Preventing type 2 diabetes in England
NDPP in Salford Dr Sheila McCorkindale, Clinical lead for diabetes NHS Salford CCG Helen Slee, Project Manager, Salford NDPP
Salford City Challenges Population 237,000 65+ 14.6% OF POPULATION • 47% of people live in the most deprived 5 th of areas in England. Unemployment 5.5% • >12,000 people diagnosed with diabetes. Estimated further 2000+ undiagnosed • Over 50% of the population have a recorded BMI in the overweight or obese category Estimated prevalence of NDH in Salford = 10% over 16s (19,693 people)
Existing assets in Salford 2 existing NDH programmes • Telephone based service (IGR2) commissioned mainstream in April 2014. • Exercise for IGR innovation pilot Commitment to partnership working • Joint working with Public Health – health checks, development of centre of contact, innovation projects • Partnership with Hitachi to develop telephone/web-based intervention • Salford/ DUK partnership – city wide ‘ Healthy City for Diabetes Initiative’ Funding for practices • IGR activity incorporated into Long Term Conditions Locally Commissioned Service
‘Team Salford’ approach • Joint working – SCCG, public health, hospital trust, Hitachi, community groups • IGR work in practices funded within ‘Salford Standards’ • ‘Hands on support’ for practices by nurse facilitator • Regular NDPP steering group and operations group • Community case finding and direct referral • Data from all sources collated in GP EPR • Full evaluation by NIHR GM CLAHRC • Patient stories and feedback • Branding developed by patient groups
Marketing and Campaigns Plan Various activities across the city using engagement materials including: • Health Bus • Newspaper and online advertising and news articles • Ad vans • Phone booth and bus shelter advertising • Targeted social media campaign
New community engagement projects • Unique Improvement and Health Improvement Team working within the community • Process established for direct referral of patients from community teams into NDH programmes – data only sent to practices • Community Team Approach: • 20 Community Champions recruited • Mixture of opportunistic engagements and planned rolling local campaigns in 8 neighbourhood areas • Clear and planned pathway developed with built in follow up and brief advice at each stage • Peer to peer engagement using Diabetes UK Risk Assessment tool • Health Improvement Service offer point of care ‘pin prick test’ (HbA1c) at Health Bus and in variety of community locations
Practice Nurse Facilitator ‘Hands on’ support for practices by CLAHRC Nurse Facilitator to: • Raise awareness of programmes/referral process across all practices • Work in individual practices involving: • FARSITE search of existing records (last 6 months) for people with IGR who are potentially eligible for programmes. • FARSITE/ DOCMAIL invitations sent to those suitable • Specific NDH review clinics set up for people who respond run by the Nurse Facilitator to discuss NDH, explain risk and refer if appropriate
Diabetes Prevention: IGR Care Call • Provided by Salford Royal Foundation Trust • 9 month MI type behaviour change programme • Education, goal setting, action planning and regular review • New web-based/ telephone programme developed in partnership with Hitachi/ SRFT Service trial (CATFISH)in progress. Recruited 200 people • Works collaboratively and signposts to Exercise for IGR and other relevant services
Exercise for IGR Programme • 8 week membership /access to all Salford Community Leisure Centres and other specialist activities • Initial one to one consultation with an Active Lifestyles Trainer who will design a personalised fitness programme for the client. • Available activities include the gym (including supervised sessions), swimming, exercise classes and other sessions, specifically designed around clients who have been found to have IGR. • Clients are referred from GP’s, Diabetes Care Call Team and other health care services. • Works collaboratively and signposts to other relevant services including Care Call
Salford NDPP Demonstrator Site Lessons Learned
Case Finding: General Lessons To succeed you must: • Raise public awareness of the risk and the importance of taking action • Advertise programmes and ensure easy and equitable access • Engage with individuals and communities, encourage self assessment and enable all to make a positive choice • Work together to build capacity at all levels • Systematically identify high risk patients using existing GP records, health checks , long term condition reviews, targeted community engagement • Evaluate impact and ensure sustainability • Contact a large number of individuals to be able to counteract the number of drop outs prior to intervention. • Providing interventions is easy – the main challenge is enabling people to make positive choices and engage with diabetes prevention programmes.
Case Finding: Community Engagement • Setting up new processes requires time and resolution of technical and operational issues • Marketing and engagement materials are essential for effective community engagement work – consider timeliness of material development and distribution • Clear referral processes into interventions need to be established before engagement work ‘goes live’ • Ensure there is enough capacity to meet the demand of the programme of engagement activities • Targeted approaches to high risk populations yields the best conversion rates from engagement to recruitment into interventions • One stop shop with opt in at every stage – making every contact count
Case Finding: Nurse facilitator • Providing support/ ‘ hands on help’ for practices appears to be a good investment: • Despite LTC LCS, initially very variable data quality, activity, enthusiasm / support for programme between practices BUT the Nurse Facilitator was welcomed by all and help appreciated. Coding and quality and quantity of ‘ natural‘ referrals significantly improved • Due to Nurse Facilitator’s work, the number of referrals to IGR services significantly increased • Extra help in searching existing records / correcting coding / specific clinics for people found to have IGR from existing records likely to be needed in medium term only • Salford is investing in a nurse facilitator role to support practices in identification of people with IGR from existing records for a further year
Interventions • Match programme capacity to demand ensuring cost effective service • Establish at the beginning of the programme: • Operational instructions • Clear referral pathways • Data recording requirements • Collaborative approaches with other providers • Signposting to relevant complementary services • Evolve and continuously improve from lessons learned
Programme Management • Governance structures and key stakeholders to be identified and agreed before the pilot begins • Meeting regularly and defining a shared aim • Dedicated Project Manager resource is beneficial to coordinate the programme • Establish a marketing plan to support with case finding and recruitment into interventions
Patient Stories “It really did me well, now I “It was a bit of a shock “ I remember when I started I try and have an outdoor but I enjoyed it! Proper was 85.7 kg and last month walk in the mornings if the chuffed” 81.5kg. My target was to weather is fine and I get up shed at least 5kg in 6 months in time” and I think that will be Patient B is 66 and has achievable. been on warfarin since a Patient A is 62 and stroke in 2010. In the 8 increased his exercise weeks of the programme I still walk into town for my capacity from 1km on the he lost 8kg in weight and work every day. I would treadmill to doing 3km on regained his confidence definitely recommend this the treadmill and 2km on in exercising. programme to other people ” the exercise bike. Patient C joined both IGR Care Call and Exercise for IGR
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