Download Slide 1 - Parsons Heath Medical Practice

Proposed Integrated Diabetes
Care Model
Tina Teague – Head of Locality Commissioning
Trish Brown – Practice Nurse/Mid Devon Clinician
to Clinician (C2C) Diabetic Lead
Catherine Argyle – Specialist Diabetic Nurse
Proposed Care Model
• Aims for equity of capability & capacity
• Recognises the need for invest to save
• Proposes 4 tiers of care provision&
commissioning options
• Identifies education (patient, community
nurses, GPs)
• Formalises the role of community DSN
• Identifies local commissioning groups as being
key to implementation
RD&E Diabetes Activity Trends – Mid Devon
New Outpatients
35
30
25
20
General
15
Obesity
10
Specialist
5
0
2009/10
Month
General
Obesity
Specialist
2010/11
Q1
Q2
25
0
16
2009/10
Q3
28
10
18
Q4
25
14
16
Q1
29
17
20
2010/11
Q2
33
19
22
Total
32
17
21
Total Cost
172
£41,108
77
£18,403
113
£27,007
RD&E Diabetes Activity Trends – Mid Devon
Follow Up Outpatients
200
180
160
140
120
100
80
60
40
20
0
General
Obesity
Specialist
2009/10
Month
General
Obesity
Specialist
2010/11
Q1
Q2
145
0
75
2009/10
Q3
Q4
145
150
23
37
77
80
Q1
171
43
92
2010/11
Q2
Total
Total Cost
170
190
971
£89,332
43
48
194
£17,848
91
102
517
£47,564
£245/Consultation
£130
£70
Mid Devon Diabetes
C 2 C and other Meetings
Trish Brown
10/01/2011
Local Vision
• To provide a world Class service, in which
Primary and Secondary care is integrated.
• Every patient will have access to the most
appropriate team to provide care.
• Quality will be measured and services
modified with a view to improvement.
Restructuring Diabetes Services
Entry Criteria
Exit Criteria
Initial management T1DM
Complications
Atypical Diabetes
Erectile Dysfunction
Young People
Insulin Pump Therapy
Ante-natal
Retinal Screening
New Referrals
Podiatry
Self management - plan
Management stable
Established diagnosis - Plan
Management Plan
Up to age 21- ? Adult Care
Established management
No longer Pregnant
Continue as before
Stable / Management Plan
Integrated Foot service
Other Service Provision
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Community Specialist Nurse
Structured Patient Education-all new T2 DM
Community Consultant / DSN clinics DGH
All Annual Reviews in General Practice
Education Programmes for PNs and GPs (Survey)
Updated Diabetes Formulary – Treatment Pathway
Protocol and Pathway Development
Telephone and Email advice
Accessible updated website