PROGRESS ON COMMISSIONING A DIABETES SERVICE

1
PROGRESS ON COMMISSIONING A DIABETES SERVICE

• Developing a Model of Care for Adult Patients
  with Diabetes
• January 2009

2
What do we know about current and future service
demands?

• Growth in obesity to continue
• Growth in new diabetics to continue
• Somerset 19,200 in 2007 to 28,000 by 2017
• Sizeable number of undiagnosed diabetics
• Need to invest in services to meet demand
• Need to increase emphasis on prevention
• Need to ensure optimal use is made of specialist
  services

3
What do patients want?

• Better information at diagnosis
• Improved access to information
• More control over their condition
• Better integration of care
• More services closer to home
• Better access to related services (dietetics,
  podiatry)
• More focus on prevention

4
What do GPs want?

• To continue to provide best possible services
  from in-house skills
• More training for members of primary healthcare
  team
• Better access to Dietitians and Podiatrists
• Better access to Diabetic Nurse Specialists
• Access to timely advice
• Optimise diabetes QOF scores
• To have the option of providing services over and
  above core diabetic care (e.g. insulin
  initiation)

5
What does Somerset PCT want?

• Ensure new service has the capacity to meet
  expected demand
• Improved services for diabetics
• Equitable access to services
• Uptake from hard to reach groups
• Measure improvements in meaningful terms
  (outcomes based specification)
• Implement health care record (eventually
  electronic)
• Affordable service

6
What are the key elements of the new service?

• Increased availability of structured education
  (Desmond/Dafne courses)
• Expansion in capacity of Diabetic Specialist
  Nurses, Dieticians, Podiatrists
• DSN run countywide community clinics
• Clinics to co-locate Dietitians, Podiatrists
  (Psychologists) according to need

7
What are the key elements of the new service?
(Continued)

• DSN service to focus on
• glycaemic control insulin initiations
• complex patients pre-pregnancy advice
• 8-8 advice line
• DSN service to deliver training to primary care
  teams
• DSN service to be monitored through specialist
  supervision
• Specialist care to focus on patients with complex
  care needs

8
Proposed Model of Care

• The proposed delivery model is based on levels of
  care
• Level 1 providing core basic care
• Level 2 an intermediate level of care
• Level 3 specialist level of care
• It is proposed to deliver all of Level 1 and
  Level 2 and as much of Level 3 as possible in the
  community as close to the patients home or work
  as possible.
• Level 1 care will normally be delivered at GP
  practices but with input from pharmacists, local
  councils, voluntary groups particularly in
  relation to opportunistic screening.

9
Proposed Model of Care (Continued)

• GP practices may also opt to provide some of
  intermediate care.
• A new community based service will be introduced,
  managed by multidisciplinary teams. This will
  deliver specified intermediate services and
  related Level 3 services, as well as training and
  ongoing support for practices.
• Hospital care will be focused on the most complex
  cases with an enhanced level of care for patients
  admitted with but not because of diabetes.
• A key theme running through all levels of care
  will be supporting patients to self manage
  through structured education programmes and
  agreement of care management plans.

10
Next Steps

• January 2009
• Clinicians finalise Care Pathways
• Patient involvement 21 January
• Information Packs available
• Feb 2009
• PEC approval of final specification
• Year of Care Project continues
• April 2009
• Commission Service details of provision still
  to be confirmed.

11
Diabetes UK information packs

• 2000 packs have been purchased from Diabetes UK
  for issuing to patients when the diagnosis of
  Type 2 Diabetes has been confirmed in order to
  provide them with consistent, quality assured
  information about their condition.

12
Year of Care Project

• Creating integrated care planner
• Delivering self-care training
• Results sharing documentation
• Identifying clinical champions
• Further details from MaggieAyre_at_somerset.nhs.uk

13
Yeovil area only

• Current Community Service
• GP referrals directly to
• Su Down
• Diabetes Nurse Consultant
• su.down_at_somerset.nhs.uk
• Tel [phone]
• Clinics held in Crewkerne, Wincanton and Yeovil.