Bromley Healthcare Diabetes - an introduction June 2014

working with Single Point of Entry Excellent GP Practice links in place EMDoc GP Out-of-Hours Over ½ million patient contacts per year 800 staff Providing SEL 111 with NHSD & Grabadoc DNA reduction from 13% to 4.3% last year Strong partnerships with SLHT, LBB, Voluntary / Community sector Leg ulcer healing times reduced from 21 weeks to 5 weeks under an innovative pilot service 35+ Service Lines Delivering services in 5 London Boroughs Specialist community service provider with significant local knowledge Introducing… Bromley Healthcare Employee-owned Social Enterprise

working with A brief history Previously the community provider unit for Bromley PCT Took opportunity to define a business case underpinning reasons for spinning out as an independent organisation Established as a standalone provider in April 2011

working with Our staff Employee owned social enterprise Over 800 staff (many have transferred in through TUPE) Over 86% of staff are shareholders – giving input into how the organisation is managed Very high satisfaction (much higher than NHS comparisons) 99% of staff would recommend their friends and families to be treated by BHC Low staff turnover and sickness rates (less than ½ of the NHS rate)

working with The Croydon Diabetes Model Level of Activity 1 (GMS / PMS / QOF requirements) 234 Area of CareDiagnosis/PreventionCore Management Enhanced Management Specialist Management Acute Hospital Management Glycaemia Screening Lifestyle advice Prevention Oral Medication Initiation & maximisation of 3 oral agents Insulin or other parenteral therapy – initiation and on-going advice Poor control/good compliance Insulin pumps Adolescence In Patient care Ante natal BP 1 – 4 agents4 agents poor control LipidsMonotherapyDual therapy Dual therapy poor control KidneysMicroalbuminuria Proteinuric CKD 3b CKD 4/5 FeetLow riskMedium Risk Active ulcers Charcot foot Severe ulceration Need of surgical intervention NeuropathyLow riskMedium painPain & symptom management

working with Exceptions New secondary care referrals will be triaged via the CDS except for: acute type 1 and adolescent; patients on dialysis pregnancy and pre-pregnancy patients using continuous subcutaneous insulin infusion (CS11) patients with a foot ulcer/suspected Charcot/new foot problem patients with diabetes in CKD stage 3 or higher acute diabetes emergencies and urgent cases which will be automatically referred onto secondary care.

working with Benefits Dedicated DSN support Consultant access Psychological services Integrated working with Diabetes UK Patient education DESMOND, Type 2 Education & DAFNE

working with Desmond It provides 6 hours of structured group education according to a formal Curriculum The 6 hours of structured group education can be offered either as a 1 day course, or as a 2 half-day course – the 2 half days being no more than 2 weeks apart Groups consist of 6-10 people newly diagnosed with Type 2 diabetes Each person attending a group can choose to be accompanied by a partner, family member or friend Each person attending a group is provided with patient material especially developed to accompany the programme and intended as a reference guide subsequent to attending the course

working with Desmond - Benefits Access to an evidence-based programme with the backing of the DoH An education programme which meets the standards of the Diabetes NSF Provides patients with a good start in their self-management of their diabetes It empowers patients to self-manage by addressing issues of motivation and realistic goal-setting It brings new skills to the PCT and practices through the DESMOND educators programme It promotes effective partnerships between primary and specialist services

working with Referral Process Patient Education –Continue to refer via CReSS Referrals as from 1 st April –Continue via CRES –New referral form and criteria

working with Locations Key Clinical Hub Patient Ed Satellite clinic

working with Contact details Nurse of the day – dedicated support line: Dedicated support: Service lead, Michelle Barratt: cic.nhs.uk

working with Q & A