1. PROCEED Preconception Care for Diabetes in Derby/ Derbyshire:
Paru King, Consultant Physician
On behalf of the PROCEED team

2. The national picture Women with diabetes are:
2-4 times as likely to have a baby with a congenital abnormality.
Five times as likely to experience a stillbirth
The risks can be reduced by preconception care
Only 34% access preconception care
8 000 pregnancies affected in 2011 in the UK
Preconception is a NICE Quality standard 2011
NICE diabetes Quaity standard 2011

3. The local scenario: Derby and Southern Derbyshire%

4. Gave us the opportunity to pilot PROCEED, the first integrated preconception service for diabetes.
Exciting opportunity to pilot the first integrated preconception service

5. Raising preconception awareness
Refer
Educators
Users (via clinician)
GPs
Practice Nurses
Pharmacy Medicines Review
Health Visitors/Surestart
Family planning clinics
Primary and secondary care diabetes teams
Non-diabetes specialist clinicians
Build on previous work

6. CHANGE CONSULTANT ROLE
PROCEED: OUR VISION 6Cs
CROSS BOUNDARIES (INTEGRATE)
COMPETENT
CONSISTENT
CONTINUITY
CHOICE
CHANGE CONSULTANT ROLE

7. Referral by paper, NHS email or telephone
Telephone contact by coordinator
Hospital clinic
(South Derby)
Community clinics
(Central Derby)
Community clinic
(North Derby)
First visit empower and care planning
Signpost to resources across primary and secondary care as appropriate
Woman self refers to the antenatal service when pregnant.
Flexibility depending on clinical need and user choice

8. PROCEED : Efficiency and productivity

9. Impact of PCC
P<0.01
P<0.05

10. PROCEED : outcomes 
PROCEED

11. PROCEED : light and dark green dollar savings

12. PROCEED: Finance Total annual savings from changes= £61,000
Recurrent cost of service =£17, 000
Overall savings Year 1 =£44,000 / year
Could save £14 Million if rolled out nationally
Summarise here and move onto users views

13. PROCEED: Summary
Preconception Care reduces abnormalities and improves outcomes in pregnancies complicated by diabetes.
We demonstrated a case for change and piloted PROCEED.
PROCEED a user centred integrated preconception service for diabetes, which is integrated not only vertically across specialities but for the first time horizontally across traditional primary and secondary care boundaries.
It improves productivity, efficiency, PCC rates, pregnancy outcomes as well as responding to user needs.
This model has a recurrent cost of £17, 000, but in the first year has resulted in savings of over £60, 000 locally, as is now commissioned.
Add challenge has been commissioning, but fortunately we are now commissioned through Intercare Health.
We have gone as far as we can go in our area.

14. PROCEED: Learning
PROCEED’S success was as much about building relationships to work across boundaries as it was the service redesign.
Listening to users is important in providing a service that meets their needs.
The importance of a solid financial evaluation should not be underestimated.
The support from the Health Foundation and Springfield was fantastic!

15. Thank You