1. Community Diabetes Care the hospital view Dr Prakash Abraham

2. 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?

3. Projected Prevalence of Diabetes Mellitus in UK 20012010 2030 1.5m 3.0m 6.0m

4. Grampian Prevalance Approaching 4% Over 19,500 patients with diabetes (April 2006) 12000 in April 2002 10,000 attendances at diabetes clinic

5. 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

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

8. Diabetic Population: Banff & Buchan 19991678 –1.9% of population 20052876 –3.6% of population

9. Place of Care Practice Only Care

10. Place of Care Hospital Only Care

11. Care Parameters Improved

12. Patients and Staff Feedback

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

15. What does the hospital Dr do? Golf Hill walking But still –about 10000 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)

16. Woolmanhill attendances

17. 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

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

19. 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

20. 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

21. GP contract

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

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

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