Bromley Healthcare

Diabetes - an introduction June 2014

Introducing… Bromley Healthcare

Single Point of Entry Specialist community service provider with significant local knowledge 800 staff Providing SEL 111 with NHSD & Grabadoc Excellent GP Practice links in place Strong partnerships with SLHT, LBB, Voluntary / Community sector 35+ Service Lines DNA reduction from 13% to 4.3% last year Employee-owned Social Enterprise Leg ulcer healing times reduced from 21 weeks to 5 weeks under an innovative pilot service Delivering services in 5 London Boroughs Over ½ million patient contacts per year EMDoc GP Out-of-Hours working with

A brief history

• Previously the community provider unit for Bromley PCT • Took opportunity to define a business case underpinning reasons for spinning out as an independent organisation • Established as a standalone provider in April 2011 working with

Our staff

• Employee owned social enterprise • Over 800 staff (many have transferred in through TUPE) • Over 86% of staff are shareholders – giving input into how the organisation is managed • Very high satisfaction (much higher than NHS comparisons) • 99% of staff would recommend their friends and families to be treated by BHC • Low staff turnover and sickness rates (less than ½ of the NHS rate) working with

The Croydon Diabetes Model

Area of Care Glycaemia BP Lipids Kidneys Feet Neuropathy 1 (GMS / PMS / QOF requirements) Level of Activity 2 Diagnosis/Prevention Core Management Screening Lifestyle advice Prevention Oral Medication Initiation & maximisation of 3 oral agents Enhanced Management Insulin or other parenteral therapy – initiation and on-going advice 1 – 4 agents Monotherapy Dual therapy Microalbuminuria Low risk Proteinuric CKD 3b Medium Risk 3 4 Specialist Management Poor control/good compliance Acute Hospital Management Insulin pumps Adolescence In Patient care Ante natal 4 agents poor control Dual therapy poor control Dual therapy poor control CKD 4/5 Low risk Medium pain Active ulcers Charcot foot Severe ulceration Need of surgical intervention Pain & symptom management working with

Exceptions

• New secondary care referrals will be triaged via the CDS except for: • acute type 1 and adolescent; patients on dialysis • pregnancy and pre-pregnancy • patients using continuous subcutaneous insulin infusion (CS11) • patients with a foot ulcer/suspected Charcot/new foot problem • patients with diabetes in CKD stage 3 or higher • acute diabetes emergencies and urgent cases which will be automatically referred onto secondary care.

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Benefits

• Dedicated DSN support • Consultant access • Psychological services • Integrated working with Diabetes UK • Patient education DESMOND, Type 2 Education & DAFNE working with

Desmond

• It provides 6 hours of structured group education according to a formal Curriculum • The 6 hours of structured group education can be offered either as a 1 day course, or as a 2 half-day course – the 2 half days being no more than 2 weeks apart • Groups consist of 6-10 people newly diagnosed with Type 2 diabetes • Each person attending a group can choose to be accompanied by a partner, family member or friend • Each person attending a group is provided with patient material especially developed to accompany the programme and intended as a reference guide subsequent to attending the course working with

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Desmond - Benefits

Access to an evidence-based programme with the backing of the DoH • An education programme which meets the standards of the Diabetes NSF • Provides patients with a good start in their self-management of their diabetes • It empowers patients to self-manage by addressing issues of motivation and realistic goal-setting • It brings new skills to the PCT and practices through the DESMOND educators programme • It promotes effective partnerships between primary and specialist services working with

Referral Process

• Patient Education – Continue to refer via CReSS • Referrals as from 1 st April – Continue via CRES – New referral form and criteria working with

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Key

Clinical Hub Satellite clinic Patient Ed working with

Contact details

Nurse of the day – dedicated support line: 01689-865911 Dedicated e-mail support: [email protected]

Service lead, Michelle Barratt: michelle.barratt@bromleyhealthcare cic.nhs.uk

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Q & A

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