Managing the growing incidences of diabetes in England is set to be one of the major clinical challenges of the 21st century. Estimates suggest that the number of people with diabetes is expected to rise to 4.2 million people by 2030, affecting almost 9% of the population.
The NHS Diabetes Prevention Programme is delivering a systematic approach to reducing the risk of individuals developing diabetes. However, it is equally important that the outcomes for those with diabetes are improved and unjustified variation is reduced.
The importance of improving outcomes for individuals with diabetes is reflected in the inclusion in the CCG Improvement and Assessment Framework (CCG IAF) of indicators covering:
- Diabetes patients that have achieved all the NICE recommended treatment targets: Three (HbA1c (blood sugar), 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
These have been selected because they are recognised evidence-based measures of whether patients with diabetes are being supported to successfully manage their condition.
As part of the CCG IAF, a support offer has been developed for each of the clinical priority areas within it. For diabetes, the support offer forms part of a wider treatment and care programme which works in conjunction with regional commissioning operation teams, clinical networks and NHS Right Care to promote an integrated approach to supporting improvement in diabetes outcomes.
The Diabetes Treatment and Care Programme includes work in the following areas:
- The NHS RightCare diabetes pathway which shows the core components of an optimal diabetes service, evidence of the opportunity to reduce variation and improve outcomes and the key evidence-based interventions which the system should focus on for greatest improvement, supported by practice examples from across the NHS. Local health economies, supported by their NHS RightCare Delivery Partner, can use this product to structure their local improvement
- Supporting CCGs to work with GPs to increase participation in the National Diabetes Audit (which is the data source for the CCG IAF diabetes indicators)
- Supporting CCGs to ensure that structured education attendance is accurately recorded and to increase attendance levels
- A possible procurement process or development of a national framework to increase capacity and promote consistent quality and costs of structured education
- Supporting CCGs to work with GPs to identify actions to promote improvement against the treatment targets and reduce variation
As part of the National Diabetes Treatment and Care Programme NHS England has invested £42 million in 2017/18 in proposals from individual CCGs, CCG collaborations and Sustainability and transformation partnerships (STPs) to improve the treatment and care of people with diabetes.
As part of reducing variation in the management and care of people with diabetes we are keen to ensure that technology is made available to those whom guidelines suggest might benefit from it. For example, this letter sets out advice from the Regional Medicines Optimisation Committee (RMOC) (North), NICE and other sources on access to blood glucose monitoring technology.
The NHS Long Term Plan makes a commitment to test an NHS programme supporting low-calorie diets for obese people with type 2 diabetes. The low calorie diet pilots will test at scale approaches that have been shown to put Type 2 diabetes in remission in those recently diagnosed with the condition.
Please send any queries regarding the Diabetes Treatment and Care Programme to firstname.lastname@example.org.