Best innovation in integrated commissioning, or integrated care, model
Genetic diabetes nurse initiative: translating genetic knowledge into clinical care
by Royal Devon and Exeter NHS Foundation Trust/ University of Exeter Medical School
Monogenic diabetes accounts for around 2% of diabetes (an estimated 40,000 NHS patients), but 80% of cases are misdiagnosed as having Type 1 or Type 2 diabetes. This means they receive the wrong treatment. The team developed the national Genetic Diabetes Nurse (GDN) educational initiative to train healthcare professionals to recognise monogenic diabetes and to support them in managing patients with a confirmed molecular genetic diagnosis. This initiative trains Diabetes Specialist Nurses across the UK to disseminate new genetics knowledge and improve diabetes care within their region, using a model of ‘training the trainers’. Running since 2002, the model was recognised as an exemplar in the DH White Paper ‘Our inheritance, our future’ for building genetics into mainstream services.
"Judges’ commented that this is a rare form of diabetes, which is often misdiagnosed and a difficult topic to teach. This initiative was beautifully presented and there were some great comments from the patients themselves."
North East Essex integrated pathway hub
by Suffolk GP Federation
The North East Essex Diabetes Service commenced in April 2014 and brings together community diabetes, podiatry, outpatients and education, under a single lead contractor – the Suffolk GP Federation. The five-year contract, worth £2.5m, involves no additional investment and 25% is contingent on delivering Key Performance Indicators (KPIs). During its first year the service has implemented transformational change at scale across a population of 18,400 patients with diabetes. This includes creating a Diabetes Services Board which brings together patients, clinicians and managers in a forum which manages the service, and forming a single Diabetes Specialist Team consisting of consultants, specialist nurses, a GP, specialist midwife, dietician and podiatrists. The role of the team, particularly consultants, has changed from seeing patients to governance and supporting primary care.
"This is a very innovative approach and a good piece of work. This initiative is financially neutral which is an achievement."