1. Devices and Desires is a 1989 detective novel by PD James. It takes place on Larsoken, an isolated headland in Norfolk.

2. Devices and Desires is also the title of a TIPS event on May 15 th 2013 where we attempt to crack open how we can achieve our desire to improve outcomes in diabetes by achieving the 9 care processes of the National Diabetes Audit, using some devices to do that.

3. Desires: The Nine 1.Weight : BMI of 18.5 to 25 kg/m 2.Blood pressure : <140/80 mm; <130/80 mm with evidence of kidney, eye or CV damage 3.Smoking status 4.HbA1c: 48-59mmol/mol (6.5-7.5%) 5.Urinary ACR: <2.5 mg/mmol for men; <3.5 mg/mmol for women 6.Serum creatinine 7.Cholesterol : TC <4.0 mmol/L; LDL-C <2.0 mmol/L 8.Annual retinal screening 9.Annual foot examination

4. Some devices…

6. Goal To enable people with diabetes in west Berkshire to live healthier lives by improving outcomes and reducing complications, and to do that efficiently To use the National Diabetic Audit as a tool to measure our success

7. Objectives Informed, engaged patients Informed, motivated HCPs Collaboration between stakeholders – so that patients get the right care when they need it Informatics

8. 1. Collaboration between stakeholders – so that patients get the right care when they need it Stakeholder Network: Diabetes Sans Frontières!

9. Stakeholder Network aka: Diabetes Sans Frontières!

10. Diabetes Sans Frontières! Key stakeholders from: Primary Care, Secondary Care, Service users, Meds Management, Community Nursing, Hospital Nursing, Public Health, Commissioning Terms of Reference in place Collaborative working Monthly meetings Focused on provision and management of services for service users and HCPs

11. 2. Informed, engaged patients Structured patient education: X-pert, DAFNE Care Planning Website

13. The X-PERT Programme: taking control The X-PERT Programme is a 6 week group structured education programme for people with Type 2 diabetes helping them to learn to self- manage and reduce the need for medication. Clinically effective It works because it develops the knowledge, skills and confidence for diabetes self-management through a process of discovery learning and it meets the key criteria to fulfil NICE Guidance

14. The X-PERT Programme: taking control First course starts TOMORROW, May 16th HEIDI is now CLOSED Community DSNs who administer the course have been taking HEIDI referrals for X-PERT Please continue to send referrals for structured patient education using the HEIDI forms, they will be replaced soon by forms specifically for X-PERT Referral of patients to accredited structured education (= X-PERT) forms part of the QoF diabetes domain

15. DAFNE

16. Dose Adjustment For Normal Eating (DAFNE) DAFNE is a way of managing Type 1 diabetes and provides people with the skills necessary to estimate the carbohydrate in each meal and to inject the right dose of insulin.

17. DAFNE provides 38 hours of structured group education, delivered by specially trained DSNs and dietitians, over a 5-day period on an outpatient basis Evidence exists for improved HbA1c, reduced hypoglycaemia, reduced anxiety and improved quality of life. Further cost-effectiveness modelling has estimated that DAFNE improves quality of life whilst reducing costs.

18. DAFNE will be gradually rolled out from secondary care. Patients will be provided with a new meter, the Roche Accu-Chek Aviva Expert. More about this in the session on HbA1c.

19. Care Planning A way of consulting that engages and empowers patients Involves patients getting their results before the consultation and then agreeing goals and actions 1.5 day courses run locally 3/year Mentoring Contact claire.scott11@nhs.netclaire.scott11@nhs.net

22. www. berkshirewestdiabetes.org.uk

23. 3. Informed, motivated HCPs HCP Foundation course PITstop advanced course DSN deployment Enhanced Management of Diabetes Virtual clinics Care Pathway development via Map of Medicine Website

24. HCP Foundation course 2 day foundation course in Diabetes Delivered locally Aimed at HCPs involved in care of diabetes patients who have not completed e.g. Warwick, Bradford 8/9 th October Oakwood Centre, Woodley Contact claire.rowell@berkshire.nhs.ukclaire.rowell@berkshire.nhs.uk LES support for signup

26. PITstop injectable therapies course A 2 ½ day course to lead Practice Nurses and GPs through initiating insulin and GLP1s, and following them up effectively. Accredited by the University of Greenwich Suitable for anyone who has completed a foundation course in diabetes (Warwick, Bradford or local course) and is involved in injectable therapies LES support for engagement with PITstop

27. PITstop injectable therapies course First course: 26 / 27 th June and 19 th Sept 2013 Venue - The Oakwood Centre, Headley Road, Woodley To book a place or for more information please contact Claire Rowell (Senior Diabetes Specialist Nurse). claire.rowell@berkshire.nhs.uk 07920236063 claire.rowell@berkshire.nhs.uk Flyers available at the stand.

28. DSNs in each CCG Help and advice for nurses and GPs Advice hotline set up

29. Enhanced Management of Diabetes >30 practices have already engaged with EMD It is a process of mentoring for practice nurses involved in providing care to people with diabetes An experienced DSN comes to your practice, conducts an audit and with PN/GP selects suitable complex, out-of-control pts to be called to a special clinic

30. Enhanced Management of Diabetes PN runs the clinic in tandem with the DSN who provides mentorship and support PNs who have done this report increased knowledge, confidence and skills Sponsored by Lilly but it really, really is non- promotional. It has been vetted by MM and there have been no reports of drug promotion You will be contacted (if you have not already done EMD)

31. Virtual Clinics A Consultant Diabetologist and Diabetic Specialist Nurse visits your practice at a pre- arranged time to discuss the management of uncontrolled or complicated patients A way of reducing referrals and building knowledge Increases interaction between members of the diabetes care team

32. Virtual clinics Being piloted in all 4 CCGs with Dr Hugh Simpson Will be offered to all practices New Consultant Community Diabetologist (to be appointed this year) will develop this along with Dr Simpson

33. Care pathways have been developed by the stakeholder network Map of Medicine have developed the format Available on the Map of Medicine website which can accessed through our dedicated diabetes website (you will need an Athens password) Care Pathway development

36. www. berkshirewestdiabetes.org.uk

37. 4. Informatics

38. The Big Bang Theory is an American sitcom revolving around 4 nerdy male physicists and a socially aware woman.

39. The Big Bang Theory is also a perfect description of what is happening for the provision of services to people with diabetes and the health care professionals who serve them in Berkshire west.

40. …and now for something different…