1. Paru King Consultant Physician Derby Hospitals

2. 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

3. 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 % stillbirth rate In %

4. 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

5. 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 to 5 wks
Savings
Efficient, Timely
Productive
Equitable Effective, safe
Improved User Experience
“Excellent”
“First Class”

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

8. Sustain and commission
Commissioning via integrated care

9. Adoption and Spread Presentations and workshops
Presentations and workshops
Feasibility study with Leeds

10. 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

11. 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.

12. THANK YOU
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