Sandwell and West Birmingham (SWB) CCG has a substantial ethnic minority, a socially deprived, non-compliant population and high rates of diabetes. Traditionally, individualised diabetes management has been disjointed, with gaps and duplication in service and no seamless care between the community and hospitals. The aim was to address unmet needs and help devolve diabetes care into the community, train and give ownership to patients and carers, increasing hospital clinic capacity for more complex patients and improving overall care for every diabetes patient. SWB CCG, in collaboration with secondary care providers Sandwell and West Birmingham Hospital Trust (SWBH) and Birmingham Community Healthcare (BCHC), commissioned a community diabetes service in all 111 practices. This model was named Diabetes in Community Extension (DICE). The CCG also commissioned a Diabetes Local Improvement Scheme (LIS) in 2014-15 to complement the DICE service in primary care. The financial model was based on block contract and sessional payment. In the last three years, nearly 5,000 patients have been seen in DICE clinics, resulting in 2,500 fewer outpatient appointments. The DICE model has upskilled primary care staff, delivered effective care closer to the patient’s home, improved satisfaction and brought significant cost savings.
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