Community Diabetes Pilot Steering Group
Thursday 2nd December 2010
Minutes of Meeting
Present :
Gill May – Executive Nurse, NHS Swindon
Elaine Lorton – PBC, NHS Swindon
Sandy Love – Lay Representative
Nicky Crossley – GP, Wroughton
Cilla Kirkman – Diabetic Specialist Nurse, GWH (&
Community Dec 2010)
Lisa King – Interface Pharmacist, GWH
Paul Clarke – Prescribing, NHS Swindon
Lindsay Gibson – Lead Nurse, Carfax Health
Ian Findlay – Pharmacist, Carfax Pharmacy
Liz Holden – GP, Park Lane
C A Gundogan – Practice Nurse, Kingswood Surgery
Karen Timbrell – Practice Nurse, Kingswood Surgery
Stephen MacMahon – Diabetes UK
Jon Elliman – GP, Kingswood Surgery
Jeshan Lau – Consultant, GWH (& Community Jan 2011)
Philip Mayes – GP, Kingswood Surgery
Bill Janson – GP, Hawthorne
John Sleggs – GP, Victoria Cross
Eric Holliday – GP, Eldene Surgery
Apologies : Graham Cooper - Diabetes UK, Stephanie Penfold – Eldene Health Centre
Action Plan (no dates added yet)
No.
Description
Own
Start
Finish
Dependencies
er
Date
Date
Workstream A – Education & Support for Practices : LEAD – Jeshan Lau (CK, JE)
Circulate information on psychology EL
& counseling courses to groups and
all GP practices
A2 Implement an advice and guidance
JL
service for primary care clinicians.
A3
Deliver mentored or virtual clinics
JL
for GPs
A4
Deliver mentored or virtual clinics
CK
for practice Nurses
A5
Develop a resource tool giving
CK
details for all services available for
referral and support
Workstream B – Education & Support for Patients : LEAD – Cilla Kirkman (SL, SM, NC)
Completed
Status
Notes
A1
B1
Review DESMOND, other options,
CK
Include focus on supporting self
management
Include focus on supporting self
management
Include community dietetics and
other lifestyle and healthy eating
programmes
Include tailoring to different
session advertising and fit.
B2
(SL)
Develop a new patient resource
pack for newly diagnosed patients
to support learning
B3
Develop a resource pack for
existing diabetic patients with
information on other sources of
advice, support and input
B4
Develop a programme of multiCK
agency workshops
(NC)
Workstream C – Pathways and Prescribing : LEAD – Jeshan Lau (JS, LK, NC, BJ)
C1
Review local pathways for diabetic
care
JL
C2
Develop a guidance and support for
community initiation of insulin
JL,
CK,
BJ
IF &
PC
C3
Develop and implement an audit for
measuring diabetic medication
wastage returned to pharmacies
Workstream D – Information & IT : LEAD – Elaine Lorton (JL, IF, PM)
D1
D2
D3
Develop a robust and standardized
template letter for sharing clinic
information
Scope software options for a shared
care record for diabetic patients
Scope options for the development
of a diabetic patient held care
record
JL,
EL
EL
IF
knowledge
Include monitoring of uptake from
practices
Include alternative options
Include number of educators and
sessions
Include information on self
management
Include information on Diabetes
UK
Include information on self
management
Include information on Diabetes
UK
Including the management of
challenging and complex patients
Removing duplication & multiple
contacts
Include clear guidance on HbA1c
Include clear guidance on
medicines management
Include self-management plans
1. Introduction : Gill May (GM) gave an overview of the resources currently available for
the pilot : Cilla Kirkman (CK) will work initially for 6 months 3 days per week (Tues,
Weds & Thurs) and Jeshan Lau (JL) will work 2 sessions a week (Thursday).
2. Defining the Service & Role :
a. JL gave an overview of his vision : to enable primary care to better manage
people with diabetes through help, guidance, training, mutual learning. To
review guidelines and pathways locally, to be available to offer mentoring
and/or virtual clinics, and be available for advice via telephone and email.
b. CK gave an overview that her vision was to support the initiation and
improved management of insulin and Exanatide in the community.
c. John Sleggs (JS) asked whether solutions were being suggested before the
scope of the problems defined : 4% prevalence of diabetes in Swindon –
8000 people. In Victoria Cross he finds 25% have HbA1c over 9 and is
unsure how to improve for these often more complex and challenging
patients.
d. Bill Janson (BJ) prompted that Swindon has historically poor performance
nationally. He and a nurse in his practice have recently attended the Insulin
for Life course at Warwick and are keen to implement the learning in
practice.
e. Philip Mayes (PM) gave an overview of focus group work done at Kingswood
Surgery with Diabetes UK and that the views and concerns of service users
were around duplication of care and frustrations with this and the unthinking
approach to primary care contacts.
f. Nicky Crossley (NC) raised the frustration that the system is inefficient and
the means of communicating care, test results, examination findings etc are
poor. It was also raised that when challenging patients are referred to
secondary care their outcomes do not often change.
i. A standard templated letter format from the diabetes clinic was
requested.
ii. A shared software system or approach of electronically sharing
between providers was also discussed – Diamond software was one
example of this given.
g. JL & CK gave information on three education sessions / opportunities :
i. GP workshop in January on motivational interviewing & behaviour
change at GWH
ii. Practice Nurse next meeting also on motivational interviewing
iii. Coping with Type 2 Diabetes – for patients who can self refer or be
referred by GP to the Psychology and Counseling service. EL agreed
to get information and circulate to the group & GP practices.
h. DESMOND education was discussed and Sandy Love (SL) suggested that it
was not always made available to patients at initial diagnosis as intended.
For those patients who had educated themselves the course offered little
new information and there was not any further support in finding more
advanced education. It was also discussed that DESMOND needs to make it
easy for people to get appropriate information and flex around the knowledge
of the patients attending. CK will review DESMOND and other education
such as expert patients and conversation maps as part of her role, SL offered
to give input into this.
i.
PM raised that the way services and consultations are structured should
support self management rather than disempower patients.
j.
NC also raised concerns about access to community dietetics and further
discussion was held about information and links to other health eating and
lifestyle change programmes.
k. Stephen MacMahon (SM) raised the sessions and support that Diabetes UK
offer, which is limited at present to a core group with some new faces the first
Tuesday of every month. They would like this to grow and spread throughout
Swindon and it was suggested that GPs may be able to support this by
sharing the information on meeting with patients. It was also raised that
Diabetes UK may be able to support training for non-specialist staff.
l.
NC raised an event that Rigdeway View ran bringing together a range of
services around diabetes for patient education. It was well attended and
considered to be a feasible and positive model that could be duplicated
around Swindon on a rolling basis.
m. Paul Clarke (PC) raised that Swindon spends 15% more than the national
average on diabetic medication (£350K per annum) and this high spend is
across all medication. If this could be addressed their may be scope to shift
some of this money into alternative services or provision. Ian Findlay (IF)
said that many diabetic meds are returned to pharmacies for incineration, it
was suggested that this could be audited. A patient held care record was
suggested as one potential option to improve understanding and compliance.
It was felt this might suit some patients but not all.
n. PC also referred to the QOF disincentive and the different messages around
HbA1c management. JL said that in his clinic he did not focus on HbA1c
results. It was also suggested that more harm can be done if HbA1c levels
are lowered too quickly in higher risk patients. It was agreed that the
conflicting information and guidance on HbA1c is not helpful.
3. Input from Pharmaceutical Industry – Concerns were raised about their input,
motives and whether there would be an specific product promotion. It was also raised
that they do have useful resources and access to training etc which is non-promotional.
It was agreed :
a. Specified sponsorship for events or training would be acceptable
b. No direct sponsorship or involvement on the steering group
c. Editorial oversight of their input would be a pre-requisite
d. All suitable companies should be treated evenly
4. Action Plan : EL stated that there seemed 5 obvious work streams following
discussion two of these were linked. From discussions there was also many pieces of
work for these groups but leadership and engagement from members was sought. EL
would develop an action plan as a starting place from the discussions (see above).
The membership stated below is provisional and further feedback was sought from all :
a. Education & Support for Practices : JL & CK (?JE)
b. Education & Support for Patients : CK & SL (?SM & NC)
c. Pathways & Prescribing : JL, JS, LK, NC, PC & BJ
d. Information & IT : EL (?PM)
5. Outcomes for Evaluation : GM clarified that a considerable amount of work has
already been put into the aims and objectives and it was agreed that clarity around this
was needed to ensure that at the end of 6 months progress had been made. The
following were suggested as key measures for success :
a. All patients with diabetes in Swindon would understand what it means, can
access appropriate information and support and easily access this if they
choose.
b. Referral pathways would be clearer and improved
c. Guidelines on medicine management would be improved
d. Easy access to specialist / consultant advice and guidance would be
available
e. Referral and clinic letters would be improved
f. There would be a functioning community/primary care service for patients
whose insulin use was suboptimal or to initiate insulin
6. Date of Next Meeting :
Surgery TBC)
Thursday 20th January 12.30 – 2.00pm (Venue Eldene