Best primary and/or community initiative


Smethwick Community Pathfinder Diabetes Project: Right care, Right here initiative

by Sandwell & West Birmingham NHS Trust

The Pathfinder Diabetes Project launched 15 years ago to address some of the unmet needs of people with diabetes. In this model, GP practices identify cohorts of difficult diabetes patients with poor HbA1c control for a one-off advice and management plan by the consultant/diabetes specialist nurse every two to three months. This model fits with the Right care, Right here model of care advocated by the SWBH Trust in devolving care into the community, giving ownership to patients and carers. Recent audits show a 50% to 62% reduction in HbA1c levels and the model is now being rolled out to 80 practices. 

Judges comment:

"The Smethwick Pathfinder project is doing a great job of upskilling GPs and practice nurses in a very deprived area to provide first class care to every diabetes patient. The education they provide has resulted in fewer new hospital referrals and an increase in patient satisfaction and quality of life. This is a model of care that has a lot of traction and is clearly adaptable as the initiative is now being rolled out to 80 practices within the CCG." 


Highly commended

PITstop: a training solution for practices providing enhanced diabetes services

by DIME Square Ltd

PITstop (Programme for Injectable Therapy) is an accredited diabetes course for primary healthcare professionals (HCPs). It is part of a training solution enabling practice teams to support people with type 2 diabetes on more complex medication regimens, including initiation, titration and adjustment of injectable therapies. A survey indicated that a minimum of nine-months after completing PITstop, 22 out of 23 students felt more confident in supporting people with type 2 diabetes in six categories, including inititating GLP-1 and basal insulin therapy.

Judges comment:

"PITstop is providing a much needed education programme to healthcare professionals to enable them to support patients with Type 2 diabetes within primary care."


Highly commended

EDEN – Promoting Primary Care in Diabetes Education in Leicester

by Leicester Diabetes Centre, Leicester General Hospital

The Leicester EDEN Project – ’Effective Diabetes Education Now’ – is a three-year project which aims to upskill healthcare professionals in the field of diabetes education. A variety of initiatives have been put in place including training sessions, mentorship and advice. The project is unique as it is individually tailored to suit the needs of each of the 63 practices in the Leicester City CCG. It enables the most relevant education to be targeted in the most prevalent areas in the city. A relationship between education and practices has been developed, so that practices are no longer isolated in their provision of care for diabetes.

Judges comment:

"The EDEN project has made a huge impact by upskilling healthcare professionals in the field of diabetes education in the Leicester City health area."



Screening for hearing difficulties in patients with diabetes

by Pendyffryn Medical Group

Studies have shown that diabetes affects hearing function and the incidence of hearing loss can range between 44% and 69.7%. Hearing problems as a co-morbidity with diabetes creates compounding psychological and social difficulties for the individual. To overcome this issue screening for hearing loss and referral for audiological assessment to monitor auditory function have been introduced into the diabetes annual review of this primary care service. This project has identified a substantial incidence of hearing loss in patients with diabetes.

Judges comment:

"It's commendable that a GP has taken the initiative and introduced this vital service, introducing hearing loss assessments to diabetic patients' annual reviews, as so much care is lost if patient's lines of communication fail."

Quality In Care Diabetes

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  • 2023 KEY DATES
  • Open for Entry:
    Thursday 27 April 2023
  • Entry Deadline:
    Friday 7 July 2023
  • Judging Day:
    Tuesday 8 September 2023
  • Awards Ceremony:
    Thursday 12 October 2023