(24th June 2013)
Diabetes is a major chronic disease which has significant impact on mortality, morbidity and health costs in the UK. In Leicester, Leicestershire and Rutland (LLR) there are 54,000 patients with diabetes mellitus, with particularly high prevalence rates amongst black and ethnic minority communities and elderly patients. This number is projected to rise to around 100,000 patients by 2030.
It is noted that across LLR significant progress has been made within the area of Diabetes but some challenges still remain which include, reducing clinical variation in general practice , improving the uptake of patient education programmes, improving care and outcomes for young people and patients with type 1 diabetes, delivering better inpatient care and reducing avoidable hospital admissions.
For 2012-13, funding was allocated to LLR to undertake a full pathway review for Diabetes. The review was to include an identification of the current pathway including spend and activity as well as review of each of the different elements of the pathway from prevention and early diagnosis, to primary, community and secondary care.
Sub groups were formulated to look at each of the individual areas, to identify gaps in current provision and recommendations for future commissioning arrangements to ensure that LLR has a sustainable pathway that ensures high quality of care for patients, in the right setting at the right time.
With the rising numbers of people with diabetes and with increasing pressure on NHS resources it is generally accepted that diabetes care where possible should be provided in the most cost effective way whilst preserving quality of care.
Any model should therefore identify all people with diabetes or at risk of diabetes, minimise patients who do not access appropriate care and services (including housebound patients), ensure that primary care has the necessary skills to manage patients who are suitable to be looked after in the community, that care is based on evidence (in particular NICE guidance) in the most cost effective environment, and that specialist services are available for those patients who require them. A diabetes service should aim to minimise avoidable hospital admissions.
The transformation group has through its work described the “what, where, who and how” of diabetes care
The diabetes care map (see below) illustrates the ‘what’ or key areas of diabetes care which a service needs to address and highlights high level considerations for a diabetes service. The LLR transformation steering group were involved in the development of this care map which encompass prevention and health promotion and on-going care for those who have a diagnosis of diabetes. The elements of the activity are described further in detail in this report.
To help underpin the thinking from the steering group other models of care were considered to help create the approach as described. This separates the complexity of diabetes care to that which needs to be provided closer to the patients home i.e. at a GP practice and this elements of care that require specialist input and other personnel to manage this care i.e. the “super 6”
The diabetes care map describes to a degree the ‘what’ in terms of diabetes care. The proposed LLR model of care starts to describe where and by whom this care can be provided.
The key elements of this map are provision by primary care (core and enhanced) , community specialist support for patients in primary care ( this depends on what practices provide themselves) and specialist care which may need to be provided by specialists in community or hospital settings
These nine key aspects of diabetes care i.e. Screening, Prevention, Regular review/surveillance, Prescribing, Insulin, Patient education, Cardiovascular risk reduction , Housebound/care homes, audit, are all suitable for provision primarily in community settings either by suitably trained general practitioners and practice nurses.
Bernie Stribling Bernie.email@example.com