Almost 30,000 people are known to have diabetes in Bedfordshire, and the figure is set to rise as cases are on the increase, according to NHS Bedfordshire Clinical Commissioning Group (BCCG).
NHS BCCG first applied for funding to look after patients with diabetes in 2017, when it was granted the finances needed to develop its first year of the programme.
Building on from last year’s positive results, which include an 11% fall in foot amputations and fewer hospital admissions caused by diabetic foot disease, the CCG finally received confirmation in April that it will receive £500,000 to fully develop its programme.
NHS BCCG’s clinical programme lead, Dr Sanhita Chakrabarti, told Healthcare Leader’s reporter Valeria Fiore how they have done it.
Q: How did you apply for the funding?
A: Applications were submitted to NHS England through a formal bidding process. CCGs were notified by NHS England of investment decisions in April 2017.
The bid to NHS England was for funding for the first two years of a five-year diabetes care and treatment programme. Initially, funding was approved for Year One (2017/18) and we have recently received confirmation of funding for Year Two (2018/19).
Year One was a period of detailed planning, implementation and commencement of the programmes. Funding is essential in Year Two to build on and fully implement what was started in 2017.
Bedfordshire CCG was successful in receiving funding for all three programme areas we bid for, namely: improving treatment targets in primary care for blood sugar, blood pressure and cholesterol in patients with diabetes; improving capacity and increasing uptake of structured education and setting up a multi-disciplinary foot care team to improve the health of people with diabetes and foot disease.
Q: What prerequisites did you have to meet before you could be awarded the funding?
A: There was a requirement for bids to be developed in partnership with clinical leads in provider services and with other stakeholders.
A key principle for funding was that it should be expected to generate savings through reduction of complications and deterioration in people with diabetes and that such savings should be reinvested in the services in order to help make them self-sustaining. Joint agreement between commissioners and providers to commit to such reinvestment was one a key factor in approval for funding. Bedfordshire CCG’s bids in all three areas were developed in a constructive partnership including good communication with acute, community and primary care services along with other stakeholders such as Diabetes UK.
The starting point for each bid was a review of data, including NHS RightCare and the National Diabetes Audit (for which Bedfordshire CCG has robust data as a result of 100% practice participation). Data analysis demonstrated that there had been little improvement in performance and outcomes in the three year period 2014-2016. We also ensured that the bids were aligned with national strategies and the CCG’s operational plan for long term conditions including diabetes. Bedfordshire CCG demonstrated its firm commitment to delivery of each programme area by making a financial contribution to support each bid. All bids set out key objectives and target outcomes to improve health and wellbeing and to deliver a level of savings that increased over the five year period of the programme including, for example, savings through a reduction in non-elective admissions, a reduction in length of stay and a reduction in the number of amputations.
Q: What challenges did you face while applying for the funding?
A: The most significant challenge was to ensure effective liaison with our provider partners and other stakeholders and to develop innovative, high quality, accurately costed proposals that were supported by all stakeholders within the tight timescale from 12 December 2016 to 18 January 2017. At the same time, proposals were approved internally by Bedfordshire CCG to ensure there was a firm financial commitment by the CCG to demonstrate support for each of the bids.
We also used available channels of communication to ensure that our general practices were aware of and supported these proposals. This was achieved through meetings with the CCG-wide primary care liaison group and the five locality boards.
Q: How did the funding received in Year One help you look after people with diabetes?
A: Additional funding from Year One has helped Bedfordshire CCG and its providers to deliver service improvements in three programme areas:
- To improve control of blood sugar, blood pressure and cholesterol in patients with diabetes – in line with the three NICE recommended ‘treatment targets’. In support of this, we developed personalised care planning for patients as part of their diabetes annual review. All three target areas are monitored as part of the annual review. The results are sent to the patient who is invited to attend an annual review meeting at which these results are discussed and a care plan is agreed between the patient and the primary health care professional (GP or practice nurse);
- To improve capacity and uptake of structured education for people with diabetes to help patients to manage their condition and to improve their overall health outcomes;
- To improve the care of patients with diabetes who have additional complications with foot disease. The main objective is to improve health outcomes and to reduce amputations and non-elective admissions to hospital.
We have already seen improvements in patient care, for example:
- A reduction in the number of non-elective admissions of people with foot disease of around six admissions per month since October 2017;
- A 50% increase in attendance at structured education for people with newly diagnosed diabetes from January – March 2018.
- By March 2018, 46 of our 50 practices had signed up to improve patient care through the delivery of an incentive scheme to implement care planning as part of diabetes annual review.
Q: How will you use the funding received in Year Two?
A: The funding received in Year Two (2018/19) will be used to sustain the three programme areas, gaining the benefit of the full year effect of service delivery.
We also aim to develop innovative solutions, such as tailored structured education sessions for BME groups and people with mental health or learning disabilities and new webinar-based training for primary health care professionals in a range of topics for diabetes.
Q: Would you encourage a fellow clinical lead from another CCG to apply for the funding?
A: Yes, if there is a further opportunity to apply for funding we would certainly encourage clinical leads from other CCGs to apply. We were delighted to have received funding from NHS England to improve services for diabetes and we already have some good local evidence that this is making a significant difference to patients in improving their health and wellbeing of patients and reducing the need for unplanned hospital admissions.
Dr Sanhita Chakrabarti is clinical programme lead at NHS Bedfordshire Clinical Commissioning Group (BCCG).