1. Prevention & Transformation
Diabetes
Prevention & Transformation
Dr Neel Basudev
GP Lambeth
Lambeth CCG Diabetes Lead
Clinical Director Diabetes Health Innovation Network (South London AHSN)
Co-chair South London Healthier You Partnership Board

2. Things to cover Type 2 Diabetes Prevention Programme
Overcoming disengagement. How effective is primary care?
Diabetes Transformation

3. Type 2 Diabetes Prevention Programme
Care on the Frontline
Type 2 Diabetes Prevention Programme

4. Evolution of Obesity

5. The Evidence Base

6. Drugs or diet to prevent diabetes?
Gillies meta-analysis, BMJ 2007
Gillies et al. BMJ 2007;334:299

7. Referrals into the programme
Despite a slow start, partners in south London have exceeded referral targets consistently since January.

8. Uptake into the programme (uptake defined as attendance at initial assessment appointment)
NHS England modelled that 40% of referrals would convert into an intervention.
The average in south London currently is 57% - ranging from %.

9. Healthier You NOT discussed
Local Picture
Total Referrals
Healthier You NOT discussed
April
May
June 34 9 44 25 24

10. Comparison

11. Flow chart

12. Coding and Feedback Monthly Feedback Minimal coding required
NDH register…metrics…referred & completed

13. The patient perspective
When we go to the course, we discuss things that motivate you.
The changes we’re making are really sustainable. It’s not about dieting and eating less, it’s about healthy alternatives and small lifestyle changes
I really look forward to the programme – it’s local, the coach is very friendly and helpful, and the materials we are given are very easy to use and understand
I’ve lost seven kilos so far
It’s been a real eye-opener. The coaches aren’t telling you what to do – it’s your choice

14. % breakdown of referrals attending an Initial Assessment (IA) by gender (as at 31.5.17)

15. % breakdown of referrals attending an IA by age-group (as at 31.5.17)

16. % breakdown of referrals attending an IA by ethnicity (as at 31.5.17)

17. % breakdown of referrals attending an IA by deprivation quintile (as at 31.5.17)

18. Overcoming disengagement How effective is primary care?
Care on the Frontline
Overcoming disengagement How effective is primary care?

19. Negotiator and salesperson
Non-compliance
“Act of obeying an order, rule or request”
Does this suggest collaboration?
Disengagement occurs at many levels
Patient (motivation, right place right time)
Provider (maintain momentum for all)
Commissioner (connective tissue)
HCP (quality of the “sell”)
What’s your sales pitch?
Negotiator and salesperson

20. How to explain the obvious

21. Attendance at structured education
DAFNE
Non- attenders
Male
BME
Older age
Social deprivation
Attenders
Positive HCP message
Female
Educational attainment
HbA1c
DESMOND
Non-attenders
lack of information/perceived benefit of the programme 
unmet personal preferences
shame and stigma of diabetes
“To improve uptake at structured education we need to consider how health professionals in primary care communicate with their patients on the subject of structured diabetes education….
Health-care professional attitude to courses is key….”

22. “Words are of course the most powerful drug used by mankind”
Rudyard Kipling

23. Any Data? Let’s Prevent Diabetes
6 hours group plus 3 hours refreshers at 12m+24m
Telephone calls every 3m
Cluster randomised 44 practices
17,972 at risk population (risk score)
3449 (19.2%) attended
880 (4.9%) enrolled
22% intervention arm did not attend initial session
29% attended all 3 sessions
Overall: 26% RR developing T2DM
Full attendance: 88% RR developing T2DM

24. Diabetes Transformation
Care on the Frontline
Diabetes Transformation

25. Overview Initiative Start date Objectives Partners
National Diabetes Prevention Programme (NDPP)
Sept 2016
Increase detection of glucose intolerance and pre-diabetes, and offer weight management/healthy eating/lifestyle support programme to prevent onset of diabetes (Our Healthier You)
All South London CCGs
Treatment Targets
April 2017
Improve the control of Hba1c, BP and cholesterol as a composite measure in general practice, and 8 care processes through:
Education of staff
Targeted support to practices
Dashboard/benchmarking of performance
Lambeth CCG
Southwark CCG
Lewisham CCG
Greenwich CCG
Structured Education
Improve the referral, uptake and completion of structured education for diabetes, through a South London co-ordinating hub, and offer wider choice of courses available across a wider geographical area.

26. South London structured education
HCP education
Design and deliver an education programme with strong consideration given to patient-led sessions and/or e-learning resources to include patient impact stories, motivational techniques, the importance of applying standardised data coding for referral, attended and completed; strengthening call and recall in primary care; developing diabetes care navigator/champion roles to maintain and sustain awareness of all of the above
Structured education hub
To agree cross-charging for structured education courses, to enable patients to attend the right course at the right time and in the right location (i.e. to meet personal time and location commitments, language, cultural needs) – cross boundary access initially across South London and North West London – intention to later stretch pan London
Workforce ‘Think Diabetes’ initiative
To focus on STP partner organisations to deliver a ‘Think Diabetes’ initiative and review current HR policies, including:
Awareness raising of the importance of employees with diabetes attending structured education
Addressing gaps in HR policies to facilitate attendance at structured education
Commitment across all elements to evaluation to support the sharing of learning and successful practice

27. South London Structured education Hub - COORDINATED SERVICE PROVISION
Lifelong self- management support for individuals with Type 1 and Type 2 diabetes
Structured Education Hub
Process and triage referrals
Conduct patient facing activities to review patient preference and activation level
Book courses and send patient reminders.
Signpost to other lifestyle services
Signpost to the latest diabetes apps and resources
Use data to conduct proactive outreach and case finding
Maintain an educator bank including peer educators
A website to promote life-long learning for patients, and support for clinicians
Collect and collate outcome data, then report this to primary care for recording and CCGs for demand and capacity analysis
Resources such as clinical e-learning modules and Think Diabetes
Structured Education Hub
Primary health care provider
Structured education provider
Primary health care provider
Refer to Hub from primary care, secondary care, or a community diabetes service
self-referral directly to the SE Hub encouraged
Structured education provider
Receive referrals from the Hub
Provide structured education
Record outcome data and submits to SE Hub who then chase DNAs and submit outcome data to the primary health care provider and/or GP

28. Thanks for listening
Questions?