Summary
Diabetes and You (D&Y) is structured education for adults with type 2 diabetes. The free course is delivered with local GP practices and led by trained diabetes educators. The course is delivered over three, 90-minute sessions (usually one per week), covering general messaging for anyone with type 2 diabetes and helping them to better self-manage the condition. In March 2021 D&Y was piloted with three GP practices in Cornwall. The courses were delivered virtually because of the pandemic, with the aim to develop a structured education course locally that could be embedded within primary care.
Innovation
NHS Kernow’s nationally available diabetes education and self-management programme had low uptake locally, with about 17% of referred patients attending. Programme delivery was detached from practices with provision spread thinly across the county. The number of affordable educators was restricted and resources were nationally based and directed. The new programme sought to address these issues and to embed the delivery of diabetes structured education in primary care activity for practices/ PCNs. When courses are promoted/delivered by people the patient already knows and trusts (ie local practice staff), they are more likely to engage with the training. The vision is to improve the provision and uptake of D&Y so that everyone with type 2 diabetes can learn skills and gain confidence to take control of their condition, thereby reducing the likelihood of long-term complications. The pilot courses were facilitated by two educators who had delivered nationally accredited diabetes self-management programmes. The social prescribing teams at the practices were instrumental to success and encouraged participants to join the course and reminded them to attend, resulting in higher attendance figures. The initiative is an integrated collaboration with primary care and their MDTs, making D&Y a co-designed, place-based project. Rather than use a central booking system referring patients to an external provider, the courses are embedded in primary care through a partnership approach, with local courses delivered by practice staff who know their patients, the demographics, challenges and local signposting opportunities to encourage patients to attend and to make healthy living choices. Primary care can get funding to support delivery of D&Y, with access to a free educator training package delivered by the training hub, Kernow Health CIC. Around Cornwall, 39 educators from different healthcare backgrounds have been trained. A mixed skill set is valuable as educators share resources and experiences.
Equality, Diversity and Variation
D&Y has been developed alongside the education team at Kernow Health CIC, drawing on the expertise of the structured education working group and educators to ensure the information suits different learners, is easy to understand and is useful. D&Y was delivered virtually via Microsoft Teams through the pandemic and now offers in-person courses close to people’s homes. The curriculum remains consistent, but the format can be adapted to the audience. D&Y can also be booked via Healthy Cornwall, the local provider of health improvement programmes. The NHS healthy living programme offers digital, self-led learning. People with learning disabilities and autistic spectrum conditions on the team co-designed an accessible course for this patient group. Patients who are digitally excluded or lack basic digital skills are directed to the Council’s digital inclusion team and kit and connectivity can be accessed through its Device and Connectivity Lending Scheme. Live Q&A sessions and refresher courses are also planned. Offering a blended model of delivery with a menu of options supports patient choice and reduces variations in access to this support. A new, self-paced digital option for educator training is available.
Results
A total of 64.7% of newly diagnosed patients were offered D&Y in the local structured education offered alongside NHS healthy living (Jan-Dec 22). Between April 2022 and March 2023, 56 courses were delivered, 563 people booked to attend, 74% attended at least one session and 55% completed the whole course, with a 26% DNA rate. A total of 31 courses (304 booked) were delivered virtually and 25 (259 booked) in person. On the virtual course 72% attended at least one session and half completed the course, while face-to-face 75% attended at least one session and 61% completed the course. Data from a cohort of patients who attended D&Y courses (Jan-Nov 2022) showed 83% of patients decreased their Hba1c and 83% of patients lost weight/ decreased BMI. This PCN uses the Social Prescribing/Health Coaching model of support for patients with follow-ups post course and a case study being prepared to demonstrate effectiveness. D&Y is enabling more people across Cornwall to access Structured Education and reap the rewards it can bring. It is estimated that D&Y will have a cost per patient of £58.25 and should show cost savings in the long term.
User Feedback
Confidential evaluation surveys from participants post course are used to improve the offering. Those who have not attended are contacted to understand their reasons. A total of 92% of participants said they would recommend the course to family and friends and 95% reported they had improved their confidence to achieve their diabetes management goals. 100% of HCP respondents viewed structured education as an important part of the diabetes management pathway. Quarterly educator forums address issues and improve delivery. A patient workbook was developed based on their suggestion and feedback has been that patients find it extremely useful.
Dissemination and Sustainability
D&Y is a Quality Institute for Self-Management Education and Training (QISMET) approved, cross-Cornwall model delivering diabetes structured education to NICE standards. It has been developed by local clinicians and delivered at place. Its working group meets regularly and has representatives from primary care, secondary care and community services, as well as educators. Courses are delivered in collaboration with 12 of the 15 PCNs across Cornwall alongside the self-registration option and the accessible course. A new booking system will streamline administration and improve attendance. The D&Y model was presented at Southwest diabetes meetings and other areas in the region are interested in replicating it. Diabetes UK is helping to improve patient experience, peer support and engagement with hard-to-reach groups.
