Does Size Matter?

This week I went to the beautiful Taunton to join in a meeting about preparation for Wave 2 of the Healthier You NHS Diabetes Prevention Programme.  It is anticipated by the end of 2018/19 that the whole of the country will have access to the Programme. 

One of the key questions for Wave 2 and Wave 3 sites will be: What is the optimal programme size?

The Five Year Forward Vision ambition is that: “Support delivery of the STP process which states that by 2020 local health economies should have developed comprehensive strategies to tackle obesity and diabetes prevention locally, with the aim of referring 500 people per 100,000 population annually to an evidence based Type 2 diabetes prevention programme.”

The word “referring” is important because a referral does not mean that the referred person will actually turn up at the course.  The way the person is referred will impact on the chances of attendance.  For example, we already know from the “Demonstrator Sites”, that a mailshot to patients identified as “at risk” and asking them to call to book a place has a lower uptake rate than referral further to a one to one discussion with the local GP practice.

Wave one sites are providing the opportunity to test the “Optimal” programme size.  Some Wave one NDPP sites have less than 200,000 population and the biggest site (South East) has a catchment size of 4,628,531!

Let’s be optimistic.  Let say that for every person referred 50% turn up.  That would mean that if programme catchment area was 100,000 population you would see 250 people attend courses.  That would mean 17 courses (or 15 people her course) per year when the programme was fully up and running.  It’s not enough.  That’s 1 course every 3 weeks that has to be sited somewhere convenient and accommodate any special needs, hearing loops, wheel chair access, interpreters, etc. To get good availability and convenience you need to go bigger.

The South East has the biggest catchment for a Wave One site.  The population is 4,628,531 and covers 3 counties across 20 CCGs and 6 local authorities.  Based on 50% attendance that would mean 767 courses were needed per year.  There is less pressure to have the programme delivering lots of referrals from the start of the programme to ensure that enough courses can be filled and a lot more courses offered to provide a variety of places.  However, the South East site is very big geographically.  You can imagine, trying to match course location to where referrals will be popping up from, particularly in the early days, will be extremely tricky.

So what is too big, what is too small and what is just right?  Are STP Footprints just the right size?

Well again, STP Footprints cover a population size of 300,000 in West, North & East Cumbria to 2,800,000 in Greater Manchester. 

Size is important.  But maybe equally important is who is going to lead and coordinate the implementation of the programme?  STP Footprints are definitely an appealing option but they will need some infrastructure and a project lead identified to lead the work.

So 2 key questions to consider for future sites for the Diabetes Prevention Programme:

1)      Think size

2)      Think lead coordination

Oh – and don’t forget to check that diabetes prevention is definitely in your STP plans.