Can you help?

This blog is one of the dullest ones I have ever written.  I don’t think I will get any awards for the most riveting reads. It is a bit technical and there are only about 300 people in the country that might find it useful.  I'm not really selling it am I?

But I wonder if  all of you could  all help?

Do you know who your CCG Lead GP and Lead Diabetes Commission Manager is?

If you do, can you forward this blog to them?  If you don’t, could you find out and pass this blog to them? 

I am hoping this blog will help them to support improvement in the CCG Improvement and Assessment Framework indicators for diabetes.

I’ll try and explain how.

This year’s National Diabetes Audit report was published on the 31st of January 2017.

The data for this report was uploaded last Summer.

The National Diabetes Audit is the source data for the CCG Improvement and Assessment Framework.

The participation rates in the National Diabetes Audit dramatically increased from 57.3% in 2014/15 to 82.4% in 2015/16.  The data this year for most CCGs will be much more reliable.

So the report gives us some clues about how each CCG will be preforming in this year’s CCGIAF Assessment for the 2 diabetes indicators:

·         “Diabetes patients that have achieved all the NICE-recommended treatment targets: Three (HbA1C, cholesterol and blood pressure) for adults and one (HbA1C) for children.

·         People with diabetes diagnosed less than a year who attend a structured education course”

We are expecting the CCGIAF assessment to be published sometime in early Spring.  The results were published last year on My NHS.

6 CCGs already know that they will be ranked automatically as “Greatest Need for Improvement” for their diabetes indicators because they had less than 25% of practices participating.

We also already know, that based on the NDA report, most CCGs will find that they have not improved since the CCGIAF report last year. 

Do not panic!

There is a reason for this.

We only knew what the indicators were in April 2016.  This gave us only 3 months before the national diabetes audit upload period in the Summer of 2016.  3 months did not give enough time to deliver any significant improvements.

HOWEVER, the next audit upload period is provisionally expected during June and July this year.  By this point we would have known about the 2 diabetes indicators for 15 months.  So we should expect to see some improvement when the data is reported on early in 2018.

Do you think we will see improvement?

My urgent advice is to get some retrospective data inputting done.

Use the recently published guidance on simplifying coding for structured patient education and work with your providers to identify those patients that have been referred to structured diabetes education since April 2015.  Then find a method to get that data into your GP systems………….. and do it before the 1st of June 2017.

Why all the way back to April 2015?  Well the NDA data capture for attendance at structured education has changed:

“Structured Education was collected differently in the 2015-16 audit.  This has meant that the time between diagnosis and the offer of structured education to the person with diabetes can be determined in days.  Therefore the numbers of people newly diagnosed within the calendar year and gives the number and percentage of people that have been offered structured education in the following 12 months, and the number and percentage of people that have attended a structure education programme in the 12 months following diagnosis .” NDA Report 2015/16

We know, from the work done by the York and Humber Clinical Network, that the “attendance” at education is poorly captured in GP systems. 

If want a quick win it would be helpful to work with structured education providers and GP practices to input this retrospective information.

Also I have a hunch that data capture for Type 1 treatment targets in GP systems could be improved too. 

I know this is dull stuff but could you help to make sure your CCG Diabetes Leads read this blog?

I need to thank Surrey Heath CCG for inspiring me to write this blog and the East Midlands Clinical Network Diabetes Lead who pointed out some important technical detail.

And ...... thank you for your help too.

Diabetes and Non Clinical Staff

Sorry for the silence.  I have been buried in the exciting Diabetes Transformation Bid process which has taken over many people’s lives ever since the application forms came out in December.  We wait to hear the results but we know that it was extremely competitive with 252 bids submitted across England for a portion of the £42m on offer.

So while we await in eager anticipation for the results I thought I’d do my first small piece of lobbying.

Did you know that there are 583,837 non-clinical staff in the NHS.  I didn’t.  I read it in the Health Service Journal published in May 2016.

Bring out your violins but sometimes I feel, as a non-clinical member of the NHS, like a second class citizen.  Even today my non-clinical role was labelled as “bean counter” and “key board warrior”.  None of it personal but still a little ouchy for a sensitive soul like me.

This feeling was reinforced by Diabetes UK last week.  Diabetes UK are advertising for more Diabetes UK Clinical Champions.

I would urge any clinical staff to apply, including Allied Health Care Professionals, Practice Nurses, Retinal Screening, Health Care Assistants, all clinical staff are eligible.  The programme, by all accounts, is really really wonderful.  It is such a luxury to have a programme where you can have quality education, surrounded and immersed in your specific area of interest.

I think the next round of places will be hotly contested.

The truth is…………….. I’m jealous.

Where are the opportunities for non clinical staff to get really good education on the disease area that they are most focused on?

I think it is human nature that we are sometimes more interested in things that we know more about.  I’ll admit, whilst I love learning something new, my eyes sometimes glaze over when a meeting turns to a topic I know nothing about and cannot contribute anything useful.

Don’t your ears prick up when discussions turn to something you are interested in and know something about?

What better way to win hearts and minds of Diabetes Commissioning Managers, Diabetes Network Managers, Diabetes Service Managers, Diabetes Clinic/Education booking staff, etc than to give them a better understanding of diabetes.  For example, I think it would be great if all managers working in diabetes knew the difference between type 1 and type 2 diabetes and why that might impact your discussion with a patient when booking them into a clinic, or the sort of service you are supporting to commission.

Obviously a doing a needs assessment first would be handy, after all, not everyone is as geeky as me.  It might prove that non clinical staff might not be remotely interested.

But quality education in diabetes could enable more non clinical managers to have confident conversations with their clinical colleagues.  It might enable better decision making and quality interactions.

So if anyone is willing to run education for Diabetes “Champions”, please put my name down.

Let’s have Diabetes champions ………………… whoever you are.

Above and Beyond

The submission deadline for the Diabetes Transformation Fund is today at 5pm.

I can almost hear the collective sigh of relief from everyone across the country involved in creating these extensive and complicated bids.

And you are all absolutely amazing. 

Hours and hours of meetings and work have been ploughed into developing the bids.  Putting a finger in the wind I suspect that nearly every CCG in the country will be a part of one or more bids.   That’s absolutely fantastic.  To complete the documents required has been a labour of love.   As always, NHS staff, have given up hours of their own time to ensure that they have submitted the best bids they can.  It also demonstrates the importance that CCGs/STPs/Providers places on care for people with diabetes. They have gone above and beyond to get the best they can for people with diabetes.

Everyone has approached the bids in different ways.  Some have done a careful analysis of local needs and have bid for their priority area in the 4 bid categories (Multidisciplinary Foot Care Teams, Diabetes Inpatient Nursing, Treatment targets and Structured Patient Education).  Some have hedged their bets and have put in a bid for all 4 categories.  Some have bid as a single CCG and some have bid in line with local patient pathways or STP footprints.  Some CCGs have done a single bid and a collaborative bid.

All have gone above and beyond. All have worked extremely hard.  If the bid evaluation was just based on effort and commitment alone everyone deserves some funding to support their plans for diabetes.

However, we know that if nearly every CCG does have at least 1 or more bids the chances are that it will add up to more than the £44m pot available.  We know that this is competitive process.  We know that there is potential for some to have put the effort in but will be disappointed. This funding will not solve all the issues that we are being asked to address, through the "STP Diabetes Aide Memoire" but every bit will help. 

Whatever happens, the richness of conversations that the bid process has created has been fantastic.  The discussions across boundaries, the further understanding of local need prompted by the bid process can only go towards supporting what has to be delivered in the CCG Improvement and Assessment Framework and the Diabetes STP Aide Memoire. None of this effort will be wasted

Ultimately you had to be in it in win it.  Everyone has done their level best to compete for a little bit extra for their local services.  Like an exam, you have done all the hard work, you have done everything you can.

We hope to hear the outcome of the bids by mid March 2017.

You have all gone above and beyond.  You are all amazing.  Good luck.