Community Diabetes Care the hospital view Dr Prakash Abraham

How many practices here? How many run diabetes clinics? What proportion of patients with diabetes come there? What are the barriers for taking this on?

Projected Prevalence of Diabetes Mellitus in UK m 3.0m 6.0m

Grampian Prevalance Approaching 4% Over 19,500 patients with diabetes (April 2006) in April ,000 attendances at diabetes clinic

Need for integrated care Two 30 minute review appointments for 19,500 patients per year.19,500hours 44 weeks work/year: 444 hours per week Each clinic ~4 hours: 110 clinics a week supervised by 3 WTE consultant diabetologists (Associate Specialists/Clinical assistants/SPRs). 10 clinics per week by permanent staff ~10 Trainee run clinics

Treatment Distributions Over 75% not on insulin Initial & realistic target for transfer of care

Diabetic Population: Banff & Buchan –1.9% of population –3.6% of population

Place of Care Practice Only Care

Place of Care Hospital Only Care

Care Parameters Improved

Patients and Staff Feedback

With all this patient exchange what does the hospital doctor do?

What does the hospital Dr do? Golf Hill walking But still –about patients attending annually –More complex patients (higher proportion of the 25% that need more time) –To see with same time as in practice clinics –28 clinics per week (still running at > twice the capacity)

Woolmanhill attendances

What does the hospital Dr do? Release of hospital resources to focus on complicated cases Develop services –Adolescent care –Pregnancy care –Foot/Renal –Insulin Pump Guidelines & Protocol development Teaching/Training/Research

Integrated care: Building blocks 1 Enthusiastic team Multidisciplinary leadership –GP –DSN –Dietitian –Podiatry –Patient –Management Representative –Secondary care link

Building blocks 2 Agreed Criteria Agreed standards Empowerment: Staff/Patients IT Support/Audit Education at all levels –GPs: Lilly course –All(Warwick, Shipley, Insulin for life) –Ongoing education/ Courses /Conferences / Network days

Incentives for transfer Better patient care Satisfied patient and staff Easier access & better service for the 25% who need more input Higher GP contract Quality points Clinical Accord

GP contract

GP Contract 2004/5 ~90/99 Points (including all 56 previous points)

Wishlist Dedicated time for –Telephone session with practices –Teleconferencing Practice education visits Redesign of secondary care to deliver better care of diabetes complications

Primary & secondary care work in partnership with the patient at the centre