patient groups in diabetes foot care - Diabetes in Scotland

COMPETENCY FRAMEWORK 

FOR THE PREVENTION, 

TREATMENT AND MANAGEMENT 

OF DIABETIC FOOT DISEASE (2010) 

Diabetes Competency Framework Draft Consultation Document January 2010 1

RATIONALE FOR THE DIABETES FOOT CARE COMPETENCY SET………...5 

• Background 

• Current Situation in Diabetes Foot Care 

THE SCOTTISH DIABETES FOOT WORKFORCE DEVELOPMENT GROUP...7 

PATIENT GROUPS IN DIABETES FOOT CARE…………………………….........8 

SUMMARY OF CARE PYRAMIDS…………………………………………............11 

• Diabetes Tiered Care Models 

• Care Mapped to Models 

WORKFORCE REQUIREMENT MODELLING……………………………………13 

• Screening 

• At risk patients who have not yet ulcerated 

• High risk patients with a history of ulceration and/or amputation 

• Current active foot disease 

THE BENEFITS OF THE COMPETENCY FRAMEWORK………………………14 

THE FRAMEWORK IN PRACTICE…………………………………………………15 

• Scope 

• Understanding the Framework 

SKILLS ESCALATOR………………………………………………………………..17 

COMPETENCY FRAMEWORK DEVELOPMENT TEAM………………………..18 

LEVEL TWO 

DIMENSION 1: Diabetes Practitioner Knowledge, Skills and Behaviours…19 

DIMENSION 2: Screening …………………………………………………………...20 

DIMENSION 10: Health Improvement……………………………………………..20 

LEVEL THREE 


DIMENSION 2: Screening …………………………………………………….…… 23 

DIMENSION 3: Dermatology in Diabetes Mellitus ………..................……...23 

DIMENSION 7: Preventative Ulcerative Care …………………………………...23 

DIMENSION 10: Health Improvement …………………………………………...23 

LEVEL FOUR 

DIMENSION 1: Diabetes Practitioner Knowledge, Skills and Behaviours....25 

DIMENSION 2: Screening …………………………………………………………..26 

DIMENSION 3: Dermatology in Diabetes Mellitus …………………………...26 




LEVEL FIVE 


DIMENSION 2: Screening and Assessment …..…………………………...29 

DIMENSION 3: Dermatology in Diabetes Mellitus ……………………………..30 

DIMENSION 4: Clinical and Pharmaceutical Knowledge …………………...30 

DIMENSION 5: Clinical and Radiological Knowledge …………………...30 

DIMENSION 6: Painful Diabetic Peripheral Neuropathy …………………...30 


DIMENSION 8: Wound Management .............................................................31 

DIMENSION 9: Post Ulcerative Management,,,,…………………………………32 


DIMENSION 11: The Charcot Foot in Diabetes Mellitus……………………….33 

DIMENSION 12: Research and Audit …………………………………………...34 

DIMENSION 13: Leadership and Service Development……………………….34 

LEVEL SIX 


DIMENSION 2: Screening and Assessment ..…………………………………36 

DIMENSION 3: Dermatology in Diabetes Mellitus………………………………37 

DIMENSION 4: Clinical and Pharmaceutical Knowledge……………………...37 

DIMENSION 5: Clinical and Radiological Knowledge………………………….37 

DIMENSION 6: Painful Diabetic Peripheral Neuropathy………………………38 


DIMENSION 8: Wound Management …………………………………………...39 

DIMENSION 9: Post Ulcerative Management …………………………………...40 


DIMENSION 11: The Charcot Foot in Diabetes Mellitus…………………........41 

DIMENSION 12: Research and Audit …………………………………………...41 


LEVEL SEVEN 


DIMENSION 2: Screening and Assessment.…………………………………….44 

DIMENSION 3: Dermatology in Diabetes Mellitus …………………………...45 

DIMENSION 4: Clinical and Pharmaceutical Knowledge …………………...45 

DIMENSION 5: Clinical and Radiological Knowledge …………………...46 

DIMENSION 6: Painful Diabetic Peripheral Neuropathy …………………...47 


DIMENSION 8: Wound Management …………………………………………...48 

DIMENSION 9: Post Ulcerative Management …………………………………...49 



DIMENSION 12: Research and Audit…………………………………………….. 51 



LEVEL EIGHT 

DIMENSION 1: Diabetes Practitioner Knowledge, Skills and Behaviour…..53 

DIMENSION 2: Screening and Assessment……………………………………..55 

DIMENSION 3 Dermatology in Diabetes Mellitus……………………………….55 

DIMENSION 4: Clinical and Pharmaceutical Knowledge……………………...55 

DIMENSION 5: Clinical and Radiological Knowledge………………………….57 

DIMENSION 6: Painful Diabetic Peripheral Neuropathy……………………… 57 

DIMENSION 7: Preventative Ulcerative Care…………………………………… 58 

DIMENSION 8: Wound Management……………………………………………... 59 

DIMENSION 9: Post Ulcerative Management…………………………………… 60 



DIMENSION 12: Research and Audit…………………………………………….. 62 


REFERENCES…………………………………………………………………………64 


RATIONALE FOR THE DIABETES FOOT CARE 

COMPETENCY SET 

Background 

Diabetes continues to be a challenge and a priority for the National Health 

Service (NHS) in Scotland. The current number of people diagnosed with 

diabetes in Scotland is over 200,000, which equates to about 4% of the 

population and it is predicted that by the year 2032, one person in ten will have 

diabetes (Scottish Executive, 2006). NHS Quality Improvement Scotland 

(Scottish Executive, 2002) highlights that, if strategic goals are not implemented 

now, the NHS will be providing crisis intervention to the diabetes population, 

rather than active chronic disease management. 

Foot disease is a potentially devastating complication of diabetes and, as a 

consequence, a lower limb is lost every 30 seconds somewhere in the world 

(Boulton, 2005). In the UK, diabetes related foot complications are the largest 

single reason for diabetes patients to be admitted to hospital (Boulton, 2005) and 

the financial costs associated with these continue to be a substantial economic 

burden on the NHS (estimated as £239 million per annum: Gordois et al, 2003). 

The indirect and often intangible costs to the patient are also high and many 

individuals with foot ulceration are unable to work and are reported to have a 

poorer quality of life than those without an ulcer (Carrington et al, 1996, Sutton, 

2000, Apelqvist & Ragnarson Tennvall, 2005). 

Multidisciplinary diabetes foot clinics have already been shown to be clinically 

effective and have also reported a reduction in amputation rates (Edmonds et al 

1986, McCormick & Young, 1999, Moriarty et al 1993). The core of these multiprofessional 

specialist teams consist of podiatrists, Consultant Diabetologists and 

orthotists with direct linkage to a wide range of other health professionals. Those 

without active diabetes foot disease must also be considered and strategies 

should be in place to educate patients and carers on self-management 

strategies. These models form the basis of national guidelines and continue to be 

the recommended approach to diabetes footcare (NICE, 2008, Roundtable 2007, 

SIGN, 2001). 


Current Situation in Diabetes Foot Care 

Currently, in the NHS, a number of podiatrists and other health professionals are 

already working at varying levels of competencies. These range from basic 

diabetes experience to extended scope practitioner levels. However, there 

continues to be no clearly defined clinical competency framework for those 

individuals working with the diabetic foot and these skills are attained through a 

variety of routes. This is leading to inconsistent clinical practice throughout the 

UK. Although there are wide ranges of educational routes for gaining theoretical 

knowledge of the diabetes foot, defined clinical exposure and experiential 

opportunities are often lacking. This identifiable gap requires a structured 

approach to attaining clinical skills that are underpinned by educational 

components. 

The rapid increase in the diabetes population is pressurising existing diabetes 

foot services and may lead to a shortage of skilled diabetes foot specialists. To 

meet the future demands of diabetes foot services, an increase in this workforce 

may be required. To ensure all patients with diabetes are considered, it will also 

require a multi-professional approach to care and a skill-mix within the workforce. 

This competency framework aims to address these issues and begin the process 

of establishing standards of professional competence for practice in diabetes foot 

care. It has been produced in collaboration with the ‘Scottish Diabetes Group 

Foot Action Group’ and ‘Skills for Health’ and a set of competencies (Level 2-8) 

have been developed. The framework stretches both ends of the skill levels 

required for diabetes foot care and management. The main objective of the 

framework is to ensure there are competent health professionals available with 

the appropriate skills at the appropriate time in a patient’s journey. It will provide 

clear guidance for individuals and managers in planning career pathways. It also 

has the potential to assist in workforce planning and inform diabetes foot service 

developments of the future. 


THE SCOTTISH DIABETES FOOT WORKFORCE DEVELOPMENT 

GROUP 

The ‘Scottish Diabetes Foot Workforce Development Group’ (SDFWDG) was set 

up in August 2007 in response to the increasing demands of diabetes foot 

services in Scotland and the lack of structure in diabetes foot training provision 

for podiatrists and support workers. The group set out to develop an integrated 

competency framework to facilitate the workforce development in diabetes foot 

care. The main outcome of the group was to ensure the highest quality of care 

possible for diabetes patient’s that is consistent across Scotland. It will also 

provide diabetes service leads and podiatry managers a skills framework to base 

their diabetes foot service structures and provide a toolbox for planning 

professional and personal development. As a result, this recommended 

framework will have benefits for patients, service providers and clinicians. 

There were four distinct stages of development in the philosophy of 

the group and its process 

Stage 1 

Stage 2 

Stage 3 

Identify benefits for introducing a competency 

framework for individual and services 

Development of the competency framework for 

treatment and management of diabetes foot 

disease 

Consultation with all stakeholders 

Stage 4 

Develop an implementation strategy 


PATIENT GROUPS IN DIABETES FOOT CARE 

The Scottish Diabetes Survey estimates that there are around 200,000 people 

with diabetes in Scotland. This number is set to grow to around 300,000 within 10 

years and the minimum numbers suggested for providing diabetes care for the 

current population should be augmented by at least a third, particularly at the 

high risk end to allow for this growth. 

The structure of diabetes foot care could be significantly streamlined in 

accordance with clinical need and in line with the NHS Modernisation Agency 

guidance on the management of long term conditions. Patients with low care 

needs should be supported and educated in their self-care and management. 

Patients with active foot disease requiring high level care should have 

appropriate provision. There are also middle levels of care which can be clearly 

identified within this population. 

Delivering for Health’ (Scottish Executive, 2005) visualises a responsive, 

personalised health service that provides a balance between localised care and 

offering specialist care in centres of excellence. In order to ensure these services 

can be met, there has to be appropriate clinicians. To provide the correct level of 

care by the most appropriate person would require a change in the current skill 

mix of the foot care services in Scotland. The podiatry workforce does not have 

the capacity to review and manage all levels of patients with diabetes; therefore, 

skill-mixing will enable capacity to be increased overall. 

Where possible, locality based services should concentrate care in larger clinics 

for better efficiency and governance. Patients with diabetes can be risk stratified 

into the following four categories to allow treatment and management to be 

targeted. 

1. LOW RISK PATIENTS 

These patients have no evidence of nerve or arterial problems and so are at low 

risk of foot ulceration. Leese et al estimate that this group will be 99.6% ulcer free 

after two years, i.e. a 1 in 500 risk of foot ulceration per year. Studies from 

Tayside and others would put this group at around 60%-65%of the adult diabetes 

population. With such a low risk of foot ulceration this group do not require 

routine NHS podiatry but will require annual screening for diabetes foot risk 

factors. 

The Scottish Diabetes Group Foot Action Group recommends that the first 

competent professional to review that patient in any individual calendar year 

should provide screening. Exclusively podiatrists should not carry out routine 

screening. A training programme for medical staff, practice nurses, clinical 

support workers, and the development of foot care assistants/screeners should 


e implemented across Scotland. This would allow podiatry resources to be 

utilised appropriately. However, these patients with no significant risk factors 

should have access to urgent appointments, within one working day, if an ulcer 

or other foot pathology develops. 

The competency sets required to provide screening and patient 

education on self-management for this group of patients map to 

the ‘Diabetes Foot Competency Framework’ levels 2-5 

2. PATIENTS WITH ESTABLISHED RISK FACTORS WHO HAVE 

NEVER ULCERATED 

These patients have demonstrated significant nerve or arterial impairment on 

screening but have not had an active foot ulcer. This group comprises around 25- 

30% of the adult diabetes population and has between a 3% and 7% risk of 

ulceration per year. National guidelines would recommend that this group of 

patients has regular podiatry care, depending on individual need. This care 

should ideally, and where possible, be provided in dedicated diabetes sessions in 

multi-chair sessions in larger community treatment centres. This group of 

patients must also have immediate, next working day, access to ulcer care if they 

develop active foot disease. 

The competency sets required to provide care, education and 

management of this group of patients, map to the ‘Diabetes Foot 

Competency Framework’ levels 5-7 

3. PATIENTS WITH A HISTORY OF PREVIOUS ULCERATION OR 

AMPUTATION 

This group of patients comprises 8-12% of the diabetes population. These 

patients currently have around a 40-50% risk of re-ulcerating each year. For this 

reason they should have close follow up by specialist podiatrists. 

Due to the high rate of re-ulceration it is recommended that the care of these 

patients takes place in services with appropriately skilled diabetes specialist 

podiatrists. These services should have direct linkage and leadership provided 

from a multidisciplinary diabetes foot team. 

The competency sets required for the care and management of 

this group of patients map to the ‘Diabetes Foot Competency 

Framework’ levels 6-8 


4. PATIENTS WITH ACTIVE FOOT DISEASE 

At any one time 1-5% of diabetes patients will have an active foot ulcer or other 

foot disease. These should be reviewed frequently in diabetes foot 

multidisciplinary clinics with a network of community podiatry and nursing teams 

to continue care in between specialist clinic visits. 

The model for ulcer care should be lead by these multidisciplinary teams who are 

able to provide the appropriate clinical skills, orthotic service, surgical access and 

radiological support. Such centres should also be leading research and audit 

activities and thereby innovating care. 

The competency sets required for the care of this group of 

patients map to the ‘Diabetes Foot Competency Framework’ 

levels 7-8 

ADDITIONAL STAFF 

It is recommended that each region should also have a co-ordinator for diabetes 

foot services and in larger population centres two. One co-ordinator for 

secondary care services and one to co-ordinate community diabetes foot 

services. 

These posts are multi-dimensional and would map to the 

‘Diabetes Foot Competency Framework’ levels 7-8 


SUMMARY OF CARE PYRAMIDS 

TIERED CARE FOR DIABETES FOOT PATIENTS 


CARE MAPPED TO COMPETENCY FRAMEWORK 


WORKFORCE REQUIREMENT MODELING 

The following workforce requirements are based on a population of 10,000 

patients with diabetes. Podiatrists and others involved in the care of diabetes 

patients are estimated to work for 30 hours per week of direct patient contact for 

40 weeks per year. 

SCREENING 

At least 6,000 diabetes patients will require annual screening alone. As 

podiatrists should not be routinely be directly involved in screening then there are 

no direct calculations for the workforce numbers required for screening in 

diabetes patients. 

AT RISK PATIENTS WHO HAVE NOT YET ULCERATED 

This will be around 2,000 per 10,000 total diabetes patients. Using the National 

Service Framework for England and Wales as an example, these patients are 

recommended to be seen on average for 6 visits per year. Estimating 20 

minutes per appointment, and allowing 30 hours of patient contact per week for 

40 weeks per year would require at least 5 wte podiatrists for this group of 

patients. 

HIGH RISK PATIENTS FOLLOWING ULCERATION OR AMPUTATION 

This would be around 1,500 patients. The optimum frequency of follow up is 

currently uncertain, however, if we estimate an average of monthly return visits 

then using the same model as before this would require a further 5 wte for these 

patients who have a previous ulcer or amputation. 

CURRENT ACTIVE FOOT DISEASE 

These will be up to 500 patients per 10,000 total diabetes patients with active 

foot disease. Each patient will require an average of 20 podiatry visits per year. 

The average clinic visit length should be 30 minutes. Using the same model for 

clinical time calculations this requires at least 5 WTE advanced specialists per 

10,000 diabetes patients for active foot disease management. 


THE BENEFITS OF THE COMPETENCY FRAMEWORK 

Diabetes foot care is complex and there is a requirement for the attainment of set 

levels of quality and consistency in its delivery. The “Competency Framework for 

the prevention, treatment and management of Diabetic Foot Disease” will be 

relevant to all staff involved in the care of individuals with diabetes foot problems. 

This framework is not designed to be exhaustive, but is designed as a guide to 

identify the individual’s learning needs and to map the individual’s learning. 

The competency framework will not only add value to those working in diabetes 

foot care, but also to patients and services: 

Benefits for those working in diabetes footcare: 

Identify existing knowledge and skills in diabetes foot disease 

• Opportunity to increase skills and knowledge in specialist area 

Support performance review and appraisal 

• Increased motivation through structured career pathways and 

education 

Benefits for patients: 

Patients will be assured the highest quality of care is received based on level of need 

• Rapid access to appropriate specialist services 

• Patients will be empowered to self-manage wherever possible 

through appropriate foot education 

• Overall better prognosis and outcomes of health 

Benefits for diabetes foot services: 

• Develop workforce planning and service development need 

Assurance that treatment is based on national standards and evidence base 

Focused diabetes foot services based on needs rather than expectation 

Staff retention through increased job satisfaction 


THE FRAMEWORK IN PRACTICE 

SCOPE 

Competencies are defined as “What individuals need to do, what they need to 

know and which skills they need to carry out an activity’’ (Skills for Health) 

The competencies within this framework are designed to encompass the wide 

range of knowledge and skills that are needed in order to deliver care to 

individuals across the spectrum of diabetes foot disease. The framework can be 

used as a whole document to guide the design or enhance a diabetes foot 

service. Conversely, the skill levels can be used in isolation to identify an 

individuals learning or training needs. 

UNDERSTANDING THE FRAMEWORK 

The infrastructure of this unique framework has been designed as a toolkit to 

guide staff and managers in professional and personal development. It is also 

flexible in that services and individuals can benchmark key skills required for the 

care and management of the diabetic foot. Therefore, it aims to provide clear 

guidance of knowledge and skills and the recommended levels. 

The dimensions and competencies have been developed in consultation with a 

wide range of stakeholders. The competencies have been individually matched 

to existing Skills for Health (SFH) ‘National Occupation Standards’ (NOS) 

indicators. The framework is multi-functional and the competencies have also 

been individually mapped to the NHS Knowledge and Skills Framework (KSF) 

and subsequent KSF levels. 

The dimensions and skill sets within the framework include and identify all areas 

of professional roles. These dimensions will not be required for all roles but they 

ensure that all areas of diabetes foot care and management are considered. The 

structure of the document reflects the SFH Escalator Concept (page 17) and as 

the SFH escalator travels higher, the dimensions, competencies and KSF levels 

will increase. A number of the competencies within the dimensions are generic, 

therefore adaptable and transferable to other health professions. 


The 10 dimensions of the framework are: 

Diabetes Practitioner Knowledge, Skills and Behaviours 

• Screening 

Dermatology in Diabetes Mellitus 

Clinical and Pharmaceutical Knowledge 

Clinical and Radiological Knowledge 

Painful Diabetic Peripheral Neuropathy (PPN) 

Preventative Ulcerative Care 

Wound Management 

Post Ulcerative Management 

Health Improvement 

The Charcot Foot in Diabetes Mellitus 

Research and Audit 

In addition to the specific dimensions and competencies above, individuals must 

also demonstrate core attitudes and values in diabetes care. The following 

represent a set of desirable behaviours in this context. 

The practitioner should display: 

• Respect for the individual, family and carers, ensuring confidentiality 

at all times. 

• Commitment to the delivery of evidence-based care, through 

reflective practice and concern for the quality of care 

• Commitment to enabling patients to support their own goals, 

including promoting healthy lifestyles 

• Commitment to being the advocate of the person with diabetes 

• Understanding of individual and societal attitudes to altered body 

image and disability 

• Concern for the safety of the person with diabetes and other 

healthcare workers 

• Honesty and integrity when communicating with patients and carers 

and other healthcare workers 

• Honesty and integrity when completing documentation 

• Commitment to maintaining and developing his or her unique 

knowledge and skills base 

• Commitment to working as a member of a multidisciplinary team 

both in hospital and community care setting 

(Modified from Stroke –Core Competencies for Healthcare Staff, 2005) 



COMPETENCY FRAMEWORK DEVELOPMENT TEAM 

• Jodi Binning Podiatry Services Lead, 

North Ayrshire 

• Margaret Doyle Podiatry Services Lead, 

South Ayrshire 

• Paul Lambert NHS Education Scotland 

Steering Group 

• John McCall Podiatry Diabetes Care Program Lead, 

Ayrshire & Arran 

• Joanne McCardle Diabetes Podiatrist, Chair of QIS Podiatry PD 

Royal Infirmary, Edinburgh 

• Duncan Stang National Diabetic Foot 

Co-ordinator 

• David Wylie Head of Podiatric Services, 

Southern General Hospital, Glasgow 

• Matthew Young Diabetes Consultant 

Royal Infirmary, Edinburgh 

Framework Development and Strategic Group 

• Jodi Binning Podiatry Services Lead 

• Lorna Hunter Skills for Health 

• Graham Leese Chair of the ‘Scottish Diabetes Foot Action Group’ 

• Joanne McCardle Diabetes Podiatrist, Chair of QIS Podiatry PD 

• Nadine Singh Skills for Health 

• Duncan Stang National Diabetic Foot 

Co-ordinator 

• Matthew Young Diabetes Consultant 

Scottish Diabetes Foot Action Group and Skills for Health - 18 -

NOS MAPPING TO THE COMPETENCY FRAMEWORK FOR THE 

PREVENTION, TREATMENT AND MANAGEMENT OF DIABETIC FOOT 

DISEASE (2009) 

Key: 

LLUK – Lifelong Learning UK sector skills council 

M&L – Management and Leadership standards developed by Management Standards Centre 

CfA – Council for Administration standards setting body 

CJ – Community Justice suite, Skills for Justice sector skills council 

HSC – Health and Social Care, jointly owned by Skills for Health and Skills for Care and Development 

All other NOS have been developed by Skills for Health 

Level 

Support Workers 

DIMENSION 1: Diabetes Practitioner Generic Knowledge, Skills and Behaviours 

Generic Knowledge 

Competency 

NOS 

Indicator 

KSF 

Dimension 

General knowledge of diabetes GEN14 Core 2 1 

Knows the limits of own knowledge and knows how and when 

to refer back to, or seek guidance from another member of the 

team or a specialist 

GEN63 

Core 2 1 

Competency 

NOS 

Indicator 

KSF 

Dimension 

General knowledge of the signs and symptoms of diabetes Diab TT01 Core 2 1 

KSF 

Level 

Aware that national guidelines exist for treatment and 

management of diabetes e.g. SIGN 55, NICE, NSF’S, Clinical 

Governance 

Generic Skills 

Diab TT01 

Diab GA1 Core 2 

1 

Competency 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 

Uses relevant patient record systems, and decision support 

tools for their job role 

Uses up-to-date information and terminology to communicate 

with patients and peers. 

Updates medical history and undertakes a protocol led 

examination appropriate to job role 

HSC434 HWB6 1 

HSC41 

GEN22 Core 1 1 

EUSC01 

EUSC02 

HWB6 1 


Generic Behaviours 

Competency 

NOS 

Indicator 

KSF 

Dimension 

Refers to and seeks guidance from another member of the GEN63 Core 1 1 

team or a specialist when necessary 

Reflects on own performance, can learn and change own GEN12 Core 2 1 

practice with support 

Challenges colleagues’ inappropriate practice constructively MH92 Core 1 1 

MH93 

Uses available networks for support, reflection and learning LLUK Core 1 1 

CDE4 

GEN31 

Takes responsibility for continuing professional development HSC43 Core 2 1 

KSF 

Level 

DIMENSION 2: Screening 

Competency 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 

Communicate clearly to the individual what is involved in the 

screening process 

Demonstrate the ability to carry out a basic diabetic foot 

screening and record the information on the SCI DC system 

where available. 

Provide up to date verbal and written advice relating to the 

risk status resulting from foot screening. 

Explain the results of the screening to the individual and carer 

in an appropriate manner and a suitable level and pace. 

Arrange further assessment when required and make 

appropriate referral. 


Diab HA3 

Diab HA3 

GEN14 

GEN22 

GEN20 

Diab TT01 

CHS99 

HWB6 2 

HWB7 1 

Core 1 2 

HWB7 1 

DIMENSION 10: Health Improvement 

Competency 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 

General knowledge of diabetes GEN14 Core 2 1 


Core 2 1 



GEN63 

Demonstrates an understanding of the importance and effects 

of patient education and self management 

PE HWB4 1 


Competency 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 

Demonstrates a basic understanding of the psychological 

impact of long term condition 

CHS61 

CM D5 

HWB4 2 

Demonstrates communication skills with individuals GEN22 Core 1 

Demonstrate a knowledge of the availability of support 

mechanisms such as Diabetes UK, My Diabetes My Way 

(www.mydiabetesmyway.org.uk) to assist the individual in 

managing their condition 

Diab DA4 

HSC330 

HWB4 1 

GEN14 


LEVEL 

– Senior Healthcare Assistants/Technicians 



Competency NOS Indicator KSF 

Dimension 

KSF 

Level 

General knowledge of diabetes Diab GA1 Core 2 1 

Knows the limits of own knowledge and knows how and when GEN63 Core 2 1 





management of diabetes e.g. SIGN, NICE NSF’s, Clinical 

Governance 

Diab TT01 

Diab GA1 

Core 2 1 


Competency 

Applies information to clinical context within agreed 

boundaries/protocol 


tools for new job role 




examination appropriate to new job role 

Be able to communicate with patients the benefits of good 

glycaemia control, self care and monitoring to prevent 

complications 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 


HSC434 HWB6 1 

HSC41 


EUSC01 

EUSC02 

PE8 

GEN14 

HWB6 1 

HWB6 1 


Competency 

NOS 

Indicator 

Scottish Diabetes Foot Action Group and Skills for Health - 22 - 

KSF 

Dimension 






KSF 

Level

MH93 


CDE4 

GEN31 


DIMENSION 2: Screening 

Competency 








NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 


Diab HA3 HWB6 2 

GEN22 

GEN20 

Core 1 2 

DIMENSION 3: Dermatology in Diabetes Mellitus 

Competency 

Understands and recognises the need for referral when a skin 

abnormality is observed 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 

CHS99 HWB6 1 

DIMENSION 7: Preventative Ulcerative Care 

Competency 

Understands diabetes, its natural progress and how to assess 

its severity in relation to preventing foot ulceration. 

Communicate with the individual in an appropriate manner, 

recognizing the stressful nature of informing the patient that 

they are at risk of foot ulceration. 

Understand the necessity for urgent treatment and referral in 

the event of suspected ulceration. 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 


CHS48 

GEN22 

Diab HA3 

CHS99 

Core 1 2 

HWB7 1 


Competency 




impact of having a long term condition 

NOS 

Indicator 


KSF 

Dimension 

KSF 

Level 

PE HWB4 1 

CHS61 

CM D5 

HWB4 2

Demonstrates a factual knowledge of the kinds of 

misinformation that people may have about their condition 

and provide them with the appropriate literature 

Demonstrates communication skills with individuals and their 

carers 





HT2 

PE8 

GEN14 

HWB4 2 


Diab DA4 

GEN14 

HSC330 

HWB4 2 


LEVEL – Assistant Practitioners/Associate 

Practitioners 



Competency 

NOS 

Indicator 

KSF 

Dimension 

General knowledge of diabetes Diab GA1 Core 2 1 







management of diabetes e.g. SIGN, NICE NSF’s, Clinical 

Governance 

Diab TT01 

Diab GA1 

Core 2 1 


KSF 

Level 

Competency 

Applies information to clinical context within agreed 

boundaries/protocol 


tools for new job role 




examination appropriate to new job role 

Be able to communicate with patients the benefits of good 

glycaemia control, self care and monitoring to prevent 

complications 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 


HSC434 HWB6 1 

HSC41 


EUSC01 

EUSC02 

PE8 

GEN14 

HWB6 1 

HWB6 1 


Competency 

NOS 

Indicator 


KSF 

Dimension 






KSF 

Level

MH93 


CDE4 

GEN31 


DIMENSION 2: SCREENING 

Competency 










Arrange further assessment when required and make 

appropriate referral. 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 



Diab HA3 

GEN14 

GEN22 

GEN20 

Diab TT01 

CHS99 

HWB7 1 

Core 1 2 


Competency 

Understands and recognises the need for referral when a skin 

abnormality is observed 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 

CHS99 HWB6 1 


Competency 








NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 


CHS48 

GEN22 

Diab HA3 

CHS99 

Core 1 2 

HWB7 1 



Competency 




impact of having a long term condition 

Demonstrates a factual knowledge of the kinds of 

misinformation that people may have about their condition 

and provide them with the appropriate literature 


carers 





NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 

PE HWB4 1 

CHS61 

CM D5 

HWB4 2 

HT2 

PE8 

GEN14 

HWB4 2 


Diab DA4 

GEN14 

HSC330 

HWB4 2 


LEVEL – Practitioners 



General knowledge of the theories of the causes of diabetes Diab GA1 Core 2 2 

Understands the impact of disease progression in diabetes Diab GA1 Core 2 2 

Understands different non-pharmacological and 


pharmacological approaches to diabetes management 

Knows the limits of own knowledge and knows how and when GEN63 Core 2 1 



Knowledge of the signs and symptoms of diabetes, including Diab TT01 Core 2 2 

WHO criteria for diagnosis 

A knowledge of normal and abnormal blood glucose and HSC224 HWB6 2 

HbA1c values and how to monitor them 

Diab GA2 

Understands National Guidelines and NHS frameworks for the 

transfer and management of diabetes (e.g. SIGN, NICE, 

NSF’s, Clinical Governance, IT strategy 

Diab TT01 

Diab GA1 

Diab GA2 

Core 2 2 


Competency 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 

Critical approach to formation and application of information 

to clinical context (linking theory to practice) 

Uses relevant patient record systems and decision support 

tools for their job role 

Uses up to date information and terminology to communicate 

with patients and peers 

Takes and /or reviews the medical and medication history and 

undertakes an examination/assessment and forms a 

diagnosis 

Assess through discussion the individuals understanding and 

reinforce the benefits of good glycaemic control, self care and 

monitoring to prevent complications 

Explain the diagnosis of diabetes accurately, based on the 

information available to you. 

PHS07 

GEN13 

Core 2 1 

HSC434 HWB6 3 

HSC41 


EUSC01 

EUSC02 

PE8 

GEN14 

Diab HA13 

Diab GA1 

GEN22 

HWB6 3 

HWB6 3 

Core 1 3 

Has the ability to request and interpret relevant diagnostic CHS83 HWB6 2 


tests in the management of diabetes 

Demonstrates the ability to apple the principles of evidence 

based medicine 


PHS07 

HI19 

Core 5 2 

Competency 

NOS 

Indicator 

KSF 

Dimension 



Communicate with the individual in an appropriate manner, GEN22 Core 1 3 

recognizing the stressful nature of the potential impact of 

diabetes 

CHS48 


practice 


MH93 

Develops own networks for support, reflection and learning LLUK Core 1 2 

CDE4 

GEN31 

Establishes multi-professional links with practitioners working GEN39 Core 1 2 

in the same specialist area 

GEN40 

GEN44 

GEN27 


Understands and works with local NHS organisations and 

relevant agencies contributing to health improvement (e.g. 

social services and patient support networks 

GEN27 

GEN44 

PHP15 

Core 1 2 

DIMENSION 2: Screening and Assessment 

KSF 

Level 

Competency 








Carry out further assessment when required and make any 

appropriate referral for specialist intervention. 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 


Diab HA3 

Diab HA3 

Diab HA4 

Diab HA3 

GEN14 

Diab HA4 

Diab TT01 

CHS99 

HWB6 2 

HWB7 1 

HWB7 1 



Competency 

Demonstrates an understanding of the importance of referral 

for dermatological diagnostic tests including microscopy and 

culture, biopsies and allergy testing 

NOS 

Indicator 

CHS4 

AL2 

CHS46 

KSF 

Dimension 

KSF 

Level 

HWB6 2 

DIMENSION 4: Clinical and Pharmaceutical Knowledge 

Competency 

Demonstrates an understanding of the mode of action and 

effects of medicines 

Demonstrates an understanding of the potential for unwanted 

effects (e.g. allergy, ADRs, drug interactions, special 

precautions and contraindications) 

Maintains an up-to-date knowledge of products in the BNF / 

drug tariff (e.g. doses, formulations, costs) relevant to the 

therapy area 

Demonstrates an appreciation of the misuse potential of 

medicines 

Demonstrates an awareness of no treatment, non-drug and 

drug treatment options (including referral and preventative 

measures) 

NOS 

Indicator 

EUSC19 

CHS74 

KSF 

Dimension 

KSF 

Level 

HWB6 2 

HWB6 2 

HWB6 2 

DANOS HWB6 2 

AA1 

CHS74 HWB6 2 

DIMENSION 5: Clinical and Radiological Knowledge 

Competency 

Understands different radiological and non-radiological 

methods of assessment 

Keeps up-to-date with any changes in clinical practice which 

may influence the requesting or interpreting of radiological 

images 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 

CHS109 HWB7 2 

HSC43 

HSC23 

HWB7 2 

DIMENSION 6: Painful Diabetic Peripheral Neuropathy 

Competency 

Demonstrates a basic knowledge and recognition of: 

1. The causes of painful diabetic peripheral neuropathy 

2. The signs and symptoms of painful diabetic peripheral 

neuropathy 

NOS 

Indicator 

CHS40 

Diab TT01 

Diab TT02 

KSF 

Dimension 

KSF 

Level 

HWB6 2 


3. Typical progression of painful diabetic peripheral 

neuropathy 

Demonstrates a basic knowledge of the treatment modalities 

available for painful diabetic peripheral neuropathy based on 

the current evidence base 

Is able to recognise painful diabetic peripheral neuropathy 

and refer appropriately 

Demonstrates the ability to differentiate between painful 

diabetic peripheral neuropathy and other painful symptoms 

and arrange further tests if required 

Demonstrates the ability to provide information on painful 

diabetic peripheral neuropathy in a suitable form for the 

individual and carer, to reinforce their understanding 

CHS179 HWB7 2 

CHS40 

CHS118 

CHS99 

HWB6 2 

CHS40 HWB6 2 

CHS118 

CHS99 



Competency 


its severity in relation to preventing foot ulceration 

Ask appropriate questions that will enable you to assess 

whether the individual is aware that they are at risk of 

developing foot ulceration. 




Competency 

Assess the individual’s understanding of the Information that 

you have given them, and where necessary confirm the main 

areas that contribute to their risk of ulceration. 



Maintains an up-to-date knowledge of biomechanical pressure 

relieving strategies and their implementation to minimise the 

risk of foot ulceration 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 


Diab HA3 


CHS48 

GEN22 

NOS 

Indicator 

Core 1 2 

KSF 

Dimension 

KSF 

Level 


Diab HA4 

Diab HA3 

HSC43 

HSC23 

HWB7 3 

HWB7 2 

DIMENSION 8: Wound Management 

Competency 

A working knowledge of local/national guidelines for diabetes 


Demonstrates a knowledge of the signs & symptoms relevant 

to diabetic foot ulceration 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 

CHS12 HWB7 2 

Diab DF03 HWB6 2 


Demonstrates an in-depth understanding of the wound 

healing process and potential complications 

Demonstrates an in-depth understanding of the psychological 

impact of active diabetic foot disease 

Demonstrate the ability to recognise and classify active foot 

ulceration. This should include identification of vascular 

insufficiency, neurological deficit, significant foot deformity, 

trauma, increased pressures, extent and degree of infection. 

Confirm that the patient and or carer understand the purpose 

and nature of the proposed management plan. 

Demonstrates the ability to access local referral pathways 

appropriately 

Recognises when there is a need for other Health Professions 

input and has the ability to refer appropriately. 

Debridement 

Understand the principles behind debridement and 

management of the wound bed to optimise the process of 

healing 

Demonstrate the ability to carry out Wound Management 

techniques such as sharp debridement and refer when 

necessary for advanced Wound Management. 

Infection Control 

Demonstrates a clinical ability to recognise the signs and 

symptoms of wound infection. 

Demonstrate the practice of microbiological sampling, 

reporting and ensure result is interpreted by appropriate 

person 

Pressure Relief 


relieving strategies and their implementation 

Dressing 

Demonstrate a wide knowledge of the availability of dressing 

products, their mode of action and appropriate usage 

CM D5 

CHS70 

Diab DF02 

Diab HA4 

HWB6 2 

HWB6 2 

HWB6 3 

Diab HA3 

GEN22 C1 3 

CHS99 

CHS177 

GEN63 

CHS99 

CHS12 

Diab DF02 

HWB7 2 

HWB6 2 

HWB7 2 

CHS12 HWB7 2 

CHS12 HWB6 2 

CHS185 

CHS7 

CHS5 

HSC43 

HSC23 

HWB7 2 

HWB7 2 

CHS12 HWB7 3 

DIMENSION 9: Post Ulcerative Management 

Competency 

Ability to provide specialist education for the patient and their 

carers in relation to prevention of re- ulceration. 

Assists in the implementation of the recommended care plan 

to prevent recurrence of ulceration 



NOS 

Indicator 

PE8 

PE3 

PE7 

PE3 

KSF 

Dimension 

KSF 

Level 

HWB1 2 

PE4 HWB6 2 



they are at risk of further foot ulceration 



Recognises the need when to refer for specialist footwear 


CHS5 

HSC43 

HSC23 

Diab HA4 

CHS140 

HWB7 3 

Core 1 2 

Competency 

Demonstrates a critical understanding of the importance and 

effects of patient education and self management 

Demonstrates an understanding of the psychological impact 

of diabetes, at diagnosis and in the long term 

Demonstrates an awareness of how culture and social context 

affect how individuals think and feel about their behaviour and 

changing it 

Recognise and manage the kinds of misinformation that 

people may have their condition and the affect of this on their 

behaviour 

Demonstrate an understanding of methods, tools and 

techniques for assessing and evaluating individual's health 

status, concerns, personal context and priorities 


carers which encourage an open exchange of views and 

information 

Demonstrate a knowledge of how to access, and provide to 

individuals, relevant information in suitable format when 

communicating with them regarding their needs 

Demonstrates a knowledge of how to develop detailed 

personal action plans to achieve and maintain goals for 

individuals who have an increased risk of developing diabetic 

foot complications 





NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 

PE HWB4 3 

CM D5 

CHS70 

HWB4 3 

HT2 HWB4 3 

PE8 

GEN14 

GEN14 HWB4 3 

CHS38 

CHS105 

HWB4 3 


CHS177 

GEN14 

GEN62 

GEN32 

CHS45 

CHS44 

Diab DA4 

GEN14 

HSC330 

Core 1 3 

HWB4 3 

HWB4 3 

DIMENSION 11: Charcot Neuroarthropathy 

Demonstrate the ability to recognise patients who have 

predisposing risk factors for Charcot foot disease 

Demonstrate the ability to recognise acute Charcot 

neuroarthropathy 

CHS40 

DiabHA4 

DiabHA3 

CHS40 

HA4 

HWB6 3 

HWB6 3 


Demonstrate the need for appropriate further investigation 

and intervention of suspected Charcot neuroarthropathy 

Demonstrates knowledge of the importance of biomechanical 

pressure relieving strategies in the management of Charcot 


Assist in the implementation of a recommended care plan for 

Charcot neuroarthropathy 

CHS99 

Diab HA1 

Diab HA4 

HWB7 3 

HSC43 HWB7 3 

CHS41 

Diab HA1 

CHS88 

Diab HA4 

HWB7 2 

DIMENSION 12: RESEARCH AND AUDIT 

Competency 

Demonstrates a knowledge of audit and research processes 

and contributes to implementation of audit and research 

finding 

Critically appraises the validity of information where 

appropriate 

NOS 

Indicator 

GEN23 

R&D 10 

KSF 

Dimension 

KSF 

Level 

General 2 2 

HI19 General 2 1 

Is able to critically appraise methods of clinical evaluation HI19 Core 4 2 

Demonstrates ability to undertake literature search to answer R&D8 General 2 1 

clinical questions. 

GEN32 

Demonstrates a knowledge of the current research 

HSC43 General 2 3 

surrounding Diabetic Foot Disease 

HSC23 

Uses audit and research tools to 

improve own clinical performance and outcomes 


Dimension 13: Leadership and Service Development 

Competency 

Demonstrates clinical leadership within their own work place 

Is aware of and works within local diabetes service 

requirements 

NOS 

Indicator 

M&L B5 

M&L B6 

GEN63 

M&L B8 

KSF 

Dimension 

KSF 

Level 

Core 4 1 

Core 4 1 


LEVEL 

- Senior Practitioners/Specialist Practitioners 

DIMENSION 1: Diabetes Practitioner Knowledge, Skills and Behaviours 


Competency 

NOS 

Indicator 

KSF 

Dimension 

General knowledge of the theories of the causes of diabetes Diab GA1 Core 2 2 

Understands the impact of disease progression in diabetes Diab GA1 Core 2 2 

Understands different non-pharmacological and 







Knowledge of the signs and symptoms of diabetes, including 

WHO criteria for diagnosis 

A knowledge of normal and abnormal blood glucose and 

HbA1c values and how to monitor them 

Understands National Guidelines and NHS frameworks for the 

transfer and management of diabetes (e.g. SIGN, NICE, 

NSF’s, Clinical Governance, IT strategy 


KSF 

Level 

Diab TT01 Core 2 2 

CHS19 

HSC224 

Diab GA2 

Diab TT01 

Diab GA1 

Diab GA2 

HWB6 2 

Core 2 2 

Competency 

Critical approach to formation and application of information 

to clinical context (linking theory to practice) 

Uses relevant patient record systems and decision support 

tools for their job role. 

Uses up to date information and terminology to communicate 

with patients and peers 

Takes and /or reviews the medical and medication history and 

undertakes an examination/assessment and forms a 

diagnosis 


assessment and management of the presenting condition 

Assess through discussion the individuals understanding and 




information available. 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 

PHS07 

GEN13 

Core 2 2 

HSC434 HWB6 3 

HSC41 


EUSC01 

EUSC02 

HWB6 3 


Diab HA13 

PE8 

GEN14 

Diab GA1 

GEN22 

HWB6 3 

Core 1 3 


Has the ability to request and interpret relevant diagnostic 

tests in the management of diabetes 

Demonstrates the ability to apply the principles of evidence 

based medicine 


CHS83 

PHS07 

HI19 

HWB6 2 

Core 5 2 

Competency 

NOS 

Indicator 

KSF 

Dimension 

Refers to and seeks guidance GEN63 Core 1 3 

from another member of the team or a specialist when 

Core 1 3 

necessary 


recognising the stressful nature of the potential impact of 


GEN22 

CHS48 

Core 2 2 


practice 


MH93 

Develops own networks for support, reflection and learning LLUK Core 1 2 

CDE4 

GEN31 

Establishes multi-professional links with practitioners working GEN39 Core 1 2 

in the same specialist area 

GEN40 

GEN44 

GEN27 


Understands and works with local NHS organisations and 

relevant agencies contributing to health improvement (e.g. 

social services and patient support networks 

GEN27 

GEN44 

PHP15 

Core 1 2 


KSF 

Level 

Competency 








NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 


Diab 

HA3Diab 

HA3 

Diab HA4 

Diab HA3 

GEN14 

Diab HA4 

HWB6 2 

HWB7 1 

carer in an appropriate manner and a suitable level and pace Core 1 2 





Diab TT01 

CHS99 

HWB7 1 

Competency 

NOS 

Indicator 

KSF 

Dimension 

Understands and recognises dermato-pathologies in diabetes HWB6 2 

Demonstrates an understanding of the importance of referral 

for dermatological diagnostic tests including microscopy and 

culture, biopsies and allergy testing 

CHS4 

AL2 

CHS46 

HWB6 2 

Based on the diagnosis and the care plan can provide 

management of dermatological conditions where appropriate 


CHS41 

Diab HA1 

CHS88 

KSF 

Level 

HWB7 3 

Competency 








therapy area 





measures) 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 

EUSC19 HWB6 2 

HWB6 2 

HWB6 2 

DANOS HWB6 2 

AA1 

CHS74 HWB6 2 


Competency 



Keeps up-to-date with any changes in clinical practice which 


images 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 

CHS109 HWB7 2 

HSC43 

HSC23 

HWB7 2 



Competency 

Demonstrates a basic knowledge and recognition of: 

1. The causes of painful diabetic peripheral neuropathy 

2. The signs and symptoms of painful diabetic peripheral 

neuropathy 

3. Typical progression of painful diabetic peripheral 

neuropathy 

NOS 

Indicator 

DF01 

EUSC1 

KSF 

Dimension 

KSF 

Level 

HWB6 2 

Demonstrates a basic knowledge of the treatment modalities 

available based on the current evidence base 

Demonstrates the ability to provide information on painful 

diabetic neuropathy in a suitable form for the individual and 

carer, to reinforce their understanding 

Demonstrate the ability to refer appropriately for further 

investigation and treatment 

CHS179 HWB7 2 

CHS179 

GEN14 

GEN62 

CHS118 

CHS99 

Core 1 2 

HWB6 2 


Competency 






What is involved in the assessment and obtain the individual’s 

informed consent to the assessment process. 




Demonstrate the ability to carry out an assessment of 

foot/feet This should include identification of vascular 


trauma or increased pressures 

Provide up to date verbal and written advice relating to 

prevention of foot ulceration 

Assess the individual’s understanding of the information that 





NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 


Diab HA3 

GEN22 C1 3 

CHS76 C1 3 

CHS48 

Gen22 

Diab HA4 

Diab HA3 

C1 3 

HWB6 3 

GEN14 

Diab HA4 

Diab HA3 

HWB7 3 

GEN22 C1 3 

Diab 

HA4Diab 

HWB7 3 


Maintains an up-to-date knowledge of biomechanical 

pressure relieving strategies and their implementation to 

minimise the risk of foot ulceration 

DIMENSION 8: WOUND MANAGEMENT 

HA3 

HSC43 

HSC23 

HWB7 3 

Competency 

A working knowledge of local/national guidelines for diabetes 






An in-depth understanding of the psychological impact of 

active diabetic foot disease 






appropriately 

Recognises when there is a need for other Health 

Professions input and has the ability to refer appropriately. 

Debridement 





techniques such as sharp debridement and to refer when 

necessary for advanced Wound Management. 



symptoms of wound infection 


reporting and ensure result is interpretated by the appropriate 

person 



pressure relieving strategies and their implementation 




NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 

CHS12 HWB7 3 


CHS61 

CM D5 

CHS70 

Diab DF03 

Diab DF02 

Diab HA4 

Diab HA3 

CHS99 

CHS177 

GEN63 

CHS99 

HWB6 3 

HWB6 3 

HWB6 3 

HWB7 3 

HWB6 3 

CHS12 HWB7 3 

CHS12 

Diab DF02 

Diab DF03 

HWB7 2 

CHS12 HWB6 3 

CHS185 

CHS7 

CHS5 

HSC43 

HSC23 

HWB7 2 

HWB7 3 

CHS12 HWB7 3 



Understands diabetes, its natural progress, pathological 

changes and how to assess the severity in relation to 

preventing foot re-ulceration. 


usual carers in relation to prevention of re- ulceration 

Assists in the implementation of the recommended care plan 

to prevent recurrence of ulceration. 






Recognises the need when to refer for specialist footwear. 

Diab DF02 

Diab HA4 

Diab HA3 

HWB6 3 

PE8 

HWB1 2 

PE7 

PE6 

PE3 

PE4 HWB6 2 


CHS5 

HSC43 

HSC23 

Diab HA4 

CHS140 

HWB7 3 

HWB7 3 


Competency 



Demonstrates an understanding of the psychological impact 

of diabetes, at diagnosis and in the long term 

Demonstrates a basic awareness of how culture and social 

context affect how individuals think and feel about their 

behaviour and changing it 

Recognises and manages the kinds of misinformation that 

people may have about their condition and the affect of this 

on their behaviour 

Demonstrate an understanding of methods, tools and 




carers which encourages an open exchange of views and 

information 

Demonstrate a knowledge of how to access, and provide to 

individuals, relevant information in suitable format when 

communicating with them regarding their needs 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 

PE HWB4 3 

CM D5 

CHS70 

HWB4 3 

HT2 HWB4 3 

PE8 

GEN14 

GEN14 HWB4 3 

CHS38 

CHS105 

HWB4 3 


CHS177 

CHS58 

GEN14 

GEN62 

GEN32 

Core 1 3 

Demonstrates a working knowledge of how to develop CHS45 HWB4 3 


detailed personal action plans to achieve and maintain goals, 

for individuals who have an increased risk of developing 

diabetic foot complications 





Demonstrate an awareness of counselling techniques, 

interview methods and motivational interviewing 

CHS44 

Diab 

DA4GEN14 

HWB4 3 

HSC330 

MH97 HWB4 3 


Competency 



Demonstrate the ability to recognise the acute Charcot 




Demonstrates knowledge of the importance of biomechanical 

pressure relieving strategies in the management of Charcot 


Assist in the implementation of the recommended care plan 

for Charcot neuroarthropathy 

NOS 

Indicator 

Diab HA4 

Diab HA3 

CHS 40 

Diab HA4 

CHS40 

CHS99 

Diab HA1 

Diab HA4 

KSF 

Dimension 

KSF 

Level 

HWB6 3 

HWB6 3 

HWB7 3 

HSC43 HWB7 3 

CHS41 

Diab HA1 

Diab HA4 

CHS88 

HWB7 2 

Dimension 12: Research and Audit 

Competency 

Demonstrates a knowledge of the audit processes and 

contributes to their implementation 

Critically appraises the validity of information where 

appropriate 

Demonstrates ability to undertake literature search to answer 

clinical questions. 



Uses audit and research tools to improve own clinical 

performance and outcomes 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 

GEN23 General 2 2 

R&D 10 


R&D8 

GEN32 

General 2 1 

HSC43 General 2 1 

HSC23 



Dimension 13: Leadership and service development 

Competency 

Demonstrates clinical leadership within their own work place 

Is aware of and works within local diabetes service 

requirements 

Offer appropriate educational advice to Podiatry and other 

professions in relation to care practices 

NOS 

Indicator 

M&L B5 

M&L B6 

GEN63 

M&L B8 

M&L D7 

DANOS 

AC3 

KSF 

Dimension 

KSF 

Level 

Core 4 1 

Core 4 2 

Core 2 3 


Level 

– Advanced Practitioners 



Competency 

NOS 

Indicator 


KSF 

Dimension 

In-depth knowledge of the theories of causes of diabetes Diab GA1 Core 2 3 

In-depth understanding of the impact of disease progression Diab GA1 Core 2 3 

in diabetes 

In-depth understanding of different non-pharmacological and Diab HA1 HWB7 3 






In-depth knowledge of the signs and symptoms of diabetes, 

including WHO criteria for diagnosis 

In-depth knowledge of normal and abnormal blood glucose 

and HbA1c values and how to monitor them 

Understands and contributes where appropriate to National 

Guidelines and NHS frameworks (e.g. SIGN, NICE, NSFs, 

Clinical Governance, IT strategy) 


Analyse, evaluate and interpret clinical information from 

diverse sources and make informed judgements about its 

quality and appropriateness to disseminate to others 

Influence and contribute to the design of patient record 

systems and decision support tools 

Utilises all current relevant and available 

information/terminology to engage with patients, other health 

care professionals and peers. 

Assesses and reviews the medical/medication history and 

undertakes examination and forms a diagnosis where 

appropriate 


assessment and ensure the individual is equipped with the 

required knowledge to allow them to provide an informed 

consent wherever possible 

Assess through discussion the individual's understanding and 



KSF 

Level 


HSC224 

Diab GA2 

Diab GA1 

Diab GA2 

B1 

CHS56 

CHS83 

HWB6 3 

Core 2 3 

Core 2 3 

HSC41 

HSC434 

CfA410 

HWB6 4 


Pharm HWB6 4 

GEN22 

CHS76 

Diab HA13 

PE8 

GEN14 

Core 1 4 

HWB6 4


information available to you, including any areas of 

uncertainty which may require further tests 


tests in the management of diabetes and its associated 

complications 

Contribute to and demonstrate the ability to apply the 

principles of evidence based medicine in a clinical and costeffectiveness 

framework 


Diab GA1 

GEN22 

CHS83 

PHS07 

HI19 

Core 1 4 

HWB6 4 

Core 5 3 

Competency 

Refers to and seeks guidance from another member of the 





Reflects on own performance, and performance impact of the 

service locally and nationally and can learn and change own 

and others practice 

Challenges colleagues’ inappropriate practice constructively 

Develops own and others networks for support, reflection and 

practice 

Establishes and monitors the effects of multi-professional 

approaches to integrated patient care 

Takes responsibility for own continuing professional 

development and acts as a mentorship for others in the team 

Establishes formal links with local NHS organisations and 

patient support networks 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 


GEN22 

CHS48 

Core 1 4 


MH92 

MH93 

Core 1 4 

LLUK Core 1 3 

CDE4 

GEN31 


GEN40 

GEN44 

GEN27 

HSC43 Core 2 3 

GEN27 

GEN44 

PHP15 

Core 1 3 

DIMENSION 2: SCREENING AND ASSESSMENT 

Competency 

NOS 

Indicator 


KSF 

Dimension 

Communicate clearly to the individual what is involved in the GEN22 Core 1 2 


Demonstrate the ability to carry out a basic diabetic foot Diab HA3 HWB6 2 



Diab HA3 

Diab HA4 

Provide up to date verbal and written advice relating to the Diab HA3 HWB7 1 

KSF 

Level

isk status resulting from foot screening. 






GEN14 

Diab HA4 

GEN22 

GEN20 

Diab TT01 

CHS99 

Core 1 2 

HWB7 1 

Competency 

NOS 

Indicator 

KSF 

Dimension 

Understands and recognises dermato-pathologies in diabetes HWB6 2 

Has an in depth understanding of which dermatological 

diagnostic test is required including microscopy and culture, 

biopsies and allergy testing and uses appropriate referral 

route 

CHS4 

AL2 

CHS46 

HWB7 2 

Can provide diagnosis and management of dermatological 

infections with effective antibiotic and anti-mycotic regimens 


CHS40 

CHS44 

KSF 

Level 

HWB7 4 

Competency 



Demonstrates an understanding of how these mechanisms 

may be altered (e.g. by age, renal impairment) and how this 

affects dosage 






therapy area 



Has the ability to request and interpret renal and liver function 

tests 



measures) 

Can establish, monitor and make changes to medication 

within the scope of the clinical management plan in light of the 

therapeutic objective and treatment outcome 

Is able to give clear instructions to the patient about their 

medication (e.g. how to take / administer it, where to get it 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 

EUSC19 HWB6 3 

CHS74 HWB6 3 

HWB6 3 

HWB6 3 

DANOS 

AA1 

HWB6 3 

CHS83 HWB6 4 

CHS106 

CHS105 

CHS74 HWB6 4 

CHS74 HBW7 4 

GEN22 

CHS74 

HBW6 4 


from, possible side-effects) 

Knows about common types of medication errors and how to 

prevent them 

Accepts personal responsibility for own prescribing in the 

context of a shared clinical management plan, and 

understands the legal and ethical implications of doing so 

Demonstrates an understanding of how current legislation 

affects prescribing practice at a local and national level 

Demonstrates the knowledge and practice required to keep 

prescription pads safely and knows what to do if they are 

stolen / lost 

Understands and uses tools to improve prescribing (e.g. 

review of prescribing data / feedback from patients) 

Understands the need to report prescribing errors and near 

misses, reviews practice to prevent recurrence 

Understands drug budgetary constraints at local levels; can 

discuss them with colleagues and patients 

Demonstrates a willingness to provide support and advice to 

other prescriber, team members and support staff where 

appropriate 

Can negotiate the appropriate level of support for role as a 

prescriber 

CHS74 HBW7 3 


GEN63 HWB7 3 

HSC43 

HSC23 

M&L E1 

M&L E2 

HSC241 

M&L D1 

HSC43 

HSC23 

Core 3 3 

Core 5 2 

Core 3 2 

Core 5 3 

Core 2 3 

Core 1 2 


Competency 

NOS 

Indicator 


KSF 

Dimension 

Has completed an IRMER course 

HWB3 3 

HSC23 


CHS38 HWB7 4 


Demonstrates the ability to request a radiological examination CHS99 HWB7 4 

with adequate, up-to-date knowledge of its actions, 

indications, contra-indications, interactions, cautions, dose 

and side-effects 

Develops and works within local frameworks for radiological GEN59 HWB6 4 

requests and uses as appropriate (e.g. PGDs, protocols and 

guidelines) 

Has the ability to interpret radiological reports CHS83 HWB8 4 

Demonstrates the ability to explain the nature of the patient’s 

condition and the rationale behind, potential risks and 

benefits, of the radiological test 

GEN22 HWB1 3 

Demonstrates the ability to communicate the result of the test GEN22 Core 1 4 

in terms the patient can understand 

Makes radiological requests often enough to maintain 


confidence and competence 

Keeps up-to-date with any changes in clinical practice which HSC23 HWB7 4 

KSF 

Level


images 

Provides support and advice to other radiological requesters, 

team members and support staff where appropriate 

HSC43 

HSC241 

M&L D1 

Core 1 4 


Competency 

In-depth knowledge of the causes of painful diabetes 

peripheral neuropathy 

In-depth knowledge of the signs and symptoms of painful 

diabetic peripheral neuropathy 

In-depth knowledge of the typical progression of painful 


In-depth knowledge of the treatment modalities available that 

are based on the current evidence base 


diabetic peripheral neuropathy and other painful symptoms 

Help the individual and their carer(s) understand what specific 

actions they can take to manage symptoms of painful diabetic 


Provide information on painful diabetic peripheral neuropathy 

in a suitable form for the individual and carer, to ensure their 

understanding and engagement in their treatment 

NOS 

Indicator 

DF01 

EUSC1 

CHS40 

DF01 

EUSC1 

CHS40 

KSF 

Dimension 

HWB6 4 

HWB6 4 

KSF 

Level 

HWB6 4 

HWB7 3 

CHS62 

CHS120 

CHS179 

CHS40 HWB6 4 

CHS179 

GEN14 

GEN22 

GEN62 

CHS179 

GEN14 

GEN62 

HWB1 3 

Core 1 3 


Competency 






Explain clearly to the individual what is involved in the 

assessment and obtain the individual’s informed consent to 

the assessment process. 




NOS 

Indicator 

Diab DF02 

Diab HA4 

Diab HA3 

KSF 

Dimension 

KSF 

Level 

HWB6 4 


GEN22 

CHS76 

CHS48 

GEN22 

Core 1 4 

Core 1 4 


Demonstrate the ability to carry out an assessment of foot/feet 

in order to determine the underlying cause of ulceration. This 

should include identification of vascular insufficiency, 

neurological deficit, significant foot deformity, trauma or 

increased pressures 


prevention of foot ulceration 

Assess the individual’s understanding of the information that 






relieving strategies and their implementation to minimise the 

risk of foot ulceration. 

Diab HA4 

Diab HA3 

HWB6 3 

GEN14 

Diab HA4 

Diab HA3 

HWB7 3 


Diab DF02 

Diab HA4 

Diab HA3 

HSC43 

HSC23 

HWB7 4 

HWB7 3 


Contributes to the development of local and have a working 

knowledge of national guidelines for diabetes Wound 

Management 











Confirm that the patient and or carer understand the purpose 

and nature of the proposed management plan. 


appropriately 

Participate in the evaluation of novel wound products. 

Recognising when there is a need and has the ability to refer 

to relevant AHP’s for specialist assessment and intervention 

M&L B1 HWB7 4 


CM D5 

CHS70 

Diab DF02 

Diab HA4 

HWB6 4 

HWB6 4 

HWB6 4 

Diab HA3 


CHS99 

CHS177 

M&L B1 

R & D 15 

CHS99 

GEN63 

HWB7 4 

HWB7 4 

HWB6 4 

Debridement 


CHS12 HWB7 4 



Demonstrate the ability to carry out Wound Management CHS12 HWB7 4 


techniques such as sharp debridement 

Demonstrate the ability to carry out advanced Wound 

Management techniques including larva and hydro surgical 

debridement. 





reporting and interpretation. 







Diab DF02 

Diab DF03 

PCS18 

Diab DF03 

CHS14 

HWB7 4 

CHS12 HWB6 4 

CHS185 

CHS7 

CHS83? 

CHS5 

HSC43 

HSC23 

HWB7 4 

HWB7 4 

CHS12 HWB7 4 


Competency 


carers in relation to prevention of re- ulceration 

Establish the cause of previous ulceration to develop a care 

plan and implement preventative strategies 






Ability to prescribe for specialist footwear when required 

NOS 

Indicator 

PE8 

PE7 

PE6 

PE3 

KSF 

Dimension 

KSF 

Level 

HWB1 3 

PE4 HWB1 3 

CHS40 


CHS5 

HSC43 

HSC23 

Diab HA4 

CHS140 

HWB7 4 

HWB7 4 


Competency 



Demonstrates and manages the psychological impact of 

patients presenting with diabetic complications 

NOS 

Indicator 

KSF 

Dimension 

KSF 

Level 

PE HWB4 4 

CHS61 

CM D5 

HWB4 4 


Understands the impact of how culture and social context on 

how individuals think and feel about their behaviour and 

changing it 


people may have about their condition, the affect of this on 

their behaviour and its consequences. 

Demonstrate an in depth understanding of methods, tools and 



Demonstrates high level communication skills with individuals 

with active diabetic foot disease and their carers which 

encourage an open exchange of views and information 

Demonstrate knowledge and appropriate use of relevant 

information in suitable formats when communicating with 

individuals regarding their needs 



individuals with active diabetic foot disease. 







CHS70 

CHS58 HWB4 4 

HT2 

PE8 

GEN14 

GEN14 HWB4 4 

CHS38 

CHS105 

HWB4 4 


CHS177 

GEN14 

GEN62 

GEN32 

CHS45 

CHS44 

Diab DA4 

HSC330 

Core 1 4 

HWB4 4 

HWB4 3 

MH97 HWB4 3 


Competency 



Demonstrate the ability to recognise the acute Charcot 




Demonstrates knowledge of biomechanical pressure relieving 

strategies and their implementation in the management of 

Charcot neuroarthropathy 

Ability to communicate to the patient and/or carer the nature 

and implications of Charcot neuroarthropathy 

NOS 

Indicator 

CHS40 

Diab HA3 

Diab HA4 

CHS40 

Diab TT01 

CHS40 

CHS99 

Diab HA1 

Diab HA4 

HSC43 

KSF 

Dimension 

KSF 

Level 

HWB6 3 

HWB6 3 

HWB7 4 

HWB7 4 

HSC23 

GEN22 HWB7 4 


Understands the different radiological and non radiological 


Demonstrate the ability to make a differential diagnosis 

between charcot and other acute diabetic foot problems 

Demonstrate the ability to select and evaluate the most 

appropriate technique to immobilize the affected joint(s) 

Demonstrate knowledge of the most up to date 

pharmacological therapy for Charcot neuroarthropathy 

Demonstrate the ability to monitor the effectiveness of 

treatment and make changes where appropriate through the 

stages of the Charcot process 

Demonstrate the ability to implement strategies for long term 

management of the stable Charcot neuroarthropathy 

CHS38 HWB6 4 

CHS40 HWB6 4 

CHS44 HWB7 4 

HSC43 HWB7 4 

HSC23 

CHS47 HWB7 4 

CHS173 

CHS85 

HWB7 4 

Dimension 12: Research and Audit 

Competency 

NOS 

Indicator 

KSF 

Dimension 

Critically appraises the validity of information and 


disseminates where appropriate. 

Contributes to current research on Diabetic foot disease R&D 10 General 2 2 

R & D 8a 

Demonstrates a thorough knowledge of the audit and 

research processes and leads on their design and 

implementation 

GEN23 

R&D 8 

General 2 3 

Implements audit and research tools to improve clinical 

performance and outcomes 

Demonstrates high level skills in literature searching to 

research clinical questions 

Demonstrates an ability to present research and audit findings 

to peer group and other HCP’s 

Dimension 13: Leadership and service development 

KSF 

Level 


R&D8 

GEN32 

LLUK L10 

GEN18 

R&D13 

General 2 3 

Core 3 3 

Competency 

Demonstrates clinical leadership on Diabetes footcare within 

local Diabetes foot services 

To contribute to developing local diabetes services in line with 

local and national requirements 

Offer appropriate educational advice to Podiatry and other 

professions in relation to care practices 

NOS 

Indicator 

M&L B5 

M&L B6 

GEN63 

M&L B8 

M&L B1 

M&L D7 

DANOS 

AC3 

KSF 

Dimension 

KSF 

Level 

Core 4 3 

Core 4 3 

Core 2 3 


Ability to challenge professional and local boundaries to 

improve care outcomes 

Awareness of resource limitations for local diabetes services 

Design, deliver and evaluate educational packages for all 

appropriate healthcare professionals and students in relation 

to care practices, service delivery and development 

GEN55 

M&L E2 

DANOS 

AC3 

LLUK L4 

LLUK L1 

LLUK L17 

Core 4 4 

Core 4 3 

Core 2 4 


LEVEL 

- Consultant Practitioners 




Dimension 

In-depth knowledge of the theories of causes of diabetes Diab GA1 Core 2 3 

In-depth understanding of the impact of disease progression Diab GA1 Core 2 4 

in diabetes 

In-depth understanding of different non-pharmacological and Diab HA1 HWB7 3 






In-depth knowledge of the signs and symptoms of diabetes, 

including WHO criteria for diagnosis 

In-depth knowledge of normal and abnormal blood glucose 

and HbA1c values and how to monitor them 

Provided leadership in the formation and delivery of National 

Guidelines and NHS frameworks (e.g. SIGN, NICE, NSFs, 

Clinical Governance, IT strategy) 


KSF 

Level 


HSC224 

Diab GA2 

Diab GA1 

Diab GA2 

B1 

B6 

HWB6 4 

Core 2 4 


Dimension 

Analyse, evaluate and interpret clinical information from 

diverse sources and make informed judgements about its 

quality and appropriateness to disseminate to others 

Influence and lead on the design of patient record systems 

and decision support tools 

Utilises all current relevant and available 

information/terminology to engage with patients, other health 

care professionals and peers. 

Assesses and reviews the medical/medication history and 

undertakes examination and forms a diagnosis where 

appropriate 

CHS56 

CHS83 

KSF 

Level 

Core 2 4 

CfA410 HWB6 4 

M&L B1 


Pharm HWB6 4 

Communicate clearly to the individual what is involved in the GEN22 Core 1 4 


assessment and ensure the individual is equipped with the 

required knowledge to allow them to provide an informed 

consent wherever possible 

Assess through discussion the individual's understanding and 




information available to you, including any areas of 

uncertainty which may require further tests 


tests in the management of diabetes and its associated 

complications 

Contribute to and disseminate widely any relevant principles 

of evidence based medicine in a clinical and costeffectiveness 

framework 


CHS76 

Diab HA13 

PE8 

GEN14 

Diab GA1 

GEN22 

CHS83 

PHS07 

HI19 

HWB6 4 

Core 1 4 

HWB6 4 

Core 5 4 


Dimension 

Refers to and seeks guidance from another member of the 





Reflects on own performance, and performance impact of the 

service locally and nationally and can learn and change own 

and others practice 

Challenges colleagues’ inappropriate practice constructively 

Develops own and others networks for support, reflection and 

practice 

Establishes and monitors the effects of multi-professional 

approaches to integrated patient care 

Takes responsibility for own continuing professional 

development and acts as a mentorship for others in the team 

Establishes formal links with local NHS organisations and 

patient support networks 

KSF 

Level 


GEN22 

CHS48 

Core 1 4 


MH92 

MH93 

Core 1 4 

LLUK Core 1 4 

CDE4 

GEN31 


GEN40 

GEN44 

GEN27 


GEN27 

GEN44 

PHP15 

Core 1 4 



Communicate clearly to the individual what is involved in 

the screening process 


screening and record the information on the SCI DC 

system where available. 


the risk status resulting from foot screening. 

Explain the results of the screening to the individual and 

carer in an appropriate manner and a suitable level and 

pace. 

Carry out further assessment when required and make 

any appropriate referral for specialist intervention. 


Diab HA3 

Diab HA4 

Diab HA3 

GEN14 

Diab HA4 

GEN22 

GEN20 

Diab TT01 

CHS99 

HWB6 2 

HWB7 1 

Core 1 2 

HWB7 1 


Competency 

Understands and recognises dermato-pathologies in 


Demonstrates an in depth understanding of which 

dermatological diagnostic tests are required including 

microscopy and culture, biopsies and allergy testing and 

refers directly. 

Establish a direct referral route for dermatological 

intervention and treatment 

Can provide diagnosis and management of 

dermatological conditions with effective antibiotic and 

anti-mycotic regimens 

NOS 

Indicator 

CHS4 

AL2 

CHS46 

CHS40 

CHS44 

KSF 

Dimension 

KSF Level 

HWB6 2 

HWB7 3 

HWB7 4 

HWB7 4 


Competency 

NOS 

Indicator 

KSF 

Dimension 


KSF Level 

Demonstrates an understanding of the mode of action EUSC19 HWB6 4 

and effects of medicines 

Demonstrates an understanding of how these 

CHS74 HWB6 4 

mechanisms may be altered (e.g. by age, renal 

impairment) and how this affects dosage 

Demonstrates an understanding of the potential for 

HWB6 4 

unwanted effects (e.g. allergy, ADRs, drug interactions, 

special precautions and contraindications) 

Maintains an up-to-date knowledge of products in the HWB6 4

BNF / drug tariff (e.g. doses, formulations, costs) relevant 

to the therapy area 



Has the ability to request and interpret renal and liver 

function tests 

Demonstrates an awareness of no treatment, non-drug 

and drug treatment options (including referral and 

preventative measures) 

Can negotiate an outcome to the consultation that both 

patient and prescriber are satisfied with, including the 

option of non-pharmaceutical treatments 

Can establish, monitor and make changes to medication 

within the scope of the clinical management plan in light 

of the therapeutic objective and treatment outcome 

Is able to give clear instructions to the patient about their 

medication (e.g. how to take / administer it, where to get 

it from, possible side-effects) 

Knows about common types of medication errors and 

how to prevent them 

Accepts personal responsibility for own prescribing in the 

context of a shared clinical management plan, and 

understands the legal and ethical implications of doing so 

Demonstrates an understanding of how current 

legislation affects prescribing practice at a local and 

national level 

Demonstrates the knowledge and practice required to 

keep prescription pads safely and knows what to do if 

they are stolen / lost 

Understands and uses tools to improve prescribing (e.g. 

review of prescribing data / feedback from patients) 

Understands the need to report prescribing errors and 

near misses, reviews practice to prevent recurrence 

Understands drug budgetary constraints at local and 

national levels; can discuss them with colleagues and 

patients 

Demonstrates leadership in providing support and advice 

to other prescribers, team members and support staff 

where appropriate 

Can negotiate the appropriate level of support for own or 

others role as a prescriber 

DANOS 

AA1 

HWB6 4 

CHS83 HWB6 4 

CHS106 

CHS105 

CHS74 HWB6 4 


CHS74 HBW7 4 

GEN22 

CHS74 

HBW7 4 

CHS74 HBW7 4 


GEN63 HWB7 4 

HSC43 

Core 3 4 

HSC23 

?? Core 5 4 

?? Core 3 4 

M&L E1 

M&L E2 

HSC241 

M&L D1 

HSC43 

HSC23 

Core 5 4 

Core 2 4 

Core 1 3 



Competency 

Has completed an IRMER course 

NOS 

Indicator 

KSF 

Dimension 

KSF Level 

HSC23 HWB3 3 

Understands different radiological and non-radiological CHS38 HWB7 4 


Demonstrates the ability to request a radiological 

CHS99 HWB7 4 

examination with adequate, up-to-date knowledge of its 

actions, indications, contra-indications, interactions, 

cautions, dose and side-effects 

Develops and works within local frameworks for 

GEN59 HWB6 4 

radiological requests and uses as appropriate (e.g. 

PGDs, protocols and guidelines) 

Has the ability to interpret radiological reports CHS83 HWB8 4 

Demonstrates the ability to explain the nature of the GEN22 HWB1 4 

patient’s condition and the rationale behind, potential 

risks and benefits, of the radiological test 

Demonstrates the ability to communicate the result of the GEN22 Core 1 4 

test in terms the patient can understand 

Makes radiological requests often enough to maintain GEN63 Core 2 4 

confidence and competence 

Keeps up-to-date with advances in radiological practice HSC23 HWB7 4 

HSC43 

Provides support and advice to other radiological 


requesters, team members and support staff where 

appropriate 

M&L D1 

Negotiates the appropriate level of support for the role of 

a requester of radiological examinations 



Competency 

In-depth knowledge of the causes of painful diabetes 


In-depth knowledge of the signs and symptoms of painful 


In-depth knowledge of the typical progression of painful 


NOS 

Indicator 

DF01 

EUSC1 

CHS40 

DF01 

EUSC1 

KSF 

Dimension 

KSF Level 

HWB6 4 

HWB6 4 

CHS40 HWB6 4 


In-depth knowledge of the treatment modalities available 

that are based on the current evidence base 


diabetic peripheral neuropathy and other painful 

symptoms 

Help the individual and their carer(s) understand what 

specific actions they can take to manage symptoms of 

painful diabetic peripheral neuropathy 

Provide information on painful diabetic peripheral 

neuropathy 

in a suitable form for the individual and carer, to ensure 

their understanding and engagement in their treatment 

CHS62 

CHS120 

CHS179 

HWB7 3 

CHS40 HWB6 4 

CHS179 

GEN14 

GEN62 

CHS179 

GEN14 

GEN62 

HWB1 3 

Core 1 3 


Competency 

Understands diabetes, its natural progress and how to 

assess its severity in relation to preventing foot 

ulceration. 




Explain clearly to the individual what is involved in the 

assessment and obtain the individual’s informed consent 

to the assessment process. 

Communicate with the individual in an appropriate 

manner, recognizing the stressful nature of informing the 

patient that they are at risk of foot ulceration. 

Demonstrate the ability to carry out an assessment of 

foot/feet in order to determine the underlying cause of 


insufficiency, neurological deficit, significant foot 

deformity, trauma or increased pressures 

Review and revise where necessary up to date verbal 

and written advice relating to prevention of foot ulceration 

Assess the individual’s understanding of the information 

that you have given them, and where necessary confirm 

the main areas that contribute to their risk of ulceration. 

Understand the necessity for urgent treatment and 

referral in the event of suspected ulceration. 


pressure relieving strategies and their implementation to 

minimise the risk of foot ulceration. 

NOS 

Indicator 

Diab DF02 

Diab HA4 

Diab HA3 

KSF 

Dimension 

KSF Level 

HWB6 4 


GEN22 

CHS76 

CHS48 

GEN22 

Diab HA4 

Diab HA3 

Core 1 4 

Core 1 4 

HWB6 4 

GEN14 

Diab HA4 

Diab HA3 

HWB7 4 


Diab DF02 

Diab HA4 

Diab HA3 

HSC43 

HSC23 

HWB7 4 

HWB7 4 



Competency 

Contributes to the development of local/national 

guidelines for diabetes Wound Management 

Demonstrates a knowledge of the signs & symptoms 

relevant to diabetic foot ulceration 





Demonstrate the ability to recognise and classify active 

foot ulceration. This should include identification of 

vascular insufficiency, neurological deficit, significant foot 

deformity, trauma, increased pressures, extent and 

degree of infection. 

Confirm that the patient and or carer understand the 

purpose and nature of the proposed management plan. 

Contribute to the development of local referral pathways 

Recognises when there is a need and has the ability to 

refer to the relevant specialist AHP’s for specialist 

assessment and intervention 

Debridement 


management of the wound bed to optimise the process 

of healing 


techniques such as sharp debridement 

Demonstrate the ability to carry out advanced Wound 

Management techniques including larva and hydro 

surgical debridement. 

NOS 

Indicator 

KSF 

Dimension 

KSF Level 

M&L B1 HWB7 4 


CM D5 

CHS70 

Diab DF03 

Diab DF02 

Diab HA4 

Diab HA3 

HWB6 4 

HWB6 4 

HWB6 4 


CHS99 

CHS177 

CHS99 

GEN63 

HWB7 4 

HWB6 4 

CHS12 HWB7 4 

CHS12 

Diab DF02 

Diab DF03 

PCS18 

Diab DF03 

CHS14 

HWB7 4 

HWB7 4 

Lead in the evaluation of novel wound products M&L B1 HWB7 4 


Demonstrates a clinical ability to recognise signs and 


CHS12 HWB6 4 


reporting and interpretation. 

Contributes to the development of local antibiotic 

guidelines 




CHS185 

CHS7 

M&L B1 

M&L B8 

CHS5 

HSC43 

HSC23 

HWB7 4 

HWB6 4 

HWB7 4 



Demonstrate a wide knowledge of the availability of 

modern dressing products, their mode of action and 

appropriate usage 

CHS12 HWB7 4 


Competency 

Evaluate and provide specialist education for the patient 

and their usual carers in relation to prevention of reulceration 

Establish the cause of previous ulceration to develop a 

plan and implement preventive strategies 

Communicate with the individual in an appropriate 

manner, recognizing the stressful nature of informing the 

patient that they are at risk of further foot ulceration 


pressure relieving strategies and their implementation. 

Ability to prescribe for specialist footwear when required 

NOS 

Indicator 

PE8 

PE7 

PE6 

PE3 

KSF 

Dimension 

KSF Level 

HWB1 4 

PE4 HWB1 4 

CHS40 


CHS5 

HSC43 

HSC23 

Diab HA4 

CHS140 

HWB7 4 

HWB7 4 


Competency 

Demonstrates a critical understanding of the importance 

and effects of patient education and self management 

Demonstrates and manages psychological impact of 

patients presenting with diabetic complications. 

Understands the impact of how culture and social context 

on how individuals think and feel about their behaviour 

and changing it 


people may have about their condition and the affect of 

this on their behaviour and its consequences. 

Demonstrate an in depth understanding of methods, 

tools and techniques for assessing and evaluating 

individual's health status, concerns, personal context and 

priorities 

Demonstrates high level communication skills with 

individuals and their carers regarding their active diabetic 

foot disease which encourages an open exchange of 

NOS 

Indicator 

KSF 

Dimension 

KSF Level 

PE HWB4 4 

CHS61 

CM D5 

CHS70 

HWB4 4 

CHS58 HWB4 4 

HT2 

PE8 

GEN14 

GEN14 HWB4 4 

CHS38 

CHS105 

HWB4 4 



views and information 

Influences the design and use of relevant information in 

suitable formats for prevention and management diabetic 

foot disease. 



patients with active diabetic foot disease 



(www.mydiabetesmyway.org.uk) to assist the individual 

in managing their condition 



HP8 

PE2 

CHS45 

CHS44 

Diab DA4 

Diab PE01 

HSC330 

Core 1 4 

HWB4 4 

HWB4 3 

HWB4 3 

DIMENSION 11: CHARCOT NEUROARTHROPATHY 

Competency 


predisposing risk factors for Charcot neuroarthropathy 

Demonstrate the ability to recognise acute Charcot 


Demonstrate the need for appropriate further 

investigation and intervention of suspected Charcot 


Demonstrates knowledge of biomechanical pressure 

relieving strategies and their implementation in the 

management of Charcot neuroarthropathy 

Ability to communicate to patient and/or carer the 

implications of Charcot neuroarthropathy 

Understands the different radiological and non 

radiological methods of assessment 

Demonstrate the ability to make a differential diagnosis 

between charcot and other acute diabetic foot problems 

Demonstrate the ability to select and evaluate the most 

appropriate technique to immobilize the affected joint(s) 

Demonstrate knowledge of the most up to date 

pharmacological therapy for Charcot neuroarthropathy 

Demonstrate the ability to monitor the effectiveness of 

treatment and make changes where appropriate through 

the stages of the Charcot process 

Demonstrate the ability to implement strategies for long 

term management of the stable Charcot 


NOS 

Indicator 

CHS40 

Diab HA4 

Diab HA3 

CHS40 

Diab HA4 

Diab TT01 

CHS99 

HSC43 

KSF 

Dimension 

KSF Level 

HWB6 3 

HWB6 3 

HWB7 4 

HWB7 4 

HSC23 

GEN22 HWB7 4 

CHS38 HWB6 4 

CHS40 HWB6 4 

CHS44 HWB7 4 

HSC43 HWB7 4 

HSC23 

CHS47 HWB7 4 

CHS173 

CHS85 

HWB7 4 


DIMENSION 12: RESEARCH AND AUDIT 

Competency 

Demonstrates a thorough knowledge of audit and 

research processes and leads on their design and 

implementation 

Leads on the development and implementation on 

current research on diabetic foot disease 

Demonstrates high level skills in literature searching to 

research clinical questions 

Critically appraises the validity of information and 

disseminates where appropriate 

Designs and implements audit and research to improve 

clinical performance and outcomes 

Demonstrates an ability to present research and audit 

findings to local, national or international audiences 



Provide support and information to other health care 

professionals to improve their knowledge and 

participation in research and audit. 

NOS 

Indicator 

KSF 

Dimension 

KSF Level 


R&D 

10,14,8,7 

6,3,15 

General 2 4 

R&D8 General 2 3 

GEN32 


HI16 

R&D14 

LLUK L10 

GEN18 

R&D13 

LLUK L19 

HSC43 

HSC23 

DANOS 

AC3 

HSC43 

General 2 4 

General 2 4 

General 2 4 

Core 2 4 

DIMENSION 13: LEADERSHIP AND SERVICE DEVELOPMENT 

Competency 

Demonstrates clinical leadership on Diabetes foot care 

on a local, national and international level 

Take responsibility for developing diabetic foot services 

in line national requirements 

To develop and sustain appropriate relationships, 

partnerships and networks to influence and improve care 

outcomes and delivery systems 

Ability to challenge professional and organisation 

boundaries to improve care outcomes. 

Ability to develop strategies to ensure the best used local 

resources and technology 

Design, deliver and evaluate educational packages for all 

appropriate healthcare professionals and students in 

relation to care practices, service delivery and 

development 

NOS 

Indicator 

M&L B5 

M&L B6 

GEN63 

M&L B8 

M&L B1 

M&L D1 

M&L D2 

M&L B4 

CJHF27 

DANOS 

AC3 

LLUK L4 

LLUK L1 

LLUK L17 

KSF 

Dimension 


KSF Level 

Core 4 4 

Core 4 4 

Core 4 4 

Core 4 4 

Core 4 4 

Core 2 4

Offer appropriate educational advice to Podiatry and 

other professions in relation to care practices 

Awareness of resource limitations for local diabetes 

services 

M&L D7 

DANOS 

AC3 

GEN55 

M&L E1 

M&L E2 

M&L D6 

Core 2 4 

Core 4 4 


Glossary 

Diab 

DA4 – Assist individuals with diabetes to help and support each other 

DF01 - Undertake advanced examination and risk assessment of the feet of an individual with diabetes 

DF02- Implement specialist foot treatment for an individual with diabetes 

DF03 - Provide wound care to treat an ulcerated foot of an individual with diabetes 

DF04 - 

GA1 - Assess and advise individuals with suspected diabetes 

GA2 - Assess and investigate individuals with suspected diabetes 

HA1 – Assess the healthcare needs of individuals with diabetes and agree care plans 

HA2 - Work in partnership with individuals to sustain care plans to manage their diabetes 

HA3 – Examine the feet of an individual with diabetes and advice on care. 

HA4 – Assess the feet of individuals with diabetes and provide advice on maintaining healthy feet and 

managing foot problems 

HA13 – Provide information and advice to enable an individual with diabetes to minimise the risks of 

hypoglycaemia 

HSC23 – Develop your knowledge and practice 

HSC43 – Take responsibility for the continuing professional development of self and others 

HSC224 – Observe, monitor and record the conditions of individuals 

HSC241 – Contribute to the effectiveness of teams 

HSC330 – Support individuals to access and use services and faculties 

TT01 – Identify symptoms of diabetes and refer individuals for further assessment 


GEN 

12 – Reflect on and evaluate your own values, priorities, interests and effectiveness 

13 – Synthesise new knowledge into the development of your own practice 

14 - Provide advice & information to individuals on how to manage their own condition 

18 – Give presentations to groups 

20 - Enable carers to support individuals 

22 – Communicate effectively with individuals 

27 – Develop, sustain and evaluate collaborative working with other organisations 

31 – Initiate and participate in networks and discussion groups 

32 – Search information, evidence and knowledge resources and communicate the results 

39 – Contribute to effective multidisciplinary team working 

40 – Contribute to the development of the multidisciplinary team and its members 

44 – Liaise between primary, secondary and community teams 

55 – Obtain and monitor the use of the funds required to implement plans to meet local needs for health 

acre service 

59 - Direct requests for assistance, care or treatment using protocols and guidelines 

63 – Act within the limits of your competence and authority 


HSC 

23 - Develop your knowledge and practice 

43 - Take responsibility for the continuing professional development of self and others 

224 - Observe, monitor and record the conditions of individuals 

241 - Contribute to the effectiveness of teams 

CHS 

4 – Undertake tissue viability risk assessment for individuals 

5 – Undertake agreed pressure area care 

7 – Obtain and test specimens from individuals 

12 – Undertake treatments and dressings related to the care of lesions and wounds. 

14 – Remove wound closure materials from individuals 

38 – Plan assessment of an individual’s health status 

40 – Determine a diagnosis of an individual’s health condition 

44 – Plan activities, inventions and treatments to achieve specified health goals 

45 – Agree courses of action following assessment to address health and wellbeing needs of individuals 

46 – Undertake a risk assessment in relation to a defined health need 

47 – Monitor and assess patients following treatments 

48 – Communicate significant news to individuals 

56 – Provide clinical information to individuals 

58 – Provide information and support to carers of individuals with long term conditions 

61 – Co-ordinate the acre of individuals with long term conditions 

62 – Provide interventions to individuals with long term conditions 

70 – Support individuals with long term conditions to optimise their psychological functions 


74 – Manage an individual’s medication to achieve optimum outcomes 

76 – Obtain informed consent for interventions or investigations 

83 – Interpret and report on the findings of investigations 

85 – Review and evaluate care management plans with individuals diagnosed with long term conditions 

99 – Refer individuals to specialist sources of assistance in meeting their health acre needs 

105 – Agree the nature and purpose of investigation into an individual’s health status 

106 – Request imaging investigations to provide information on an individual’s health status and needs 

120 – Establish an individual’s suitability to undergo an intervention. 

140 – Authorise assistive devices to meet the individual’s needs 

173 – Develop care pathways for patient management 

179 – Advise on requirements for choice of therapeutic intervention 

185 – Perform basic specimen/sample preparation 

330 - 


PE 

1 – Enable individuals to make informed health choices and decisions 

2 – Manage information and materials for access by patients and carers 

3 – Work with individuals to evaluate their health status and needs 

4 – Agree a plan to enable individuals to manage their health condition 

5 –Develop relationship with individuals that support them in addressing their health needs 

6 – Identify the learning needs of patients and carers to enable management of a defined condition 

7 – Develop learning tools and methods for individuals and groups with a defined health condition 

8 – Enable individuals to manage their defined health condition 

R&D 

3 – Design and formulate a research and development proposal 

6 – Produce a detailed research and development plan 

7 – Direct and manage research and development activities 

8 – Conduct investigations in selected research and development topics 

10- Interpret results of research and development activities 

13 – Present findings of research and development activities orally 

14 – Translate research and development findings into practice 

15 – Evaluate and report on the application of research and development findings within practice 


LLUK 

L1 – Develop a strategy and plan for learning and development 

L4 – Design learning programmes 

L10 – Enable learning through presentations 

L17 – Evaluate and improve learning and development programmes 

L19 – Provide learning and development in international settings 

CDE 

4 – Develop people skills and ideas within community groups/networks 

M&L 

B1 – Develop and implement operational plans for your area of responsibility 

B4 – Put the strategic business plan into action 

B5 – Provide leadership for your team 

B6 – Provide leadership in your area of responsibility 

B8 – Ensure compliance with legal, regulatory, ethical and social requirements 

D1 – Develop productive working relationships with colleagues 

D2 – Develop productive working relationships with colleagues and stakeholders 

D6 – Allocate and monitor the progress and quality of work in your area of responsibility 

D7 – Providing learning opportunities for colleagues 

E1 – Manage a budget 

E2 – Manage finance for your area if responsibility 


HI 16 – Facilitate and clinically validate the implementation, evaluation and improvement of 

communication, information and knowledge systems to meet the needs of clinicians, patient and the 

public 

HI 19 – Critically appraise clinical information and evidence 

PCS 18 – Prepare, apply and attach dressing, wound supports and drains to patients 

EUSC19 – Administer pharmaceutical interventions 

CFA410 - Create and manage information systems 

PHP15 – Encourage behavioural change in people and agencies to promote health and well being 

PHS07 – Assess the evidence and impact of health and healthcare interventions, programmes and 

services and apply the assessments to practice 

HP8 – Develop materials for information and education for specific audiences to support their 

engagement and participation in health protection processes 

CJHF27 – Evaluate, prioritise and review demands for service 

HT2 – communicate with individuals about promoting their health and wellbeing 

DANOS AC3 – Contribute to the development of the knowledge and practice of others 


KSF Dimension & Levels 

Core 1 

Level 1 – Communicate with a limited range of people on day to day matters 

Level 2 - Communicate with a range of people on a range of matters 

Level 3 – Develop and maintain communication with people about difficult matters and/or in difficult 

situations 

Level 4 – Develop and maintain communication with people on complex matters, issues and ideas 

and/or in complex situations 

Core 2 

Level 1 – Contribute to own development 

Level 2 – Develop own knowledge and skills and provide information to others to help their development 

Level 3 – Develop oneself and contribute to the development of others 

Level 4 – Develop oneself and others in areas of practice 

Core 3 

Level 1 – Assist in maintaining own and others’ health, safety and security 

Level 2 – Monitor and maintain health, safety and security of self and others 

Level 3 – promote, monitor and maintain best practice in health, safety and security 

Level 4 – Maintain and develop an environment and culture that improves health, safety and security 

Core 4 

Level 1 – Make changes in own practice and offer suggestions for improving services 

Level 2 – Contribute to the improvement of services 

Level 3 – appraise, interpret and apply suggestions, recommendations and directives to improve 

services 

Level 4 – Work in partnership with others to develop, take forward and evaluate direction, policies and 

strategies 


Core 5 

Level 1 – Maintain the quality of own work 

Level 2 – Maintain quality in own work and encourage others to do so 

Level 3 – Contribute to improving quality 

Level 4 – Develop a culture that improves quality 

Core 6 

Level 1 – Act in ways that support equality an value diversity 

Level 2 – Support equality and value diversity 

Level 3 – Promote equality and value diversity 

Level 4 – Develop a culture that promotes equality and values diversity 

HWB1 

Level 1 – Contribute to promoting health and wellbeing and preventing adverse effects on health and 

wellbeing 

Level 2 – Plan, develop and implement approaches to promote health and wellbeing and prevent 

adverse effects on health and wellbeing 

Level 3 – Plan, develop, implement and evaluate programmes to promote health and wellbeing and 

prevent adverse effects on health and wellbeing 

Level 4 – Promote health and wellbeing and prevent adverse effects on health and wellbeing through 

contributing to the development, implementation and evaluation of related policies 

HWB3 

Level 1 – Recognise and report situations where there might be a need for protection 

Level 2 – Contribute to protecting people at risk 

Level 3 – Implement aspects of a protection plan and review its effectiveness 

Level 4 – Develop and lead on the implementation of an overall protection plan 


HWB4 

Level 1 – Help people meet daily health and wellbeing needs 

Level 2 – Enable people to meet ongoing health and wellbeing needs 

Level 3 – Enable people to address specific needs in relation to health and wellbeing 

Level 4 – Empower people to realise and maintain their potential in relation to health and wellbeing 

HWB6 

Level 1 – Undertake tasks related to the assessment of physiological and/or psychological functioning 

Level 2 – Contribute to the assessment of physiological and/or psychological functioning 

Level 3 – Assess physiological and/or psychological functioning develop, monitor and review related 

treatment plans. 

Level 4 – Assess physiological and/or psychological functioning when there are complex and/or 

undifferentiated abnormalities, diseases and disorders and develop, monitor and review related 

treatment plans. 

HWB7 

Level 1 – Assist in providing interventions and/or treatments 

Level 2 – Contribute to planning, delivering and monitoring interventions and/or treatments 

Level 3 – Plan, deliver and evaluate interventions and/or treatments 

Level 4 – Plan, deliver and evaluate interventions and/or treatments when there are complex issues 

and/or serious illness 

HWB8 

Level 1 – Undertake tasks to support biomedical investigations and/or interventions 

Level 2 – Undertake and report on routine biomedical investigations and/or interventions 

Level 3 – Plan, undertake, evaluate and report biomedical investigations and/or interventions 

Level 4 – Plan, undertake, evaluate and report complex/unusual biomedical investigations and/or 

interventions 


General 2 

Level 1 – Appraise concepts, models, methods, practices, products and equipment developed by others 

Level 2 – Contributing to developing, testing and reviewing new concepts, models, methods, practices, 

product and equipment 

Level 3 – Test and review new concept, models, methods, practices, products and equipment 

Level 4 – Develop new and innovative concepts, models, methods, practices, products and equipment 


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patient groups in diabetes foot care - Diabetes in Scotland

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