Heatlhcare professionals working with people with Type 2 diabetes who require insulin treatment.
The service is provided for the population of people with Type 2 diabetes in Newcastle within the North of Tyne Primary Care Trust
In 2005 a diabetes service delivery plan was implemented in Newcastle, to deliver the majority of diabetes care, for people with Type 2 diabetes in primary care. Patients would receive care locally according to individual needs, provided by appropriately trained and skilled healthcare professionals (DOH/DUK 2006).
An integrated pathway of care was initiated for people with Type 2 diabetes which included a Community Assessment Clinic (CAC) for GPs to access further advice on management and Referral for Insulin therapy, via a structured group education programme, was also offered (NICE 2008).
Why this service is a good example of shared practice
This service has been designed to respond to patient needs. There is considerable flow of patients moving to and from the specialist diabetes service as care is provided appropriate to need. The total number of patients receiving all their diabetes care in primary care has increased from 50% in 2000 to 67% in 2007, and this trend is continuing despite the rise in prevalence of diabetes.
Participants are invited to attend a four week structured education programme, delivered by a Diabetes Specialist Nurse and Dietitian. The programme includes education, dose titration of insulin, diet, management of hypoglycaemia and acute changes in glucose control, driving issues, holidays and travel.
Telephone support is provided throughout the duration of the course and immediately after the programme.
After the programme the participants are discharged back to their GP, with further access to CAC as required. Biomedical data and weight are collected at baseline, 6 weeks and 3 months. Validated questionnaires - satisfaction with treatment and Hospital, Anxiety and Depression scores are completed before and after the programme. Regular updates, for management of insulin treatment and adjustment of doses are also provided for GPs and Practice Nurses to improve their confidence in providing this ongoing care for their patients.
The programme is continuously audited, updated and developed as required.
The aims of the project include:
- To allow rapid access to expert clinical advice for GPs via the CAC
- Initiation of insulin with appropriate follow-up telephone advice until stable, and return to primary care as soon as possible
- Support health professionals in primary care with regular update sessions, providing an opportunity to discuss current management issues and therapies
No extra funding was available for the project. The existing staff provided the input required. Venues for the education programmes Insulin and specified equipment A DSN telephone helpline