The finalists for the General Practice Awards, which celebrate leading examples of innovation, hard work and leadership within primary care, were revealed at the end of August.
The awards, which will be held on 30 November at the Park Plaza Westminster Bridge hotel in London, are in their tenth year and, in the run-up to next month’s awards ceremony, Healthcare Leader is profiling the shortlisted candidates.
Judges were looking for excellence when working with patients with diabetes, or pre-diabetes. Entrants had to demonstrate how they had improved patients’ lives and the management of symptoms of diabetes through innovative, sustainable and effective methods.
Muhammed Akunjee, GP partner at West Green Surgery
In November 2017, an audit found that the National Diabetic Audit (NDA) achievement in this surgery was only 37%, and 28% of patients recorded poorly controlled hypertension. To better manage this, this London-based practice developed a new software.
Personalised text messages are sent out using the software, which educate patients on their recent results, urges medical compliance and directs patients to an appropriate clinician if necessary. This has reduced workload for practice staff, who used to either phone or send letters to patients.
After six months, results showed an average reduction in HbA1c by 5.85. NDA achievement also increased to 45% the first three months of using the system.
Mani Dhesi, transformation director at SDS MyHealthcare, West Health Medical Centre
GP Federation, SDS MyHealthcare, recognised the need to give patients with diabetes the best care they could. In order to do this, the services were redesigned to increase their reach, yet be more efficient.
The redesign involved piloting a diabetes community clinic, which proved successful as there was a reduction in the number of patients requiring outpatient appointments, and in 78% of cases, there was improvement in HbA1c results after action plans were recommended by GPs.
However, after piloting the face to face clinic, it was found that a large number of patients did not require face to face appointments.
Therefore, patients with diabetes who are suitable for virtual appointments are now given them – which is around 70-80%. This has increased efficiency alongside improving patients’ ability to manage their diabetes.
Chorley Central Collaborative Group Diabetes Team
After diabetes was identified as a significant problem for the Chorley, South Ribble and Greater Preston CCGs, a Diabetes Hub was launched to try and reduce this and manage the condition among patients.
Covering six surgeries and just over 55,000 patients, the hub has provided training to staff so that services that would traditionally have been given at an acute level can be given by the primary care team.
Group sessions are also used for patients, to chat through injectable therapies, review progress and to share experiences of diabetes with other patients.
The pilot hub proved a success, and is set to start a three year rolling contract in March 2019. The CCG has also rolled out three other hub sites.
Sheffield CCG Primary Care Development Nurses – CVD Team
Over 30,000 people in Sheffield have diabetes, yet 13,000 do not have their blood pressure controlled to NICE targets, and over 20,000 do not have HbA1c controlled to NICE targets, according to the lead primary care development nurse in Sheffield CCG, Tracey Turton.
To make a difference, a primary care development nurse team was put together to create a diabetes treatment targets project.
All 82 general practices were engaged across the city, and given resources and basic training, alongside the establishment of an MDT steering group.
In the first year of the project, 835 more patients achieved blood pressure controlled to NICE targets, and an additional 173 patients have been put on lipid lowering therapy.
Dr Kunal Chawathey, Sister Anita Green, Ms Sue Siddorn – Goodrest Croft Surgery
An initiative was launched in 2015 by this Birmingham practice to improve in-house diabetes care, in order to reduce the likelihood of patients developing long term conditions in their care.
This scheme was called the Three Ds initiative, and saw the appointment of a clinical lead GP for diabetes, Dr Kunal Chawathey, and a diabetes nurse, Sister Anita Green.
The approached focused on three ds. Firstly, diagnosis, where patients were classified into four target groups based on their HbA1c results. Secondly, discussions, where both leads for diabetes discussed the management of patients and made recommendations for treatment. Thirdly, delivery and regular follow ups.
Within two years, 85.5% of patients had an HbA1c below 59, up from 62.7% in 2015. The practice is now within the top 4% of practices in regards to HbA1c control.