LEICESTER, LEICESTERSHIRE AND RUTLAND (LLR)

Improving the delivery of diabetes care

The Diabetes UK report 'Improving the delivery of adult diabetes care through integration' shares key lessons for commissioners and providers to overcome barriers and improve the delivery of diabetes care in their area. LLR is included as a case study in that report. Information about the model of care being developed in LLR is provided below. For a full explanation of how an integrated model of diabetes care should look please download the report.

The model of care

Organisations involved: Leicester City CCG, East Leicestershire and Rutland CCG and West Leicestershire CCG. The Leicester Diabetes Transformation Project Operational Steering Group includes clinical leads, University Hospitals of Leicester consultant diabetologists and patient representatives.  

Prevalence of diabetes: 54000 people are diagnosed with diabetes in LLR.

Delivering diabetes care in Leicester: in 2012/13 LLR were allocated £1m transformational funding to undertake a full pathway review for diabetes. This included a full spending review as well as a review of each element of the pathway from prevention and early diagnosis to management of complications. The aim was to determine the "what, where, who and how" of delivering diabetes care, considering the clinical expertise and skills needed.

This model is an adaptation of the 'super six' used in Portsmouth, which centres on defining the areas of diabetes care which must be delivered by a specialist and providing the appropriate training to enable primary and community care to deliver the rest.

A key feature of the redesign in Leicester is the provision of education for people with diabetes and for those at high risk. Across the CCGs, the aim is to provide:

• An evidence based patient intervention programme for the prevention of Type 2 diabetes
• Access to DESMOND for people with Type 2 diabetes and access to DAFNE for all people with Type 1 diabetes.

Supporting the delivery of whole pathway diabetes care

To effectively support the delivery of this whole pathway of care, the LLR model introduces the following:

IT: data sharing agreements are in place across all practices and are reported at CCG level.  

Aligned finances and responsibility: defining responsibility for the delivery of every aspect of diabetes care is central to this model. GPs are responsible for core service provision and suitably trained practices can provide an enhanced service commissioned by the CCG. Training is provided by CCGs to ensure competence to deliver core and enhanced services as appropriate. Further support is offered by specialists working as part of a community diabetes specialist support team. This team includes diabetologists, diabetes specialist nurses and dietitians, they provide support and advice for practices offering an enhanced service. For people with diabetes registered at clinics not providing an enhanced service this is provided by the community specialist team.

To further support clinicians in their delivery of specific aspects of diabetes care a programme of workforce education and training is available.

Clinical engagement and leadership: The Transformational Project Operational Steering Group included representatives from primary, community and specialist care. As part of the initial assessment of service transformation subgroups were formed including diabetes specialists, GPs and specialists with appropriate skills and knowledge of that area (e.g. midwives and obstetricians).