelle Flint, who is leading the project in Oldham, and quickly identified an opportunity to support our patients to self care in-between face to face consultations.  We hoped that Flo could help our patients to identify problems with their feet that need our intervention and empower them to seek support sooner, thereby avoiding further deterioration.
What was the challenge?
We know that keeping feet healthy can be difficult for patients with diabetes.  Often patients don’t realise that there is a problem until it has deteriorated as patients can have a loss of sensation in their feet.  In this case, any break in the skin can develop into a foot ulcer and exacerbate quickly, compromising the patient clinically and elongating the treatment plan required.  Sometimes we ask patients ‘How long have you had this wound?’, and they’ll answer ‘8 weeks’, meaning that we are now dealing with a more complex wound that will take longer to treat and have a greater impact on the patient’s lives.  This is very common, patients don’t always recognise the importance of looking after their feet and often think they can put a plaster on and sort it out themselves.
Where did we focus?
Active self care is so important for patients with diabetes.  Many of our patients are gentlemen over the age of 50 who we find can be less engaged and motivated to take on board the foot health education that we have been providing in clinic.  As a team we recognise the importance and actively educate our patients so that they feel confident in their foot care at home.  However, it has proved challenging to generate sufficient engagement for patients to enable them to understand that the condition of their feet needs close attention by them in-between appointments, or even to acknowledge the importance of just attending their routine foot clinic appointments.

We provide paper based education for our patients to take away, however the impact of this is limited and it becomes apparent that it does not always result in helping our patients to become motivated to self care.  We often find it screwed up in their wound dressing bags ourselves when they come in for their appointments!  Therefore we looked to Flo to engage with our patients outside of clinic appointments to provide them with the motivation and capability to self care effectively.

Flo interacts with our patients every evening to remind them to check their feet for any change or damage, along with offering regular advice and information pertinent to their foot care.  We recognised that most patients use their mobile phone regularly, and so we know that Flo is in their pocket rather than in the bottom of a bag!  It’s also reassuring to know that Flo’s messages are recorded on the patient’s phone enabling patients to look back on them at anytime should they need a recap.  The reinforcement that Flo provides around the importance of attending clinic for regular foot checks is also really important, to support an increase in the patient’s motivation and ability to self care in-between.

Here at Oldham Podiatry Department we operate a two tier system: high risk and routine.  When we discharge patients from the high risk clinic to the routine clinic, some patients tell us that they can feel vulnerable, even though they are under shared care where the patient is seen weekly or fortnightly by the high risk team alongside routine follow up with podiatry.  This feeling can be present especially if the patient has had a long-standing foot ulcer and built up a close rapport of trust with specialist staff or if they have had amputation.

Using Flo offers additional support in this transition, patients still have a link to us via Flo which increases patient’s confidence and that feeling of being supported.
What do patients think?
Recently we’ve had a lovely handwritten letter from a gentleman that describes how his feet have “ never been as good as they are now ”.  The patient goes onto explain how he now applies his cream on at 7 o’clock when Flo tells him to!  Self care can be challenging, and we strive to ensure that we support our patients effectively so that they feel confident and motivated to engage regularly in their foot care; that’s what Flo is helping us to teach them.


What’s Next for the Oldham Podiatry Team and Flo?
We’ve now introduced Flo for patients who have undergone nail surgery to support them to self care for their wounds post discharge.  Flo is helping patients to identify any deterioration sooner and motivate them to seek help earlier before the symptoms worsen.  This is a younger patient cohort so Flo has proved very popular with this group, fitting even more easily into their lifestyles.

Moving forward, we hope that even more patients with diabetes are introduced to Flo.  We’ve had patients who’ve come into clinic and given us anecdotal feedback that their feet are in a much better condition, so now our next step is to collect robust clinical evidence to support this.  We’ll be reviewing all of our Flo patients to establish a picture of their condition before Flo and what it’s been like since, regarding ulceration and their presentation at clinic.  I am passionate about taking this forward, because I have seen that Flo is of real benefit to our patients.