PROCEED Preconception Care for Diabetes in Derby/ Derbyshire: Paru King, Consultant Physician On behalf of the PROCEED team

The national picture Women with diabetes are: 2-4 times as likely to have a baby with a congenital abnormality. Five times as likely to experience a stillbirth The risks can be reduced by preconception care Only 34% access preconception care 8 000 pregnancies affected in 2011 in the UK Preconception is a NICE Quality standard 2011 NICE diabetes Quaity standard 2011

The local scenario: Derby and Southern Derbyshire %

Gave us the opportunity to pilot PROCEED, the first integrated preconception service for diabetes. Exciting opportunity to pilot the first integrated preconception service

Raising preconception awareness Refer Educators Users (via clinician) GPs Practice Nurses Pharmacy Medicines Review Health Visitors/Surestart Family planning clinics Primary and secondary care diabetes teams Non-diabetes specialist clinicians Build on previous work

CHANGE CONSULTANT ROLE PROCEED: OUR VISION 6Cs CROSS BOUNDARIES (INTEGRATE) COMPETENT CONSISTENT CONTINUITY CHOICE CHANGE CONSULTANT ROLE

Referral by paper, NHS email or telephone Telephone contact by coordinator Hospital clinic (South Derby) Community clinics (Central Derby) Community clinic (North Derby) First visit empower and care planning Signpost to resources across primary and secondary care as appropriate Woman self refers to the antenatal service when pregnant. Flexibility depending on clinical need and user choice

PROCEED : Efficiency and productivity

Impact of PCC P<0.01 P<0.05

PROCEED : outcomes  PROCEED

PROCEED : light and dark green dollar savings

PROCEED: Finance Total annual savings from changes= £61,000 Recurrent cost of service =£17, 000 Overall savings Year 1 =£44,000 / year Could save £14 Million if rolled out nationally Summarise here and move onto users views

PROCEED: Summary Preconception Care reduces abnormalities and improves outcomes in pregnancies complicated by diabetes. We demonstrated a case for change and piloted PROCEED. PROCEED a user centred integrated preconception service for diabetes, which is integrated not only vertically across specialities but for the first time horizontally across traditional primary and secondary care boundaries. It improves productivity, efficiency, PCC rates, pregnancy outcomes as well as responding to user needs. This model has a recurrent cost of £17, 000, but in the first year has resulted in savings of over £60, 000 locally, as is now commissioned. Add challenge has been commissioning, but fortunately we are now commissioned through Intercare Health. We have gone as far as we can go in our area.

PROCEED: Learning PROCEED’S success was as much about building relationships to work across boundaries as it was the service redesign. Listening to users is important in providing a service that meets their needs. The importance of a solid financial evaluation should not be underestimated. The support from the Health Foundation and Springfield was fantastic!

Thank You