Assignment

Assignment

1. Background

Diabetes has become a significant priority both for the PCT locally and across the national picture. It is one of the three main priorities in the PCT commissioning strategy plan. With incidence increasing, it will form an increasing part of expenditure. The PCT has been working through the Public Health Department, with PBC leads, and the Community Provider Unit to develop a revised specification for diabetes services which will bring services closer to primary care and to community bases.

2. Health Needs Assessment

Incidence of Diabetes in Bromley is increasing (see table below). Nationally 90% of patients have Type 2 Diabetes whilst the remaining 10% have Type 1. Of those with Type 2 Diabetes 20% will require specialist support for complications.

2003/04

2004/05

2005/06

2006/07

2007/08

2008/09

No on practice diabetic register

8,661

9,244

10,084

10,504

11,994

12960

(est)

DM prevalence

2.7

2.92

3.18

3.28

Note: estimate for 2007-08 is from Diabetes retinal screening register

estimate for 2008/09 is based on an anticipated 8% increase in prevalence (Diabetes UK stats)

Diabetes has a significant impact on health:

Diabetes accounts for 8% of the NHS budget nationally,

People with diabetes are twice as likely to be admitted to hospital as the general population and once admitted have a length of stay up to twice the average. (Local data from an inpatient audit in 2006 showed a similar outcome.)

Diabetes complications such as heart disease, stroke, renal failure and amputation increase costs more than five fold.

3. Current Service

The current service delivery for Diabetes can be broken down into several components.

(a) Primary Care

General Practice work to an agreed Shared Care Protocol managing mainly Type 2 diabetic patients working to QOF requirements.

(b) BHT Out Patient Clinics

The current out patient service provides:

3 Consultant led clinics per week (1 with additional medical support)

1 Medical Assistant led clinic per week

1 Joint Obstetric clinic per week

4 sessions Dietetic support.

Consultant advise and clinical leadership on Diabetes and support for primary care.

Specialist services for Vascular, renal, Type 1 education and insulin pump management are referred to Kings and Lewisham.

(c) PCT Diabetes Specialist Nursing Service

This service is provided by the Community Provider Unit operating out of the Diabetes Centre and consists of:

Support Consultant and Obstetric clinics

15 nurse led clinics per week

Telephone support for patients.

Support and education to Practice Nurses, including Insulin for life programme.

Support to inpatient care for BHT, this is an informal good will arrangement.

(d) PCT Community Diabetes Team

The Community Team provides:

Diabetes Specialist Nurse, Dietetic and Podiatry support, advice and education for primary care.

Individual patient advice for patients at home, including Nursing Homes (linked with District Nursing)

6 clinics per month for insulin initiation

6 Dietetic clinic per month

DESMOND Programme (3 x 6 hour programmes per month)

Education and support for health professionals and nursing homes.

GP Lead support

(e) PCT Podiatry Service

Support for Diabetes is provided as part of the mainstream Podiatry service.

(f) In Patient Services

Inpatient care is delivered predominantly from BHT under the management of the Consultant Endocrinologist. At present a good will in patient DSN support service for high risk patients is provided by the Community Provider Unit.

The current anticipated cost of the out patient and community diabetes service in 2008/09 is set out ...