Health Area
South Staffordshire Primary Care Trust
Background
The service was redesigned due to the changing face of healthcare, increasing workload, people’s expectation and experiences and also to meet the National and local agendas.
It was found that there were problems with the traditional model of diabetes service delivery. People with diabetes attend either general practice where there may be inadequate knowledge and skills to manage diabetes, or the acute setting where there may be difficulties in following up, especially the case when appointments slots are filled with uncomplicated diabetes.
In order to ensure high quality care to people with diabetes, increased specialist input are facilitated into community settings: Diabetes Specialist Nurses offer care for people with diabetes at a location best suited to the individual’s need.
Why this service is a good example of shared practice
Redesign has improved quality of diabetes care being delivered and benefits people with diabetes, for example, HbA1c improved in 89% of people referred. Healthcare professionals in general practice are increasing knowledge and skills and are more able to support self management for people with diabetes; evidence also shows that the service is cost saving and is comply with the national and local agendas.
Service Provided
By providing more diabetes clinics nearer to people’s homes with the diabetes specialist nurses input, the service aims to bring care closer to people’s homes and offer more personalised one to one advice on understanding and managing diabetes.
Under the following conditions, people with diabetes are referred to the nurse led community specialist clinics:
Intermediary:
• Poor glycaemic control on orals
• Poor control on insulin
• Insulin initiation
• Preconceptual care
• New Type 1s
• Type 1s with poor control
• Hypo unawareness
• Stuck in secondary care with poor control
People with the following condition are referred to the Diabetes Centre:
Diabetes Centre:
• New Type 1s
• Children and Adolescents
• Pregnancy
• Renal
• Active foot problems
• Diabetes on the ward
The team deliver nurse led specialist service and have employed 2 full time diabetes specialist nurses. In order to better meet the needs of people with diabetes and to receive 80% previous years referrals from the diabetes out-patients clinics, the team have identified clinic venues within the locality at people’s convenience. This in turn benefits people with diabetes: e.g. no parking fees, ease of access, pharmacies close to clinics, no waiting time, out of hours service, guaranteed appointment time and better sign-posting within services. Services are also delivered to people with diabetes in a variety of locations near to where they live, such as clinics, local pharmacies, supermarkets and health environments.
Also, by providing a written report and management plan on discharge for people with diabetes and referrer, the team is now more able to return people with diabetes back to practice with continued healthcare professional support.
Benefits for General Practitioner:
• No waiting time
• No duplication of care
• Tailored diabetes specialist nurse support in practice
• Improved communication
• Structured feedback
The service delivery based on education, behaviour change and self management for people with diabetes, the team also support education of health care professionals in general practice.
Education provides for the professionals and people with diabetes are as follow.
For professionals, the following are offered to help extending knowledge even further:
• Structured accredited education course
• Insulin management course
• Diabetes in a bite
• Nurse Forums
• Education evenings
For people with diabetes, they can be referred to training courses to enable them understand diabetes better and learn how they can help take care of themselves, make decisions and change their current habits and behaviours. The following are offered by the Diabetes Special Nurse:
• Desmond
• Dafne
• Munch (Making Useful Nutritional Choices for Health)
Munch was set up to share food information with people with diabetes and their cares including friends and family. Munch consists of a tour around the supermarket where nurses select products and discuss the implications for people with diabetes. This includes information about oils, fat types, sugars and carbohydrates. Participants are able to ask questions about products throughout.
Accountability
This project is accountable both financially through significant cost savings but also clinically through achievement of clinical outcomes demonstrating improvement in diabetes measures. Both of these have been shown through audit. A satisfaction questionnaire for people with diabetes to fill in has yet to be evaluated.
Evaluation
Data has shown that in the first year, there were approximately 3000 people with diabetes have been seen in the community by the diabetes specialist nurses in different settings and activities, e.g. in practice, practice support sessions, education sessions and following up. HbA1c improved in 89% of people referred.
In addition, approximately about 200 healthcare professionals have attended the education sessions.
Project Aims
• Redirect 80% of uncomplicated diabetes to intermediary service
• To increase ability in general practice to manage uncomplicated Diabetes
• Provide a locality based diabetes service
• Remain cost neutral
Resources
Resources needed included the employment of 2 fulltime diabetes specialist nurses and one full time admin person. In some areas resource reallocation may be valuable. Immeasurable resources such as a positive attitude and enthusiasm are essential for such a role.
Learning
The re-design of the Diabetes service now means that the PCT can better meet the needs of people with diabetes by delivering services to them in a variety of locations near to where they live, such as clinics, local pharmacies, supermarkets and health environments.
An initiative such as Munch help promoting lifestyle changes to people with diabetes through an informal way of communication and is very well received.
Work could be further developed in the following areas in the future: Podiatry, Glucose tolerance testing, education for people to prevent diabetes