Improvement plan for developing the pre-diabetic register and managing diabetic patients

 

Darwen Healthcare in Darwen, Lancashire was the winner of the inaugural Bright Ideas Awards in England.

The problem:

Early in 2015 Blackburn with Darwen CCG offered practices a Long Term Conditions Local Incentive Scheme to develop two improvement plans – one for diabetes and one for respiratory. We researched websites with information about diabetes and felt that providing education to patients at a much earlier stage would eventually reduce or delay the risk of patients becoming diabetics if they listened to the advice and we were able to engage them in self-education. We also hoped that delaying the diagnosing of diabetes would reduce our medication prescribing budget. We wanted to make a difference and offer quality of care to patients and for them to start to take control of their health.

The Bright Idea:

Our idea was to provide lifestyle education for patient whose HbA1c blood tests were within the pre-diabetic range and encouraged engagement and motivation of our patients. Our Advanced Nurse Practitioner (ANP) developed an education program to upskill our healthcare assistants (HCA) to provide lifestyle advice to patients. Patients were opportunistically invited in for an NHS Health Check and all our existing chronic disease patients were also screened with HbA1c blood tests and if a patient had a HbA1c blood result that fell within the pre-diabetic range they were invited in for a 30 minute appointment with the HCA to discuss the results and provide lifestyle advice along with lifestyle information leaflets. They were then invited in for two further 10-minute review appointments one month apart followed by a repeat HbA1x blood test after 3 months.

This would then be followed by an annual review. The ANP used 10 hours of protected study time to develop the protocols. The secretarial staff formatted the protocols, taking 2 hours. HCA training was provided in 3 weekly sessions of 1.5 hours. The practice manager provided oversight to monitor that it could also be sustained for the long term.

The impact:

Patients

Patients are pleased attend these appointments at their own practice rather than having to go out to different areas with staff they do not know.

Two-thirds of the blood tests completed showed a reduction in HbA1c level keeping them within pre-diabetic range.

A recent audit shows out of 546 patients bloods:

  • 253 (46%) had an improvement in their HbA1c
  • 248 (46%) remain with a stable HbA1c in the low range of HbA1c
  • 45 (8%) had an increase in their HbA1c

Workforce

The change has allowed the ANPs and practice nurses to concentrate on managing the already diagnosed diabetics more effectively with better control.

The NHS Health checks were previously completed by practice Nurses and the upskilling of HCAs allowed us to free up 190 practice nurse hours allowing them to concentrate on complex long term conditions.

The staff resources were not increased – we just restructured the nursing team appointments and upskilled clinical staff from the bottom up.

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Bright Ideas for General Practice – Free Events

The RCGP’s Bright Ideas initiative recognises that GPs and practice staff regularly see opportunities to improve their practice, and often do so by taking a fresh and innovative approach. We want these new approaches to be recognised, celebrated and shared, to inspire other practices to consider implementing ideas which have been successful elsewhere to address issues in their practice and to encourage innovative thinking across general practice.

Bright Ideas for General Practice
27 February 2018, Cardiff
The event will include presentations from six Bright Ideas submitters whose ideas have shown a real impact to practice staff, practice processes and/or patient care. This event is free to attend.

At Scale working and Bright Ideas
8 March 2018, Northern Ireland
RCGPNI invites to you a free half­day event to explore and understand federated working in Northern Ireland. This event is free to attend.