Solihull has seen an increase in people with diabetes in the last three
years of 11%, compared to the national average of 6%. In addition,
diabetes has been identified by Heart of England Foundation Trust
as an area where savings on current annual spend could be made.
Therefore the challenge has been to effect a redesign of the diabetes
pathway achieving financial efficiency while providing quality
patient care in general practice. Through collaboration between
commissioners, community services, primary and secondary care the team has developed a high
quality service which has enhanced the skills of the Primary Health Care Team and delivered
improved outcomes and satisfaction for patients but without incurring any appreciable increase in costs.
Solihull has a population of 240,000 and the incidence of diabetes is rising by approximately 3% per year. Diabetes
is currently being looked after in primary care both in dedicated GP/Practice Nurse led clinics and in a Community
Diabetes Clinic. All GP Practices are signed up to the Locally Enhanced Service although neither the provision nor
the quality of this service is audited. Solihull CCG is, like many CCGS across the country, facing increased pressure
from cuts in funding. An Effectiveness Review Group (ERG) was set up to review all commissioned services to
achieve the financial savings required to maintain statutory requirements. The ERG identified diabetes as an area
where savings could be made because of the apparent duplication of expense streams. It was also noted that there
was a wide variation in the standard of diabetes management in primary care (the percentage of patients achieving
an HbA1c less than 7.5% ranging from 52% to 72%) and that Solihull had a high rate of outpatient appointments
for diabetic medicine (ranked 196 out of 211 CCGs). A diabetes working group was therefore set up to look at review
and redesign of the whole diabetes pathway. This consisted of members from primary care, secondary care,
community care and Public Health as well as Diabetes UK and patient representation. From its inception this group
was clear in its desire not to sacrifice patient care in order to achieve savings. It would therefore have to come up
with innovative ways to design the pathway which would keep patient outcomes paramount while also being cost
effective. The collaboration which resulted has led to the development of a truly integrated diabetes pathway in
Solihull, bridging the divide between secondary and primary care and incorporating the patient perspective.
To pilot a specialist diabetes service for the population of Solihull that shifts care from hospital and community
out-patient clinics to general practice without incurring major cost. To remove the barriers between
primary and secondary care allowing collaborative working for the improvement of patient outcomes.
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