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New National White Paper Calls for Urgent Reform in Vascular Care – With a Strong Role for Primary Care

17 March 2026

A major opportunity to transform lower‑limb vascular care

A new national White Paper, Making the Case for Reform in the Vascular Sector, has been published today, outlining a comprehensive plan to deliver faster, fairer and more effective lower‑limb vascular care across England. The report, produced by the Vascular and Venous Disease All-Party Parliamentary Group (VVAPPG) with support from NHS England, the Royal College of Podiatry and industry partners, highlights vascular disease as one of the leading causes of preventable disability and premature death.

Despite advances in other cardiovascular areas, too many patients still experience delayed diagnosis, inconsistent referral pathways and uneven access to specialist care – leading to thousands of avoidable lower‑limb amputations every year.

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The scale of the challenge

The White Paper highlights several urgent pressures across the system:

• Thousands of major amputations each year, many preventable with earlier treatment.
• Over 80% of diabetes‑related amputations are preceded by a foot ulcer, underlining the importance of early detection and rapid triage.
• Chronic wounds cost the NHS more than £8 billion annually, most spent on wounds that fail to heal.
• Only half of patients with severe PAD (CLTI) receive revascularisation within recommended timelines, contributing to poorer outcomes.

Outcomes also vary significantly across England, reflecting deep regional inequalities in access to vascular assessment, community podiatry and wound care services.

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The five key policy asks

The report identifies a clear package of reforms that can be implemented within existing NHS frameworks:

1. Implement a National Foot Attack Pathway – including mandated same‑day or next‑day triage and a public awareness campaign.
2. Establish Foot Protection Services in every ICS – with multidisciplinary teams linked to arterial centres.
3. Introduce national waiting‑time standards – 5 days for inpatients, 2 weeks for outpatients.
4. Reform commissioning to reward outcomes – supporting prevention, faster healing and reduced amputations.
5. Accelerate proven innovation – including digital wound monitoring and cost‑effective technologies via the NHS Innovator Passport.

These reforms aim to deliver faster urgent care, improved healing rates and reduced variation in outcomes across the country.

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Why community‑based services matter

A central theme of the White Paper is the shift towards prevention‑led, community‑anchored care. Community podiatrists, nurses and primary care teams play a crucial role in early diagnosis, triage, wound assessment and escalation. Embedding dedicated Foot Protection Services in every ICS enables earlier intervention, reduces hospital admissions and helps tackle inequalities experienced by older adults, rural communities and those in deprived areas.

The report also calls for interoperable digital systems, strengthened community workforce capacity and stronger links between community and arterial centres – ensuring patients receive the right care at the right time.

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What this means for primary care

For primary care teams, the proposed changes would support:

• Faster access to urgent vascular triage and specialist input
• Standardised pathways for foot and wound assessment
• Earlier intervention for people with diabetes and vascular disease
• Clarity on referral routes for suspected Foot Attack
• Better tools for identifying risk and preventing deterioration 

A renewed focus on earlier recognition, combined with the new national awareness campaign, will be critical in preventing avoidable harm.

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