The APPG on Diabetes has launched at the beginning of the year its investigation in Diabetes Care to improve standards and reduce variation. On September 7th it has held its fourth and last meeting on Improving Standards in Diabetes Care: Putting Learning into Practice.
The previous meetings showcased the challenges faced by those living with both Type 1 and Type 2 diabetes and healthcare professionals (HCP) in dealing with and addressing the variation in knowledge, processes, technology access and consequently care across the country.
The final meeting focused on how local areas have successfully applied knowledge and learning to improve the standards and reduce variation in care in practice. The speakers included consultants and specialists in the field of diabetes with expertise in influencing improvements in care and treatment outcomes, who have designed and implemented new ways of removing the barriers and delivering better diabetes care.
The first speakers were Dr David Lipscomb, Consultant in Diabetes and Endocrinology East Sussex Healthcare NHS Trust, and Abigail Kitt, Independent Consultant in the Healthcare Sector and Diabetes Support for South East Coast Strategic Clinical Network. Together they spoke about the role of Clinical Networks, a non-statutory body that supports commissioners and providers to implement improved care for diabetes. They identified three key challenges: CCG management capacity, capability and engagement.
According to the speakers, there is a rapid turnover of CCG diabetes commissioners in England, which leads to a varying capability and engagement, as diabetes is not necessarily a priority to everyone, and a slowness of change. Furthermore, there is an overall lack of capacity in commissioning and providers to have space to develop and engage with the Clinical Networks.
To address this, they spoke about the importance of using education to champion improvement. One of the strategies is to provide clinical leadership and Healthcare Professionals training face-to-face and via webinars, enabling a wide participation. Moreover, they conduct gap analysis every year in order to have locally specific data that can support business planning.
They also highlighted the importance of relationships, developing a consultants’ forum that meets twice a year to share problems and brainstorm solutions.
“We became leaders in diabetes prevention because of the relationships we built”, said Dr. Lipscomb.
Dr Kate Fayers, lead consultant for the new West Hampshire Community Diabetes Service (WHCDS), spoke next about the need to design 21st century diabetes service. According to Dr. Fayers, people with diabetes and the NHS have changed across the years, but the models haven’t, leading to stagnation and complication. She identified the three “As” that constitute her vision for improved diabetes care: access to excellent skills and knowledge, achieve individual goals where possible and activate self-care where possible.
To address this, she stated the importance of integration, improving patient care through improved communication with ambulance crews and community teams and working together with other practices. “I need to work collaboratively to work more”, said Dr. Fayers.
Furthermore, she spoke about the need for innovation across the system, explaining the staff are too busy to change practice and there is a limited access to research opportunities. To address this, Dr. Fayers advocated for a new triage pathway, which improves patient care with swifter consultant advice, and the development of a research unit, which improves patient care with equitable access to research for community patients.
In order to achieve her vision, Dr. Fayers created a successful evidence-based intervention, which focused on patient engagement and on integration with different groups and providers. She developed an intermediate community service, which has moved Type 1 and Type 2 diabetes care into the community, supported by a portfolio of education for patients and healthcare professionals. The results showed that contact goes down as engagement goes up.
Carol Metcalfe, Lead Paediatric Diabetes Specialist Nurse at Macclesfield District General Hospital, spoke about paediatric diabetes. She explained that while the issues and problems with diabetes care are still the same, national paediatric diabetes outcomes are improving steadily since 2011, due to a number of interventions such as Best Practice Tariff (BPT), National Paediatric Audit (NPDA), peer reviews and regional and national networks. However, there are still variances across the country and the need for a strategy to eliminate it.
She also stated the importance of education, advocating for a consistent and continuous message for children across the country. She explained that as children develop, there is a need for regular contact. There are also specific issues about the level of care during the transition from paediatric to adult diabetes care.
Furthermore, Carol Metcalf spoke about the need for this education to be more accessible to parents and healthcare professionals. She said all healthcare professionals working in paediatric diabetes should be trained to teach all ages, from toddlers to adolescents, and should have access to accredited courses recognized and supported by their managers.
“We need to continue with the ongoing work and ensure diabetes staff receive high class education to deliver excellent diabetes education to children and families”, said Carol Metcalfe.
David Hiles, Consultant for the Diabetes UK Service Redesign and Improvement Consultancy, explained how health care professionals and practices that are achieving better results in diabetes primary care often don’t realize what it is that make them different. To address this, he works with a system for improvement called Best Practice Modelling, which focuses on taking the learning from these practices and spreading it throughout all practices across the CCG.
After identifying the top performing CCGs using the Diabetes Primary Care Profiling Tool (DPCPT), David Hiles conducts structured interviews with key players in each practice to identify the reasons for this success. He asks them to walk him through the detailed process of different patient journeys, revealing that the secret is on what and how very specific pieces of information are given to patients at key moments. He identified three simple answers for success: use of resources, continuity of care and point of diagnosis.
With this information, local best practice pathways are created for each parameter and a short education programme is delivered to help embed the new pathways and produce enduring change. “The answer to better care is a local answer”, said David Hiles, explaining that as solutions are locally owned, those are simple, cost effective and easily replicable ways to deliver local improvement.
As a consequence, practices successfully encourage patients to attend for essential diabetes reviews and to gain better control of their condition, lowering the incidence of diabetes complications and therefore helping generate savings.
MP George Howarth chaired the meeting and highlighted the need for a collaborative and inclusive work; the need to reinforce the message to children; and advocated that a care model should be part of ideas put forward.
Following the panel speakers there was a chance for questions and comments from the audience. Discussions were centred on a variety of areas including: the possibility of an international model of care; how can parliament help improve diabetes care in CCGs; the challenges of providing consistent education in varied regions and to a varied public; and the need for more qualitative data.
This meeting finalises the APPG’s investigation into how to improve standards and reduce variation in diabetes care. On November 23rd the report for the full investigation will be launched looking, in depth, at what practical solutions there are to reduce variations and making clear recommendations for change.
The APPG is still accepting until midnight, 16th of September, case studies from commissioners and providers from across the UK who have implemented new ways of working to improve standards and tackle variations in diabetes care. If you would like to submit your story, please use this guidance form.