A new diabetes foot educational and risk assessment tool for people with diabetes and health care professionals has been created: ACT NOW: Accident, Change, Temperature, New pain, Oozing, Wound, an acronym to recognise warning signs of foot complications, and reduce delays in much needed and timely specialist intervention(s) to avoid amputation

Aims: When a person with diabetes (PwD) develops a foot problem there is often a delay in receiving specialist help, which may result in amputation and this may be blamed on medical negligence. Our aims were to develop an educational tool to recognise the warning signs of foot complications that might lead to amputation and to disseminate the tool and seek endorsement. Methods: The delay to specialist help was analysed by the iDEAL group (Insights for Diabetes Excellence, Access and Learning), a multidisciplinary team of diabetes specialists together with a PwD and recommendations were made. Results: An educational tool based on the acronym ACT NOW: Accident (recent trauma to foot), Change in colour or shape, Temperature-hot or cold, New pain, Oozing and Wound) was devised to help PwDs and health care professionals (HCPs) recognise the warning signs of foot complications, leading to potential amputation, that should trigger referral to specialist care. On recognising one or more of these features, the PwD can gain confidence, especially during the covid-19 pandemic, to seek specialist help either directly from a diabetes foot service or through a first contact HCP who can then refer. An ACT NOW checklist was also devised to aid the HCP in making the referral. The tool has been disseminated through digital and traditional media and endorsement granted from the Foot in Diabetes UK (FDUK), the English Diabetes Footcare Network and the Primary Care Diabetes Society. Conclusion: ACT NOW has been accepted as an innovative educational tool to reduce delay of foot referral to specialist care.