Bromley Healthcare
Diabetes - an introduction
June 2014
Introducing… Bromley Healthcare
Single Point of Entry
Providing SEL 111 with
NHSD & Grabadoc
Specialist community service
provider with significant local
knowledge
Excellent GP Practice
links in place
800 staff
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
Over ½ million patient
contacts per year
Delivering services in
5 London Boroughs
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
Level of Activity
1
2
(GMS / PMS / QOF requirements)
Diagnosis/Prevention
Core Management
Enhanced
Management
Screening
Oral Medication
Insulin or
Lifestyle advice
Initiation &
other
Prevention
maximisation of 3
parenteral
oral agents
therapy –
initiation and
on-going
advice
BP
3
4
Specialist
Management
Poor
control/good
compliance
Acute Hospital
Management
Insulin pumps
Adolescence
In Patient care
Ante natal
1 – 4 agents
4 agents poor control
Dual therapy
Dual therapy
poor control
poor control
CKD 4/5
Lipids
Monotherapy
Dual therapy
Kidneys
Microalbuminuria
Feet
Low risk
Proteinuric
CKD 3b
Medium Risk
Neuropathy
Low risk
Medium pain
Active ulcers
Charcot foot
Severe
ulceration
Need of
surgical
intervention
Pain & symptom management
working with
Exceptions
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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.
working with
Benefits
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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
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 1st April
– Continue via CRES
– New referral form and criteria
working with
Key
- Clinical Hub
Satellite clinic
Patient Ed
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Locations
working with
Contact details
Nurse of the day – dedicated support line:
01689-865911
Dedicated e-mail support:
BROMH.Croydondiabetesservice@nhs.net
Service lead, Michelle Barratt:
michelle.barratt@bromleyhealthcarecic.nhs.uk
working with
Q&A
working with