1. All Party Parliamentary Group Dr Karunakaran Vithian
Tackling Variation
All Party Parliamentary Group
Dr Karunakaran Vithian

2. Background
Rising demand – 2014/15 prevalence NEE 6.7% v 5.8% (I&ES) & 6.2% (WS)
Relatively high deprivation e.g. Jaywick
In 2013/14 - North Essex lower quartile outcomes:
Care processes – 125th of 206 CCGs
HbA1c <64 – 168th
High rate of amputations
‘Hospital model + outreach’ seen as unsustainable & fragmented

3. 5 Year (+2) contract – commenced 1/4/15
Diabetes & podiatry, outpatients & education – adult only
Separate agreement with CHUFT for inpatient specialist nursing
Approx. £2m per annum – existing budgets & no additional investment
Fixed budget with 25% contingent on delivering KPIs – no exception coding /16 focus on:
8 care processes
Clinical – HbA1c, BP & Chol
Newly diagnosed offered education
Feet – T1s with check, foot ulcers & high risk feet referred to podiatry
Patients with care plans

4. The strategy Diabetes Service Board to manage the services
3 legged model
Patient involvement – Year of Care planning & service delivery
Investment in primary care capacity & expertise
Practice Enhanced Service – outlined on next slide
Monthly extract of data from practice clinical systems
Diabetes Specialist Team – working in the community
Consultants on secondment – Contracted on a PA basis
Specialist nurses, dieticians , specialist midwife & admin
Podiatry – sub-contacted back to community provider

5. Primary care PES - £6.44 over five years
Governance
Practice lead GP & nurse
Quarterly meetings with consultant & Link DSN
Referrals triaged via Specialist Team
Monthly primary care data extract
Case finding e.g. IGR
Implement Year of Care
Manage wider range of patients – stable T1 & T2 discharged from hospital
Involve partially engaged
Focus on KPIs – moved to 100% on outcomes from 2015/16

6. Achievements April 2014 March 2015 Dec 2015 NDA Participation 84% 93%NA
Number of patients with diabetes on register
17470
18400
18766
8 care processes
40.1%
60.3%
68.3%
Structured education for newly diagnosed
Unclear
50% T1DM
85%T2DM
60.7% T1DM
88.9% T2DM
HbA1c<65 mmol/mol
66.9%
65.8%
66.8%
Cholesterol<5
71%
74.2%
85.8%
BP<140/80
67.4%
70.3%
73.4%

7. 8 care process achievement 01/04/2014

8. 8 care process achievement in 01/04/2016

9. 8 Care processes