The Typical PAD Care Pathway in the NHS
Many people with peripheral artery disease first discuss their symptoms with their GP. Symptoms such as leg pain when walking, cramping in the calf, or slow-healing wounds on the foot often prompt this first evaluation.
If PAD is suspected, the GP may perform an examination and order circulation tests such as the ankle‑brachial index (ABI). This test compares blood pressure in the ankle with blood pressure in the arm to determine whether circulation to the leg is reduced.
If the test suggests PAD, the patient may be referred to a vascular service for further evaluation. Specialists may then perform additional imaging tests such as duplex ultrasound, CT angiography, or MR angiography to understand where arteries are narrowed.
Treatment often begins with lifestyle changes, medications, and structured exercise therapy. If circulation is severely reduced or symptoms remain disabling, procedures to restore blood flow may be considered.
NHS CARE PATHWAY & PATIENT RIGHTS
When Patients Are Referred to a Vascular Specialist
Patients are typically referred to a vascular specialist when circulation tests confirm PAD or when symptoms suggest severe disease.
Situations that often prompt referral include:
• significant leg pain during walking that limits daily activity
• symptoms suggesting advanced PAD
• wounds on the feet that are slow to heal
• abnormal results on circulation testing
Vascular specialists may include vascular surgeons, interventional radiologists, or interventional cardiologists who treat diseases of the arteries.
Urgent Evaluation for Foot Wounds
A wound on the foot that does not heal can be one of the most serious warning signs of advanced PAD.
When circulation is poor, the body may not be able to deliver enough oxygen and nutrients to support healing. Infection can also develop more easily when blood flow is reduced.
Patients with PAD should seek urgent medical evaluation if they develop:
• a foot ulcer that is worsening
• signs of infection such as redness or drainage
• severe pain in the foot while resting
• darkened or black tissue on the toes
Many hospitals manage these situations through multidisciplinary diabetic foot or limb‑salvage clinics, which include vascular specialists, podiatrists, diabetes specialists, and wound care teams.
NHS Waiting Time Standards
Within the NHS in England, patients generally have the right to begin consultant‑led treatment within 18 weeks of referral for non‑urgent conditions.
However, urgent conditions such as severe circulation problems or infected foot wounds are typically evaluated much more quickly because delayed treatment may increase the risk of serious complications.
If a patient feels their symptoms are worsening while waiting for evaluation, it is important to contact their GP or specialist for further advice.
Your Right to Choose a Hospital
Patients in England often have the right to choose which hospital they attend for their first outpatient appointment after being referred by a GP.
This means patients may be able to select a hospital with a vascular team that has experience treating PAD or advanced circulation problems.
GPs and referral coordinators can provide information about available options and waiting times at different hospitals.
Requesting a Second Opinion
Patients sometimes wish to seek a second opinion before undergoing a procedure or making major treatment decisions.
In many situations, a GP or specialist can help arrange a referral to another hospital or vascular specialist for additional evaluation.
Second opinions can be particularly helpful when patients want reassurance that the recommended treatment plan is appropriate for their situation.
When Patients Are Discharged Back to Their GP
After evaluation or treatment, some patients may be discharged from specialist vascular services and continue their care with their GP.
This often occurs when symptoms are stable and ongoing management focuses on lifestyle changes, medications, and cardiovascular risk reduction.
However, patients should seek re‑evaluation if symptoms worsen, walking distance decreases significantly, or new wounds develop on the feet.
The Patient Advice and Liaison Service (PALS)
The Patient Advice and Liaison Service (PALS) provides support to patients who have questions or concerns about NHS care.
PALS can help patients:
• obtain information about services
• resolve concerns about appointments or treatment
• understand how to make formal complaints if necessary
Many hospitals provide contact details for their local PALS office on their website.
Advocating for Your Own Care
Patients with PAD benefit from understanding their condition and actively participating in their care.
Keeping track of symptoms, asking questions during appointments, and seeking timely evaluation when symptoms change can help ensure that problems are addressed early.
Clear communication between patients and healthcare providers helps support better outcomes and more confident decision‑making.