1. NHS West Kent Clinical Commissioning Group Level 3: Specialist Community Based Diabetes Service 2016/17 Dr Sanjay Singh, Chief GP Commissioner Dr Andrew Roxburgh, GP Clinical Lead: Diabetes PPG Chairs Meeting: 12 th May 2015

2. NHS West Kent Clinical Commissioning Group West Kent CCG West Kent: 470,000 Population Sevenoaks Maidstone & Malling Invicta Weald Tonbridge & Tunbridge Wells

3. NHS West Kent Clinical Commissioning Group Key Facts Increase in prevalence of diabetes in the UK from 2.4% in 1994 to 5.8% in 2012; Rising trend is predicted to continue from the current 3 million to nearly 5 million diabetic patients by 2025; For West Kent it will mean a rise from 20,485 to 34,140 with diabetes in the next 10 years; Diabetes and its related disorders consumed nearly £23.7 billion from the NHS budget (18.3%) in 2014 and is set to rise to £39.8 billion by 2035, For west Kent CCG this relates to nearly £87 million spent on diabetes alone (with its related conditions and complications) in 2014.

4. NHS West Kent Clinical Commissioning Group Current Provision Level 4: Specialist team within MTW – complex cases Level 3: Specialist team within Maidstone & Tunbridge Wells NHS Trust (MTW) Level 2: Local Enhanced Service delivered by 26 accredited General Practices Level 1: Delivered through the General/Personal Medical Services contract as part of the Quality & Outcomes Framework (QOF)

5. NHS West Kent Clinical Commissioning Group Case for Change Lack of a comprehensive obesity strategy; Current programmes (e.g. Vascular checks) for early detection of Diabetes have had variable impact; Significant variance in Primary care (Level 1 and Level 2); No increase in Primary care capacity to meet rise in prevalence; Lack of ‘workforce planning ‘ for Diabetes in West Kent; Services like specialist nursing, diabetic podiatry, dietetics are mainly secondary care based - both expensive and fails to reach patients who need these services in the community;

6. NHS West Kent Clinical Commissioning Group Case for Change continued Diabetic related preventable non-elective admissions are on the rise and consuming a lot of resources; Most secondary care based diabetes services are based on activity rather than outcomes; The financial risks to the CCG related to the above points are worsening each year with the rise in planned, unplanned and Prescription costs; It is estimated that only 15% of Diabetic patients meet the 3 ‘Best Practice Targets’ (Hba1c 6.5, Cholesterol <4mmol & BP < 135/80).

7. NHS West Kent Clinical Commissioning Group Commissioning Proposal Provide a more local, specialist led service to include: Access to community specialist services for housebound diabetics; Specialist dietetics including psychological support; Specialist podiatry; Insulin pump service; Education and support for patients; Multidisciplinary assessment and case management (specialist, nurse, dietician and podiatry); Education, training and closer communication between this new service and GPs/Practice Nurses; Services would be provided face-to-face as well as via email and telephone as appropriate. Level 3: Specialist team within Maidstone & Tunbridge Wells NHS Trust (MTW) Level 3: Moving services typically provided at hospital to community settings

8. NHS West Kent Clinical Commissioning Group Questions for the PPG Chairs: Prevention: Are you aware of information for patients to prevent them being at risk of diabetes? How can the PPGs help in providing messages to patients on the risks?

9. NHS West Kent Clinical Commissioning Group Thank you for your time