Paru King Consultant Physician Derby Hospitals

The national picture Preconception care reduces the risks of pregnancies complicated by diabetes. 2-4 times as likely to have a baby with a congenital abnormality. Five times as likely to experience a stillbirth Women with diabetes are: Only 34% access preconception care 1:250 pregnancies affected by diabetes Preconception is a NICE quality standard NICE diabetes Quaity standard 2011

The local scenario: Derby and Southern Derbyshire 600,000 population 6000 deliveries year 50 with diabetes 300+ GDM PCC in antenatal clinic 32% PCC rate 10% abnormality rate 6% stillbirth rate In 2002-3 %

Family Planning Clinics PROCEED: HOW? Raise Awareness Delivering Care Refer Health Visitors Family Planning Clinics Practice Nurses/ GPs Users 6 Cs Choice Cross Boundaries Pharmacists Consultant Role Competent Educators Continuity Consistent

PROCEED: OUTCOMES (12 months) £68,000 £40,000 “dark green dollar” Better prepared PCC rate 32 to 70% Abnormalities 10 -4% Stillbirths 6% to 0. Doubled numbers DNA 18 to 5% Waiting time 13 to 5 wks Savings Efficient, Timely Productive Equitable Effective, safe Improved User Experience “Excellent” “First Class”

Sustain and commission PROCEED: What next? Challenges Sustain and commission Spread Accurate cost savings Further funding from The Health Foundation

Sustain and commission Commissioning via integrated care

Adoption and Spread Presentations and workshops www.derbyproceed.co.uk Presentations and workshops Feasibility study with Leeds

Costs from congenital abnormalities: 3 centre audit Health and social care costs evaluated using HRG codes Lifetime costs Differing levels of disability £3,270, 000 savings compared with an estimated £7000

Summary Preconception care (PCC) improves outcomes of pregnancies complicated by diabetes. Nationally, the uptake of PCC remains poor We developed PROCEED, the first integrated model for preconception care that integrates care vertically and horizontally. The model has improved quality whilst saving money. We have sustained the improvements, and developed a website and costing tool to facilitate its adoption and spread.

THANK YOU www.derbyproceed.co.uk Contact us: dhft.proceed@nhs.net