This category was open to any primary care and/or community initiative which has improved access and delivered positive outcomes and change for people with diabetes.
First Diabetes – a new clinical integrated diabetes service for patients in Derby
Derby Hospitals NHS Foundation Trust
First Diabetes is a not-for-profit organisation designed as a unique partnership between primary and secondary care for the delivery of comprehensive, integrated, patient centred care for 2,500 patients with diabetes in Derby. By bringing diabetes care services under a single budget and single clinical governance structure, it has managed to provide care closer to home in a coordinated and safe manner, resulting in improved quality of care and improved patient experience. Resources used are within the budget that was spent on diabetes care in the previous years, while outcomes have been significantly better. In addition, it has strengthened relationships across traditional NHS boundaries and influenced collaborative working for all long-term conditions. Patients were represented from the beginning and continue to be members of the clinical board which meets monthly.
Validation of a new strategy for improving glycaemic control across a PCT
Glycaemic control was identified as an area of poor performance amongst the population with diabetes in the City and Hackney PCT area. A four-component innovation was devised which took a multi-factorial approach to improving glycaemic control at a whole population level. This included structured patient education; consultant-led targeted medical education; interventions in poorly performing practices through a peer review intervention team; and increased numbers of diabetes specialist nurses and dietitians performing in a co-ordinated way in community settings. As a result of this innovative approach, the performance of the PCT in the three QOF indicators of overall diabetes control (HbA1c) have been lifted by a quintile (from a starting point of amongst the bottom 5 per cent nationally). Benchmarking against local PCTs helped prove that this was a specific rather than a general local effect.
The Super Six model: integrating acute and community diabetes care across South East Hampshire
Starting in November 2011, the existing community diabetes team was joined by the local hospital diabetes specialist consultant team to provide regular in depth educational support to GP practices and locality nursing teams as well as providing day-to-day advice via email and telephone. This was influenced by the need to tackle three key issues: pathway inefficiencies involving secondary care follow-up; unacceptable variations in quality of care and knowledge of diabetes and management; and the disconnect between care services resulting in fragmentation and duplication. Specific objectives included MERIT training for 50 clinicians per year; DESMOND training for 520 patients per year; and bespoke training to meet identified local need. Since the initial service began it has delivered MERIT training for 227 clinicians; DESMOND training for 2263 people with diabetes and 35 of 53 GP practices have had education visits. Feedback is overwhelmingly positive from clinicians, people with diabetes and their carers and training courses are consistently over-subscribed.
Putting your best foot forward – Diagnosis and Treatment Tool for Diabetes Painful Neuropathy
South Tees Hospitals NHS Foundation Trust
In the absence of a diabetic peripheral neuropathy (DPN) screening tool anywhere in the UK, one was developed by a group of healthcare professionals following NICE guidance and including a validated screening tool from Leeds Assessment of Neuropathic Signs and Symptoms (LANSS) to support effective diagnosis and treatment. Pilots were carried out in three practices across South Tees, and engagement was sought from podiatrists. Templates are now on SystmOne, a centralised clinical system that provides healthcare professionals, with read codes to enable audit. The tool has been used to screen 94 per cent of patients with diabetes within the South Tees region, while 23 per cent of patients have responded ‘yes’ to one of the trigger questions.
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