Summary
Discover Momenta has worked for 20 years to develop, evaluate and disseminate behavioural healthy lifestyle programmes for delivery by trained non-specialists. The aim was a scalable and replicable, evidence-based type 2 diabetes (T2D) prevention programme (DPP) to achieve world-class health outcomes cost-effectively across multiple commissioning/delivery contexts. Momenta’s DPP has been independently evaluated as achieving the best health outcomes (weight-loss and HbA1c reduction) of all NHS DPP (NDPP) providers (Valabhji et al, 2019). It is demonstrably the most cost-effective. Furthermore, it has led to further programmes in T2D remission and cardiovascular disease prevention, launching in September 2020.
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Method
The NDPP framework tender for a new national service clarified the need and catalysed this DPP development. The tender required full delivery so Reed Momenta (RM), a joint venture with Reed in Partnership, submitted the bid. Momenta’s role was to develop the DPP at its own cost/risk and to license delivery to RM by go-live. Timeframes were tight, with service commencement within six months of Framework and three months of the local delivery contract award. A day-by-day timeline was developed, with individual responsibilities to track progress/dependencies across all elements of a licensed, 18-session, in-person programme for participants, coaches and licensee. Weight management programme participant feedback was incorporated, and later improvements/adaptations included extensive DPP participant feedback. The programme development approach is to optimise the ‘Bermuda Triangle’ of clinical effectiveness, operational replicability, financial viability and cultural competency to maximise impact at scale, all underpinned by a collaborative partnership ethos and transparency. An experienced programme development director (PDD) managed the multi-disciplinary team, taking the programme and training from NHSE/PHE/DUK specification to a scalable, replicable and cost-effective service. This complex behavioural intervention incorporates relevant NICE guidance and international evidence across the following essential ‘programme elements’: a structured curriculum, promoting active group participation and peer engagement/support, underpinned by clear learning outcomes, timetabled session plans and personalised participant journeys (18 sessions); high quality, Accessible Information Standard-compliant, interactive participant resources; comprehensive coaches’ manuals and kitbags, plus in-person training, underpinned by distance learning and online assessment. The PDD assessed progress against the daily plan/milestones in weekly calls. A twophase approach was adopted, whereby the first 12 sessions (18 weeks) were developed, followed by the final six sessions. This enabled the programme to go live on time without compromising quality. In parallel, RM received tender support, a clear licence agreement, an interim Clinical Director, a Quality Assurance Framework and technical support. Weekly contacts advised on mobilisation and agreed a Minimum Data Set (MDS) for performance analysis. The initial goal was met, which was to launch five contracts (South London to Herefordshire) on schedule. Over the subsequent four years the same approach was used to make adaptations for Northern Ireland and NDPP Framework 2, as well as for development of T2D remission and CVD prevention programmes. Furthermore, reactive interim management support was provided when RM encountered unanticipated staffing challenges, and training/digital resources supplied to ensure COVIDsecure virtual delivery. Learnings are shared across licensees in England and Northern Ireland to improve performance.
Results
Superior outcomes and effectiveness derive from Discover Momenta’s understanding of behaviour change, extensive experience, provision of complete solutions, with extensive supporting resources for coaches and participants, highly regarded training, and a foundation in partnership. This solution-focused approach, centred around optimising participant experiences and outcomes, enabled rapid delivery of the DPP and coach training. Momenta has trained over 200 DPP coaches and provided supplementary ‘virtual-delivery’ training. The independent paper by Valabhji et al (2019) stated that the NDPP is effective and compares favourably internationally. It added that, within the NDPP, the DPP provided by RM delivered the best health outcomes across all providers. Chadwick et al (2020) and subsequent unpublished analysis of 10,109 completers (to December 2019) confirmed similar outcomes across larger numbers as participants continue to be referred to, enrolled on, and complete the DPP. DPP NI outcomes analysis was delayed by COVID-19 but anecdotal indications are positive. T2D Remission and CPP results will follow later, as mobilisation restarted in September 2020.
Sustainability and Spread
In England RM is licensed as a provider on both NHSE/PHE/ DUK NDPP Framework 1 (2016-20) and Framework 2 (2019-24). Discover Momenta supported RM’s delivery at nine Framework 1 contracts (South London to Cumbria), covering 50 CCGs with >1,500 GP practices generating >75,000 referrals. RM secured seven larger Framework 2 contracts (four mobilising late-2020), which receive referrals into 2023 (contract extension possible). In November 2018 Momenta won a three-year DPP contract in Northern Ireland (2-year extension possible). Lessons and good practice are shared with English and Northern Irish licensees to support improved outcomes and cost-effectiveness. The continuous improvement process is now on DPPv3.0 and more than 200 coaches have been trained. Many use their transferable skills and understanding of behaviour change in other healthcare areas, representing an innovation multiplier. There has also been participation in multiple conferences and contributions to NHSE provider days. Furthermore, academic research is supported, including the University of Manchester national study, local contractspecific research and PhD dissertations e.g. BAME community perception. Momenta’s poster was accepted for Diabetes UK’s 2020 professional conference and a sophisticated statistical analysis by University of Oxford and UCL researchers will be submitted for publication. The most compelling evidence for sustainability is shown by the collaborative development of two T2D remission and CVD Prevention programmes, based on the DPP. The T2D remission NHSE pilot contract runs from 2020-23. The South Eastern HSC Trust will deliver the CPP indefinitely from September 2020.
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