1. Diabetes Clinical Audit- July/Aug 2014
147 new patient referrals and
178 follow up referrals were audited.
Jamie- can you complete the numbers based on returns

2. Some Facts
There is significant growth in diabetes prevalence and service demand for care in the future.
Currently over 15,000 adults in SW with diabetes, 80-90% of which possess type 2 diabetes. This figure is destined to rise with new diagnoses expected each year.
It is estimated that a further 10-15,000 people remain undiagnosed.
Actual prevalence is expected to grow from 7.5% in 2012 to 9.4% in 2030, which will be higher than the England national average.
We have seen a 22% increase in new patient attendances and 10% increase in following up appointments over the last two years (11/12 to 13/14) across diabetic medicine outpatients for SW.

3. QOF Position as of 12/13 13/14 data not yet available
Indicator
SW Value and CCG ONS ranking 2011/12
SW Value and CCG ONS ranking 2012/13
SW Value against CCG ONS ranking 2012/13
Trend
Aspirational target (to be in top 10% of ONS group 2012/13)
Practice distance from target
DM % patients with diabetes in whom last HbA1c is 8 or less (formerly DM27)
77.2
72.3
73.5 1
73.0
0.4
DM003 - % patients with diabetes in whom last BP is 140/80 or less (formerly DM31)
64.0
66.0
73.2
71.4
1.8
DM004 - % patients with diabetes whose last measured total cholesterol is 5 or less (Formerly DM17)
71.7
70.8
74.1
75.3
-1.2
DM005- % of patients with diabetes, on the register, who have a record of an albumin: creatinine ratio test in the preceding 12 months
83.1
82.2
82.1
87.2
-5.1
DM007- % of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 59 mmol/mol or less in the preceding 12 months
68.3
63.9
66.1
64.2
1.9
DM012- % patients with diabetes, on the register, with a record of a foot examination and risk classification
84.1
85.4
85.5
88.3
-2.8
DM002- % of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less
86.1
86.0
88.7
88.6
0.1
DM006- % of patients with diabetes, on the register, with a diagnosis of nephropathy (clinical proteinuria) or micro-albuminuria who are currently treated with ACE-I (or ARBs)
80.9
79.8
81.7
84.3
-2.6
Top 10%
Top 10-25%
Top 25-50%
Bottom 10-50%
Bottom 10%
68.3
81.7

4. First Out Patient referrals

5. Jamie- can we increase font size of x axis, don’t think they will be able to read
can we add % of patients as well as number of patients
Can we colour code to full LES , partial and non LES

6. Could referred patients have been managed differently?

8. Can % be added and LES non LES colour code

9. Who sees the Type 2 patients referred?

10. Increase font on x axis

11. Thoughts
Diabetic medical management increasingly complicated as so many new drugs (increasingly within class).
Confusion with which drugs are allowed to be initiated within primary care.
Many practices have a lead in DM which is increasingly needed when treatment regimes get more complicated.
Many referrals for Insulin or GLP1 initiation could these be done in practice.
A common reason for in retrospect being able to have dealt with the referral differently was awareness with what practices already have.
Very little referrals for preconception ? Should we refer more?
Many more patients where referred for DSN advice but saw a consultant first before being referred on to the DSN.

12. Follow ups

17. If under shared care could you manage the patient solely in primary care

18. If under hospital care could you manage the patient under shared care

19. Thoughts on follow up Patient choice is a factor in 12%.
Many patients followed up for years.
GP’s who conducted the audit felt >50% could have increased follow up in primary care.
This is the first time in years we have looked at this. Is there a way of changing substantially what happens. Challenging the inertia?
Secondary care is concerned that if they discharge patients with suboptimal control to primary care they may just be referred back.