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Untangling Notts

Untangling Notts

Insight: diabetes
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Dr Rahul Mohan
East Leake Medical Group

Task and finish group for the diabetes project

 

Principia is one of five clinical commissioning groups in the Nottinghamshire area covering Rushcliffe with a patient population of 121,361 and one of the lowest deprivation scores in England.

Dr Rahul Mohan
East Leake Medical Group

Task and finish group for the diabetes project

 

Principia is one of five clinical commissioning groups in the Nottinghamshire area covering Rushcliffe with a patient population of 121,361 and one of the lowest deprivation scores in England.

In February 2010, Principia launched a diabetes service within general practice for patients, offering sub-optimal control of type 2 diabetes. The service targets patients requiring insulin initiation, and also repatriates patients into primary care who are routinely managed in secondary care. The service is subject to 'patient choice' and patients can elect to remain in secondary care for their treatment.

The number of people with diabetes is rising every year. Around 3,474 (Quality and Outcomes Framework 2005/06) are on a practice diabetes register. This is around 3% of the local population and just below the national average. As the proportion of older people in the population continues to grow and obesity trends rise, this figure will rise and so will the demand on diabetes services.

To date, 15 out of 16 GP practices have signed up to deliver one of the three service levels (see Figure 1). The task and finish group, which led the programme, visited all 16 practices to tell them about the service, which was launched at a protected learning education event for Principia clinicians.

The practices are supported by a community diabetic specialist nurse (DSN), provided by secondary care from Nottingham University Hospitals (NUH). For patients, this means that there is regular DSN support in practices and they are accessing care closer to home.

For health professionals there is an opportunity to hold dual clinics with the DSN and the ability to access a DSN-led telephone and email advice line. In addition, DSN-led education sessions for staff are available to help develop the skills of practice doctors and nurses.

The DSN also has a role in delivering patient education and will be involved in future reviews of the dietetic, podiatric and retinopathy services. They also support data capture for audit purposes and contract management and receive weekly mentorship from a consultant at NUH.

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To date, 102 patients have been discharged from secondary care to primary care and 124 referrals have been avoided (these include the insulin/GLP1 starts).

The proposal for a DSN supported service in general practice for diabetics takes forward the standards set by the Diabetes National Service Framework (NSF) 2002/03, by: providing a service in a community setting; greater convenience by offering a service often closer to patients' homes; speed of access; and fair and equal access to patients delivering safe and effective care. This approach is supported by the Nation Diabetes Workforce Strategy (September 2007).

The service is forecast to operate at more that a 20% cost-saving on the current provision, which is around £21,000.
Principia established the task and finish working group to make this project happen. It was made up of GPs, nurses, public health specialists, medicine management specialists, PBC managers, clinical governance experts and patients. The group looked for other examples of innovation and found a similar project in another area of Nottingham. Principia were able to build on the foundations to create a bespoke service for its population.

Principia also took the innovative approach of working in partnership with pharmaceutical company Takeda, who offered project management support that really drove the project to an early implementation date. Takeda continue to come to the biannual reviews of the service. Principia also work in partnership with them to share the learning from 
the project.

The benefits of the service are:

  • More choice for patients.
  • Care closer to home.
  • Cost-effective care allowing savings to be reinvested for the benefit of the local population.
  • Secure future capacity to meet anticipated demand.
  • Professional development of clinicians.
  • Promotion of a more holistic approach to the care of diabetic patients.
  • Continuity of care for patients in their own practice.
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