Dr Partha Kar, NHS England’s associate national clinical director for diabetes, explains how NHS RightCare can deliver the best care to patients
NHS RightCare is a programme committed to reducing unwarranted variation to improve population health. The programme is about delivering the best care to patients and improving patient outcomes.
A team of different partners works together to implement the programme at both a national and local level. Here’s how the approach works in practice when it comes to diabetes.
The NHS RightCare pathway: diabetes
The pathway looks at specific areas of intervention where the return-on-investment is likely to have the biggest benefit. It also looks at clinical areas that need to be tackled to benefit the population living with or at risk of developing diabetes.
There are seven key areas of focus. These align with the Five-Year Forward View and the cardiovascular prevention optimal value pathway. Identification of those at high risk of developing Type 2 diabetes and increasing attendance in the Healthier You: the National Diabetes Prevention programme (NDPP) are both priorities.
Identifying people with Type 2 diabetes earlier is understandably a key focus with emphasis on the correct diagnosis and prioritisation at an earlier stage to help prevent future complications. This also touches upon the importance of correctly diagnosing Type 1 diabetes, to prevent diagnosis at admission, as well as genetic sub-types, all of which have significantly different treatment paradigms compared with Type 2 diabetes.
Safety within hospitals continues to be an issue as per the National Diabetes Inpatient Audit. With about 4% of Type 1 diabetes patients going into diabetic ketoacidosis (DKA), or 25% of drug charts having errors related to diabetes, the focus is on safety. The NHS RightCare pathway: diabetes has made this a priority for acute trusts. Inpatient diabetes care is now an issue that all trusts must tackle, especially in light of the fact that 17-20% of inpatients at any given time have diabetes as a co-morbidity.
The majority of diabetes foot amputations are preventable, yet the NHS continues to experience issues in this area. There is a real drive in the sector to reduce this across the country. We’re starting that by raising awareness among patients and professionals, encouraging self-management of the condition and access-to-multi-disciplinary clinics.
According to the National Diabetes Audit, attendance at structured diabetes education programmes continues to be poor. This has to change and we have to understand and overcome the barriers that contribute to poor and low attendance.
A significant number of patients still report not being offered or provided diabetes care education. We need to understand whether it is timing or the modes of delivery that are preventing education. There should also be focus areas for improvement, along with increasing awareness among professionals about the benefits education can bring in a long-term condition.
In line with the Five-Year Forward View, another major focus is on variation of care. The National Diabetes Audits show a huge degree of variation in markers and the onus is on all policymakers and professionals to help reduce this level of variation. The CCG Improvement and Assessment Framework (IAF) shows starkly the variation in care across the country. The hope is that with support from NHS RightCare this will improve over time.
Priority of care
Finally, NHS RightCare pathway: diabetes also brings to the fore the importance of highlighting Type 1 diabetes care as a priority area. The needs, training and fundamentals of Type 1 diabetes care do differ from the care for Type 2 diabetes patients. It’s important to focus on this area, especially when looking at the data from the National Diabetes Audits.
The publication of the audits highlight what’s required for Type 1 diabetes care, the need for commissioners and sustainability and transformation partnerships (STPs) to recognise this condition as a part yet a distinct entity from Type 2 diabetes care and the access to technology in Type 1 diabetes as per NICE guidelines.
A smooth handover from paediatric departments is also an area of huge variation in the country. So transitional services should be embedded. The theme that runs throughout is the need to reduce variation, base interventions on evidence and gain the maximum benefit, clinically as well as financially.
These are exciting times for diabetes care with availability of the transformation funds and digital interventions from NHS England also focusing on these areas. NHS Improvement is also looking at reducing variation as part of their Getting It Right First Time (GIRFT) programme work.
Only time will tell how successful these priorities are but it certainly helps set the tone for areas to focus on. The challenge now is for all systems to dovetail into delivering these seven priorities with support from all stakeholders, including clinical networks, the NHS RightCare team and, of course, the NHS England diabetes team.
Dr Partha Kar is national clinical director for diabetes at NHS England