LES Initiating Insulin
Practice Name ____________________
Specification for a Local Enhanced Service (LES)
Initiating Insulin in Primary Care
Introduction
This enhanced service specification outlines the more specialised services to be provided. The specification of this service is
designed to cover the enhanced aspects of clinical care of the patient, all of which are beyond the scope of essential
services. No part of the specification by commission, omission or implication defines or redefines essential or additional
services.
Diabetes affects between two and five percent of the population. The prevalence is increasing rapidly and this is expected to
double the number of cases over the next decade. Diabetes control and quality of life can be greatly enhanced by effective
patient education and encouragement of self-management. There is convincing evidence of significant clinical and quality of
life benefits from the provision of high quality diabetes care and education. Good quality diabetes care requires a multidisciplinary approach to patient care.
Aims
The aim of the service would be to contribute to whole system diabetes care by enhancing the quality and consistency of
diabetes management throughout primary care.
To increase clinical capacity within Primary Care achieving improved access to services, reduce secondary care waiting
times, and to provide a more cohesive and streamline patient journey.
Service Outline
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Initial GP consultation to discuss the initiating insulin phase
Continues close contact with GP/Nurse on regular basis to support patient in the initial initiating insulin phase.
The initiating phase must including face to face and phone consultation as required by patient or clinical need.
Practice to provide patient information leaflet and direct patients to user group information e.g. Diabetes UK
The fee is payable to the practice to perform this service in their practice premises
Continue to link in with secondary care services specialising in all areas relating to diabetes
Every patient attendance for the diabetes service should be coded on the practice computer system - using an
appropriate Read code.
Training Requirements
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Practitioners must hold a minimum of diploma level qualification in diabetes, obtained within the last 4 years
Practitioners must also have undertaken formal accredited training in initiating insulin
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Practitioners must be able to demonstrate continued professional development and training in the field of diabetes.
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Clinical requirements
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Provide assessment, advice, information and treatment to primary care colleagues for patients whose care does not
require a specialist diabetes service.
Address the needs of hard to reach patient groups, e.g. housebound / care home residents / black and minority
ethnic groups.
Support patient’s self-management about their condition and empower them to take a leading role in its
management.
Education and Liaison
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Provide education and support to the Practice primary health care team to raise the general standard and
consistency of diabetes.
Fees
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Practices to be paid quarterly in line with other enhanced services
£130 per patient for initiating insulin phase not maintenance. Please note payment is per patient not per
consultation
Clinical Governance
Accreditation
Practitioners should undertake regular continual professional development (CPD) - a minimum of 1 approved training
session per annum.
Practitioners should undergo annual appraisal and be able to demonstrate continuing experience, training and competence
as necessary to provide this service.
Monitoring
Quarterly activity must be submitted as part of the enhanced services quarterly quality form, which will be directly linked to
payment.
An annual audit of number of patients seen for the initiating insulin phase, a service evaluation and a record of CPD
undertaken by each practitioner involved with the delivery of this service must be submitted.
Service Delivery
The Clinical Governance arrangements will follow those used by the practice.
Any complaints from patients should be handled in accordance with the Practice complaints procedure.
Risk Assessment
Premises
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Consultation room with good lighting with adequate facilities for diagnosis and treatment procedures and
operative/diagnostic equipment that meets the requirements necessary to undertake the service must be
provided
The Practice will keep their facilities up to date and that their patients have access to new innovation in the
treatment of heart failure where appropriate
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Equipment
- ensure that all equipment used is regularly checked, maintained, and meets all health and safety requirements
- ensure all staff using the equipment have been properly trained on how to use it safely.
- Ensure that it meets all the PCO guidelines on equipment
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Application
GP Provider Application for Nationally Enhanced Scheme
Practice Name:
Address:
How will you meet the aims of the scheme?
Briefly describe the service to be provided and facilities available.
Will providing this service adversely affect the practice’s ability to provide essential or additional services?
Who will be providing the service?
Do you have evidence of appropriate staff qualifications, if appropriate?
How will you ensure staff providing the service remain suitably qualified?
How will you monitor and audit service provision (refer to any requirements within the scheme).
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Please outline any other details relevant to your ability to provide this service
Practice declaration:
The practice has understood the terms of the scheme and is seeking to provide a service on this basis. If commissioned the
practice will adhere to the terms of the scheme.
Signed: ____________________________________
As GP principal representative of the practice
Date: _____________________________________
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Breach
Breach of conditions of this contract will be referred to the Primary Care Service Development Group.
Signed on behalf of Practice………………………………………….
Name of Practice ………………………………………………………
GP Name (Print)……………………………………………………
Date………..….
GP Signature…………………………………………………………...
GP Name (Print)……………………………………………………
Date………..….
GP Signature…………………………………………………………...
GP Name (Print)……………………………………………………
Date………..….
GP Signature…………………………………………………………...
GP Name (Print)……………………………………………………
Date………..….
GP Signature…………………………………………………………...
Signed on behalf of the PCT
……………………………………………..
Jayn Hughes
Head, Primary Care Development
Date…………...
LMC Comment:
Good specification but pricing may not be commensurate with workload.
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