Vithian Karunakaran
Colchester Hospital University NHS Foundation Trust, UK
Title: Integrating diabetes care to improve diabetes care across the community- experience from North East Essex
Biography
Biography: Vithian Karunakaran
Abstract
The North East Essex Diabetes Service (NEEDS) was established in 2014 with a view of integrating specialist diabetes services with Primary Care across the North East Essex Clinical Commissioning Group area and improving diabetes outcomes. Quality of diabetes care across the region was patchy with delivery of the key 8 care processes of diabetes around 40% and extreme variation seen between different GP surgeries. Amputation outcomes were above national average and less than a third of high risk foot patients being referred to Podiatry.
Since its inception NEEDS has been working closely with the Primary Care workforce through a Practice Enhanced Service that remunerates Practices for delivering 8 care processes and for improving diabetes outcomes with focus on HbA1c, blood pressure and cholesterol. Practices can assess their progress via the Diabetes Dashboard and quarterly meetings enable Practices to benchmark themselves and share best practice. These measures have resulted in delivery of 8 care processes increasing from 40% in 2014 to 74.2% by 31/03/2017. 82.8% have reached target cholesterol levels (cf 76.3% in 2014), 76.6% with BP<140/80 and 75.9% with HbA1c <65 mmol/mol (cf. 69.6% in 2014). The numbers of high risk patients being referred to podiatry have also increased from 27.9% to 85.1% and there is now much less variation between the best performing and least performing practices within this locality.
In summary with proper clinical engagement vertical integration of diabetes services can transform diabetes care and improve patient experience and outcomes.