Digital Behaviour Change Interventions for T2 Prevention – Progress to Date • Procurement currently live • Responsible for contracting with digital service • Appoint Service Provider providers, supporting implementation, evaluation Feb 2017 Commission design, supplier management and evaluation. Delivery and Evaluation Partner • Procurement for 3 rd Party “App Assessor” currently • Open call for digital service providers to take part in live evaluation • Expect a Call for Digital Identify DBCI • Assessment of digital products Providers in Feb 2017 • Products assessment in March 2017 • 3 Digital Only STP’s • Digital only Geographies identified from Yr 2 EOI Identify • Digital as choice at point of offer • 3 Digital as choice Geographies for identified from EOI call • Digital offer for those that have declined F2F referral piloting • EOI requested from Yr 1 site s NHS DIABETES PROGRAMME
Digital Behaviour Change Interventions for T2 Prevention – Next Steps • Communicating intent • Establishing referral sites • December2016 - February Dialogue with local • Governance arrangements 2017 geographies • Evaluation Design • Pathway Design • February 2017- June 2017 Evaluation Design • Implementation Planning and Implementation Planning • Referrals Commence • Data Collection / Qualitative Evaluation • June 2017 - Jan 2019 Service mobilisation • Interim and final findings report and live running NHS DIABETES PROGRAMME
Type 1 – Aims and Objectives • Improve information provision and support for individuals living with Type 1 diabetes • Develop a mobile-first website which provides insight, direction and support all in one place • Move more T1Ds towards being fully engaged with their condition, and more knowledgeable and active patients, in an easy, low friction manner NHS DIABETES PROGRAMME
Type 1 – Progress to Date • Content and discovery phase nearly complete • Mock up (“wireframes”) developed • Initial market sounding with developers • Proposals for phased agile development and investment case NHS DIABETES PROGRAMME
Questions NHS DIABETES PROGRAMME
LONDON REGION – NATIONAL DIABETES PROGRAMME LAUNCH EVENT
Diabetes Treatment & Care Programme Jeff Featherstone, Diabetes Treatment & Care Programme Manager 30
Treatment & Care transformation programme 1. Improving uptake of structured education £10m 2. Improving achievement of the NICE recommended treatment targets (HbA1c, cholesterol and blood pressure) and reducing variation £17m 3. Reducing amputations by increasing availability of multidisciplinary footcare teams £8m 4. Reducing lengths of stay for inpatients with diabetes by increasing availability of diabetes inpatient specialist nurses £8m • Good evidence to suggest that these priorities will: Have the most clinical impact Are most likely to offer the highest return on investment and be sustainable Will lead to improved outcomes for patients
Best Possible Value (BPV) • Details subject to final confirmation before publication • Bidding process focused on which identifying bids offer Best Possible Value in terms of Strategic Fit, Value and Risk. • Bids should be jointly agreed between CCGs and relevant providers with single Senior Responsible Officer • Application form asks for details of: Analysis of reasons for local position and actions proposed, with timescales Planned improved outcomes and expected savings Mutual commitment to reinvest savings in sustainable services.
Structured education (1) • Delivery of SE for patients with type 1 diabetes could deliver savings from reduced complications of : • an estimated £440 average per person after 5 years and £1,800 after 10 years for newly diagnosed patients • an estimated £880 average per person after 5 years and £3,600 after 10 years for the prevalent population • Delivery of SE for patients with type 2 diabetes could deliver savings of • an estimated £93 average per person after 5 years and £129 after 10 years for the prevalent population • an estimated £77 average per person after 5 years and £118 after 10 years for newly diagnosed patients
Structured education (2) • Understand actual level of attendance at structured education courses- may well be higher than reported attendance levels. (5.7% reported nationally. Actual levels may be between 15-30% • Understand why actual structured education attendance is low and agreeing actions to tackle it. Consider: How clinicians explain structured education to patients Are providers incentivised to maximise attendance? Are attendance issues different for differing populations? Do the time and locations of offer meet patient needs Do content and cost reflect evidence? .
Treatment targets (1) • Treatment target achievement associated with reduced risk of complications • Great deal of variation in achievement: i) > 1 in 2 patients achieving the targets in some CCGs, <1 in 3 in others. ii) 40% of type 2 patients achieving targets, but only 20% of type 1. • Estimated per patient saving (gross): i . After 5 years, average per patient saving would be £270 due to reduced risk of complications ii. After 10 years, average per patient saving would be £600 due to reduced risk of complications
Treatment targets (2) • Understand reasons for local underachievement of treatment targets • Is underachievement focussed within specific GP practices, populations, localities? • Appropriate achievement of the treatment targets will vary between different parts of local populations e.g. high elderly population, South Asian population etc. • What are positions of comparator CCGs? If in better position, what do they consider to be reasons for this? • Actions that have a clear rationale for why they are considered ones to bring about improvement and are sustainable.
Footcare and Inpatient teams • Estimated 57 hospital sties do not have a multidisciplinary footcare team and 54 sites do not have diabetes inpatient specialist nurses. Others have teams but with insufficient capacity for current demand. • Evidence suggests that, for every £5m invested in Multi-disciplinary Footcare Teams (MDFTs) or Diabetes Inpatient Specialist Nurses (DISNs), net savings of around £9m annually can be achieved. • Bids for funding for footcare and inpatient teams for sites without these in place, and expansion of capacity in existing services. • Need to set out how teams will support other professionals also treating the same patients to promote consistency of care and improved outcomes.
The application forms (1) 2 sections: Word – qualitative including - written descriptions of plans and anticipated outcomes Excel – quantitate including - key metrics around savings and expected improvements in clinical outcomes Each question clearly labels which aspect(s) of the evaluation framework it refers to 38
The application forms (2) 39
Evaluation criteria: Appraisal dashboards - Clinical - Cohort size - Clinical outcomes - CCG IAF rating (for TT and SE) / Current services in place (for MDFTs and DISNs) - Patient experience - Patient experience measures or improvement plans - Safety / quality - High quality service provided - Sustainability - Commitment to fund service after transformation funding is withdrawn - Tracking savings - Resources - Per patient cost of service and non-financial costs - Strategic - Financial - Replicability Risks – risks around implementation, relationship, targeting, inter-relationship with - other strategic plans 40
Overall: Must haves Good bids will include details of; • All partners (CCGs, providers, others) having mutually committed to the bid, including to costs/savings profiles and to reinvestment of savings for sustainability of the service developments • An agreed Senior Responsible Officer, Clinical Lead and an Implementation Lead across the partnership • The proposals being in line with local priorities for diabetes e.g. priorities within STPs • Engagement (with clinicians, providers and patient groups) and their support for the proposals • Governance and oversight arrangements to oversee the delivery of the interventions • How participation in the National Diabetes Audit will be increased to ≥ 90% by 2018/19 As well as the specific details of bids in each priority intervention area. 41
Bids for funding to improve uptake of structured education Importance Value equation Outcomes/Criteria (%) Number of additional patients referred for structured education. Evidence drawn from National Diabetes Audit. This should be expressed as per X% of population or similar. Also 10% collect information on current and future referral and attendance rates to support Clinical assessment of bids. Planned improvement in CCGIAF rating for structured education 5% Planned increased attendance at structured education and completion of course. 20% OUTCOMES Set out local measures of patient experience or use qualitative information about plans for Patient 10% improvement. Experience Safety/quality Service adheres to NICE guidelines and quality standards. 15% Total amount of local funding committed in each year 15% Sustainability Savings generated locally. 10% Number of additional patients to attend annually. Total cost of service and details of any RESOURCES 15% capital requirements upon which successful delivery of the bid is reliant Assessment of identification of implementation risks and mitigating actions 25% Assessment of identification of degree of support of key partners 25% RISKS Assessment of risk that intervention is not well targeted 25% Assessment of degree to which inter-relationship with other strategic plans are identified 25% and addressed. Proportion of new/additional service cost to be funded locally in 2017/18 50% STRATEGIC Degree to which the improvement approach can be replicated elsewhere. 50%
Bids for funding to enable an increase in achievement of the 3 NICE recommended treatment targets Bids should clearly set out; • Percentage of patients with diabetes that achieved the 3 NICE recommended treatment targets according to the most recent NDA and the expected improvement up to 2020/21 • Understanding of the reasons why treatment targets achievement levels may be lower than national average (40.2%) including consideration of different segments of the CCG’s population • The proposed intervention(s), actions to be taken and the resources required for these • Local measures of patient experience and/or plans for improvement of patient experience • Demonstration of how improvements will be sustainable (including whether the bid requires ongoing funding or describes a short term intervention) • The profile of anticipated savings and commitment to reinvest these to support long term sustainability of the service • Degree to which the approach could be replicated elsewhere • Any risks to delivery which have been identified and mitigating actions
Bids for funding to put in place a new or expanded multidisciplinary foot care team (MDFT) Bids should clearly set out; • Whether the bid is for a new or expanded service • Current number of patients seen by the MDFT and for each year up to 2020/21 the planned levels of improvement in; • Number of patients who will be seen by the MDFT • Waiting times / accessibility for patients with major / minor foot care needs • Number of amputations • Describe how the proposed additional or extended MDFT function will fit into the wider treatment pathway and interface with other services • Provide detailed implementation plans including the resources required and the criteria which will be used to determine which patients are seen by the MDFT • Local measures of patient experience and/or plans for improvement of patient experience • Demonstration of how the new/expanded service will be sustainable • The profile of anticipated savings and commitment to reinvest these to support long term sustainability of the service • Any risks to delivery which have been identified and mitigating actions
Bids for funding to put in place a new or expanded diabetes inpatient specialist nursing (DISN) service Bids should clearly set out; • Whether the bid is for a new or expanded service • Average number of inpatients with diabetes that have needs that would be appropriate for the DISN to support • For each year up to 2020/21 set out the planned levels of improvement in average length of stay for patients with diabetes, reduction in medication errors and reduction in hypoglycaemic and hyperglycaemic episodes in inpatients • Describe how the proposed additional or extended DISN function will fit into the wider treatment pathway and interface with other services • Provide detailed implementation plans including the resources required and the criteria which will be used to determine which patients are seen by the DISN • Local measures of patient experience and/or plans for improvement of patient experience • Demonstration of how the new/expanded service will be sustainable • The profile of anticipated savings and commitment to reinvest these to support long term sustainability of the service • Any risks to delivery which have been identified and mitigating actions
What to avoid when developing bids • Not including all key partners – ensure you work in an appropriate group of CCGs and providers • Failure to ensure that the proposals address all key issues in the appraisal dashboard • Submitting many separate bids – an individual CCG may be part of different partnerships covering differing priorities or providers, but should not submit multiple bids for the same priorities and providers • Vague responses – if you don’t have the evidence to back up your proposals set out how you plan to get it and your best estimate • Not demonstrating an understanding of the key issues for different parts of the local population that affect outcomes • Failure to demonstrate mutual commitment to the proposals across commissioners and providers • Failure to confirm mutual support for the cost and savings profiles and for reinvestment of savings to sustain the improvements
Support available National support • Call to bid slide pack which includes; • The scale of the opportunity for CCGs including what national modelling based on the evidence suggests in terms of return on investment • The background and logic models for each of the 4 interventions • Appraisal dashboard for each of the interventions which will be used in the assessment of the bids, including the weighting for each criteria • Various links to supporting information such as a data dashboard which sets out the available data by CCG to support CCGs developing bids • A programme of webinars to support organisations developing individual bids (details TBC) • Regular webinars with NHS England regional clinical networks • An email address to direct specific queries to (england.diabetestreatment@nhs.net) • A FAQs document to support by answering all the regularly raised questions Clinical network support • Support in developing individual bids • Responding to queries from local commissioners and their partner organisations
Provisional timescales and actions • Invitation to CCGs to submit funding bids to be issued early December 2016. • Funding bids to by submitted by 18 January 2017 • Bids can be by individual or groups of CCGs. Bids should be jointly agreed with providers • Successful bidders to be advised by end February 2017
LONDON REGION – NATIONAL DIABETES PROGRAMME LAUNCH EVENT
NHS National onal Diabetes betes Preventi ention n Prog ogramme amme Healt althier ier You- South th London on Alison White Interim Programme Director – Diabetes and Stroke Prevention, Health Innovation Network www.hin-southlondon.org @HINSouthLondon
NATIONAL DIABETES PREVENTION PROGRAMME
The he pic ictur ture e in in Sou South th Lo Lond ndon on • Population of just under £3 million • 430 GP Practices across the 12 boroughs • 369 Commissioned GP practices provide NHS Health checks • 10 out of the 12 boroughs commission a community outreach provider for Heath Checks. 74 pharmacy providers • Over 140 different languages. The most common non-English languages are Portuguese, Yoruba, Tamil, Polish, Punjabi, Urdu, Guajarati, Bengali, Spanish, Nepalese and Mandarin • South London has an estimated at risk population of 275,549 NATIONAL DIABETES PREVENTION PROGRAMME
Our approach London Transformation Board Regional NHSE Board Southwark CCG South-west co-chair South-east co-chair Merton Lambeth Merton Wandsworth Richmond Croydon Kingston Sutton Lambeth Southwark Lewisham Bexley Bromley Greenwich CCG/LA CCG/LA CCG/LA CCG/LA CCG/LA CCG/LA CCG/LA CCG/LA CCG/LA CCG/LA CCG/LA CCG/LA NATIONAL DIABETES PREVENTION PROGRAMME
South London at a glance • Provider is Reed Momenta with Lloyds pharmacy as a partner • To date, South London partners have referred over 2000 people onto the programme across 11 boroughs • Over 28 programmes have started, with lots more planned for the new year • Partners have localised the offer to suit their populations • Issues are being resolved quickly and learning is shared across the partnership NATIONAL DIABETES PREVENTION PROGRAMME
Monthly dashboards (a work in progress) • Feeds monthly highlight report • Risk log capture • Review of call off numbers versus actual numbers • To include outcome data NATIONAL DIABETES PREVENTION PROGRAMME
Local success stories Sutton Southwark One of the larger practices sent out Southwark took the approach of 300 letters to patients identified as at sending out mailshots to their at-risk risk of developing type 2 diabetes and population. invited them to attend an open day • Patients received a primer text where they: message alerting them to an • Had their BMI done important health message being sent by the practice • Attended an short information • session where they could ask Followed up with a letter informing questions them that they have been identified as at-risk of developing • Filled out referral forms type 2 diabetes- Trial • Had their blood tests After the first batch of texts and letters, over 150 people had called the As a result, 96 people were referred provider , and over 50 had booked that month. onto an individual assessment . NATIONAL DIABETES PREVENTION PROGRAMME
Local success stories Lewisham Greenwich Using the existing local model of Lewisham identified a GP champion Patient Information Clinics, Greenwich who engaged a number of practices are running their own individual to encourage them to send out assessments for their local population. mailshots inviting eligible patients. • Eligible patients are contacted and Here the delivery team trialed two invited to a clinic different types of mailshot. • At the clinic, they have a blood • The standard mailshot check and find out more about • services for preventing diabetes A mailshot including specific demographic information and a Greenwich have found that this model follow up text message leads to higher quality referrals and patients are more motivated to attend The more specifically targeted the programme . mailshot leads to higher levels of engagement and an increase in referrals. NATIONAL DIABETES PREVENTION PROGRAMME
Next steps • Continue with successful implementation delivery mechanisms and use learning to improve patient experience • Explore place-based outcomes for each CCG area using data collected by the national team and the provider • Ensure sustainability of referrals • Work closely with the provider to start embedding programmes as business-as-usual NATIONAL DIABETES PREVENTION PROGRAMME
LONDON REGION – NATIONAL DIABETES PROGRAMME LAUNCH EVENT
NHS Diabetes Prevention Programme CWHHE Ibrahim Khan Senior Public Health Commissioning Manager
CWHHE Collaborative C entral London • Total registered population: 1.4m W est London • CCGs: 5 • Local authorities: 5 • H ammersmith & Fulham PH departments: 3 • Total GP practices: 251 H ounslow E aling
Application Process (Jan – March 2016) • Organisation and partnership working across CWHHE • 99% of practices use the same clinical system (SystmOne) Ability of standardise templates and reporting across CWHHE • Able to demonstrate the need for NDPP i.e. Diabetes, pre-diabetes burden, BME population, areas of deprivation etc • Non Diabetic Hyperglycaemia (NDH) register • Out of Hospital contract incentive (managing register, annual reviews and NDPP referrals) • Successful NHS Health Check programme • Existing local programmes • Readiness to refer (templates, reports, identification of eligible patients, incentive)
Pre Diabetes Prevalence
High Risk of Diabetes Register by March 2016 CCG High risk of diabetes register Uncoded high risk of diabetes Ealing 13421 12774 Hounslow 10709 6083 West London 3101 4711 Hammersmith & Fulham 2219 3921 Central London 2205 4003 CWHHE Total 31655 31492
2 Year Programme Allocation Central London West London H&F Hounslow Ealing Total 13% 13% 13% 25% 36% Number of referrals 800 800 800 1538 2214 6152 Upper uptake (40%) 320 320 320 615 886 2461
Pre Mobilisation Phase (April – July 2016) • CWHHE successful in their bid to join first wave • Procurement process to choose the provider • ICS (Independent Clinical Services) announced as the preferred provider in July 2016 • MoU signed between CWHHE and NHSE with H&F CCG as lead organisation • NDPP steering group set up to meet weekly (teleconference and face to face) led by Hounslow Public Health. Attended by CCG clinical leads, PH managers, CCG managers, comms team, NHSE, provider) • Links with CWHHE Diabetes Strategy Group
Mobilisation Phase (July – Sep 2016) • Weekly steering group meetings • Referral pathway a) Mass invitations b) Face to face invitations – referrals c) Active case findings (diabetes risk calculator, NHS Health Check) • Invitation letter and referral form (available in SystmOne) • SystmOne crib sheet • Patient and health professionals leaflets (PPG coordinators engaged) • Roll out plan (GP engagement, venues, priority areas etc) • Communication plan
Roll Out (Sep 2016) • Email communication to all GPs during week commencing 19 th of September (led by CCG comms) • Communication pack with leaflets sent to all practices • Promotion and presentations at CCG federation/network meetings • Expression of interest by GPs to conduct initial assessments at practices • Monthly OOH dashboard
The story so far! CCG Area Number of referrals Central London 192 Ealing 588 Hammersmith and Fulham 194 Hounslow 739 West London 322 Total Referrals 2035 Current Position Number Processing referral 392 Accepted invitation (awaiting IA 1059 appointment) Initial Assessment booked 324 Ready for groups 110 Booked on Group 111 Not Progressing 39
Demand management • Staggered approach to referrals • Monitor out of hospital contract performance • Monitor uptake rate from referrals to initial assessment and from initial assessment to groups • Most initial assessments in Nov/Dec, majority of groups to start after Christmas
Thank You! Ibrahim Khan Senior Public Health Commissioning Manager London Borough of Hounslow Ibrahim.khan@hounslow.gov.uk
LONDON REGION – NATIONAL DIABETES PROGRAMME LAUNCH EVENT
Diabetes Prevention Programme Progress and reflections from Camden, Islington and Haringey Alice Ehrlich Public Health Strategist Camden and Islington Public Health
Our partnership • Members • Project team – CCG commissioners x3 – Public Health – Diabetes clinical lead in Islington – Practice manager (early days)
Our approach 1. Developing a referral pathway 2. Using NHSE resource
Our approach Opportunistic interaction Searches Community NHS Health Check GP NHS Health HbA1c/ FPG reading HbA1c/ FPG reading Check Outreach (H) Outreach Pharmacy (C&I) (C&I) ≤ 12 months Other* > 12 months ≤ 12 months > 12 months Add to NDH Add to NDH Invite for HbA1C test RPG test HbA1C test HbA1C test register (C&I) register HbA1C test Risk stratify Inform Inform Inform (QDiabetes) Add to NDH Add to NDH Add to NDH individual and individual and individual and and focus on register register (C&I) register get consent get consent get consent high risk groups first Inform Inform Inform Inform Inform GP Inform GP individual and individual and individual and individual and get consent via get consent get consent get consent text, phone or letter (letter with a form for self- referral counts as consent) Referral to DPP *Specialist Primary Care Diabetic Service, Adult Weight Management and other NDH= non-diabetic hyperglycaemia; RPG = Random Plasma Glucose; FPG = Fasting Plasma Glucose; (C&I)= relates to Camden and Islington only; (I)= relates to Islington only; (H) = relates to Haringey only
Our approach 1. Developing a referral pathway • Primary care, Community Health Checks 2. Using NHSE resource – IT tools – GP ‘incentive’ for invitations 3. Project planning 4. Implementation…
Our progress • Referrals 16/17 Aug Sep Oct Nov Dec Jan Feb Mar Target - 33 68 196 187 232 255 267 Actual 33 68 93 • Challenges • Primary care engagement • GP IT • The pathway in practice
Our next steps • Getting to ‘business as usual’ • Monitor referrals and patient journeys • Tackle inequalities • Practice variation • Language • Non-primary care referral routes
LONDON REGION – NATIONAL DIABETES PROGRAMME LAUNCH EVENT
NHS Diabetes Prevention Programme NDPP East London Partnership
NDPP East London Partnership Demographics headlines: • 866,595 18 yrs and over across the partnership • 183 GP practices • All 4 boroughs have very diverse populations: White British 17% - 38% White Other 12% - 16% Asian (Bangladeshi, Indian, Pakistani, other Asian) 29% -36% Black African & Caribbean 17%-20%
The scale of the ‘Diabetes Challenge’ in NE London • 63,737 people diagnosed with Diabetes! • 10,118 estimated undiagnosed diabetes ( local intelligence suggests this is an under estimate) • 92,632 estimated as having non-diabetic hyperglycaemia Borough Diagnosed Undiagnosed Non-diabetic diabetes diabetes hyperglycaemia City & Hackney 12,752 2,064 20,322 Newham 21,312 2,998 28,911 Tower Hamlets 14,916 2,252 20,002 Waltham Forest 14,757 2,804 23,397 TOTAL 63,737 10,118 92,632
Referrals and uptake targets Referrals Uptake 40% Year 1 2,191 876 Year 2 4,080 1,632 Total 6,271 2,508 • Projected Referrals in specification: • 6,271 over 2 years • Equates to 1-2 referrals per GP practice per month (2191/136) • Delivery to-date: • 337 (Nov-ytd) vs 961 (Sept-Dec)
Challenges encountered • Mobilisation phase ( Do not under-estimate the time required ! ) • Developing relationship with the provider (included personnel changes) • Fully understanding the product being promoted • Partnership working • Engaging general practice teams • Developing and embedding an efficient system of referral • Competing priorities • 1 ○ Care Access, CQC, extended services, capacity , organisational changes , religious/holidays times • Projected referrals • Not an exact science: attrition along each step of the referral • Integration with existing services • Assimilation with other similar commissioned community based services including – exercise on referral / fit for life / community prescription / health trainers / pre-diabetes sessions • Electronic referral process • Embedded into1 ○ Care practice systems, search , filtering for exclusion criteria at the initial call/re-call system-takes time, dashboard for monitoring purposes, refining !
Lessons learned to date • Clear and consistent communication to all within the practices Cluster/network meetings, 1:1 practice support / TH developed a pack administration staff Robust materials for clinicians with evidence based references for the NDPP Local stakeholder implementation meetings (borough level) often required • Organising incentives to generate referrals Recognising additional administration cost to be met at a practice level Ensuring it will be on the general practices agenda as many competing priorities Guaranteeing a level of referral • Requires active engagement to follow up and motivate practice referrals Having dedicated resources to encourage low referring practices /networks to improve Organising a robust practice dashboard to regularly monitor the referrals being made IT guidance and 1:1 support to ensure GP practices know how to use the referral template • Regular engagement with the Provider To support the promotion of the NDPP – using materials such as a brief video clip To fully understand and keep up to date on the referral – initial assessment - group attendance and numbers of exceptions • Utilise a local clinical champion - “Call to action”
LONDON REGION – NATIONAL DIABETES PROGRAMME LAUNCH EVENT
London Diabetes Clinical Network Date Dr Stephen Thomas, Consultant Diabetologist Chair, London Diabetes Clinical Network
Treatment & Care programme priorities 1. Improving uptake of structured education 2. Improving achievement of the NICE recommended treatment targets (HbA1c, cholesterol and blood pressure) and reducing variation 3. Reducing amputations by increasing availability of multidisciplinary footcare teams 4. Reducing lengths of stay for inpatients with diabetes by increasing availability of diabetes inpatient specialist nurses Priorities reflect evidence as to which interventions best improve outcomes for people with diabetes and show a positive return on investment. Treatment & Care programme forms core of CCG IAF diabetes support offer
Recent publications… • Type 1 Diabetes commissioning pack • Building the right workforce for diabetes care; A toolkit for healthcare professionals • Best practice renal foot care guidance • Report | Living with diabetes: What support is needed? • Infographic | Living with diabetes: What support do people want? • Improving the management of diabetes care: A toolkit for London clinical commissioning groups • Commissioning guidance: Foot care service for people with diabetes • Using HbA1c for better diabetes detection
Structured Education Bid Date Draft bid developers - Alison White and Aileen Jackson Health Innovation Network http://www.hin-southlondon.org/
Structured Education Application Questions 1. CCGs? 2. Understanding of reasons for low uptake? ( T1 / T2 / children) - identify which specific populations and GP practices attendance low / reasons why / feedback for reasons of non-attendance / what can help? 3. Funding for Structured Education 4. Plan to improve attendance and completion of courses / accurate recording of attendance / coded reporting of attendance / link payment to attendance 5. Implementation Plan • Initiatives you plan to put in place to increase uptake( all ages) • How to support GPs to max attendance • Focus – newly diagnosed or prevalent diabetes pop across all ages. • Proposed level of increase in attendance • Flex numbers attending? • Plan to develop the workforce so that other clinical services not depleted 6. Specific Actions? 7. Risks – to implementation / arising from relationships / that interventions are not well targeted / interrelationships with other strategic plans 8. Financial 9. Savings/ reductions 10. Service spec for structured education? 11. Will structured education courses be nationally accredited – if so by whom? / non-nationally accredited / internally accredited? Have quality standards to meet? 12. Key learning
Diabetes Structured Education Project Project deliverables What is the need/ Outcomes • Design and deliver an education programme with strong current situation? What will the project Increase referrals and consideration given to patient-led sessions and/or e-learning Lack of understanding attendance at structured resources to include: Patient impact stories, motivational do? around the value of education. techniques, the importance of applying standardised data structured education coding for referral; attended and completed, strengthening call Improve GP practices leading to low levels or and recall in primary care knowledge and poor quality of referrals. • Developing diabetes care navigator/champion roles to understanding of the value of maintain and sustain awareness of all of the above / Professional Education, Facilitation Inconsistent information structured education to • Commitment to evaluation for spread and adoption of good and engagement with increase referrals into support for primary care / practice • Commissioning a structured education hub, to include: a patients, leading to structured education centralised booking system for structured education ready for Mentorship and Training variation in take-up programmes. digital options, capacity to engage harder to reach patients, Provide cross-boundary Contracting , Finance and Value: Patient choice is limited to self-referral, signposting to other services and information and opportunities to access peer to peer support what’s available in their structured education for Strategy, Governance and • To agree cross-charging for structured education courses, to place of residence. patients to meet individual enable patients to attend the right course at the right time and Accountability needs, leading to increase in There is spare capacity in in the right location (i.e. to meet personal time and location attendance. the system commitments, language, cultural needs etc.) Provide proof of concept for Ad hoc provision for • To focus on STP partner organisations to deliver a ‘Think the structured education hub Diabetes’ initiative and review current HR policies, including: additional languages for CCGs to sustain Awareness education of the importance of employees Inequality in structured with diabetes attending structured education To design and deliver a Think education delivery for Addressing gaps in HR policies to facilitate attendance at Diabetes workforce initiative working-age population structured education to improve uptake of • Provision of tools that can be used to spread and adopt the Lack of understanding in structured education for ‘Think Diabetes’ initiative in any workplace the workplace around working age adults the importance of self- management for diabetes Outcomes Structured Increased variability, accessibility and availability of Structured Education Education:
Proposal 1: Increase referrals Design and deliver an education programme with strong • consideration given to patient-led sessions and/or e- learning resources to include: Patient impact stories o Motivational techniques o The importance of applying standardised data coding for referral; o attended and completed Strengthening call and recall in primary care o Developing diabetes care navigator/champion roles to • maintain and sustain awareness of all of the above Commitment to evaluation for spread and adoption of good • practice Outcomes Increase in GP practice staff understanding SE/diabetes • Increase in referrals that translate to actual attendance • E learning resource that can be used for spread and adoption •
Proposal 2: Increase attendance To commission a structured education hub, to enable • adults and children with diabetes to attend the right course at the right time with language and cultural options : A centralised booking system for structured education ready for o digital options Capacity to engage harder to reach patients o Self-referral o Structured education refreshers o Signposting to other services and information o Peer to peer support o Agreement for a cross-charging for structured education courses o Outcomes increased referrals and attendance at structured education o Opportunity for the evaluation of patients to include treatment o targets/structured education choice Evaluation of outcomes between different types of structured o education provided Evidence the benefits of a centralised hub o
Proposal 3: to increase working age adult attendance To focus on STP partner organisations to deliver a ‘Think • Diabetes’ initiative and review current HR policies, to include : Awareness education of the importance of employees with diabetes o attending structured education ( links with proposal 1) Addressing gaps in HR policies to facilitate attendance at structured o education • Outcomes Increased number of HR policies meeting the needs of people with o diabetes to attend structured education Provision of tools that can be used to spread and adopt the ‘Think o Diabetes’ initiative in any workplace
NHS Transformation Fund NICE Treatment targets: Lessons learned from NW London Date Dr Tony Willis, Clinical Lead for Diabetes, CWHHE CCG Collaborative
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