The Coventry diabetes model: empowering primary care

The face of healthcare delivery is rapidly changing. In many areas around the UK diabetes care appears to be at the forefront of of that kind change. The models adopted, however, are by dint of no means identical. In this article, the authors describe individual such model that has, to date, proven to be happy and popular in Coventry among the two the healthcare professionals and the service users.

lock opener words

- GPwSIs

- Triage

- Care pathway

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Coventry city has a population of approximately 305000 with 11% from an Asian background (National Statistics, 2006) In the Indices of deprivation 2004 Coventry was ranked at 64 on the outside of 354 local authorities in England (with number 1 being the greatest in quantity deprived; Department for Communities and Local regulation 2004). The latest survey of clan with diabetes suggested that there were just beneath 12000 such individuals in Coventry (Health and Social Care Information middle point 2005), although epidemiological modelling refer tos that the figure should be closer to 15000 (Yorkshire & Humber Public Health Observatory, 2005)

Before the establishment of the GP with a Special Interest (GPwSI) in diabetes service, referrals from primary care went to the local hospital: University Hospitals Coventry and Warwickshire. In public with many other diabetes units, the secondary care team base themselves overwhelmed by 'revolving door' patients (who previously would have been upon continual review in the diabetes clinic), with insufficient resources to absorb the growing numbers of referrals and to adequately address diabetes complications.

In 2004/2005 the local diabetes implementation assemblage agreed a new integrated prototype of care supported by additional investment from the primary care trust (PCT) The GPwSI service was considered an important constituent of the Coventry diabetes prototype of care that was to be implemented from 2005

The Coventry diabetes model

The Coventry diabetes original (see Figure 1) is a a whole of care designed to empower primary care. The whole emphasis of the protoplast is to continue the care of patients in primary care who previously would have been followed up in a secondary care clinic. This proces of empowerment is mediated via initiatives similar as the two-stop GPwSI clinic protoplast (McMorran et al, 2006) and the various educational processe that have been focused upon Coventry primary care clinicians. The educational initiatives include practice-based diabetes meetings and the Coventry diabetes network, which is discussed later.

The GPwSI clinic service is designed to act as a clinical problem-solving resource for primary care and then to 'hand back' clinical care to the referring primary care team. The focus of continuing care of patients in primary care facilitated by dint of the Coventry diabetes model differentiates it from other GPwSI-based diabetes care services, in our view.

[FIGURE 1 OMITTED]

The team

The team consists of three GPwSIs in diabetes working for individual session a week each, sum of two units part-time community dietitians, one part-time podiatrist and four diabetes specialist nourishs (DSNs). In addition to their special interest, experience and expertise in diabetes, each of the three GPwSIs has a particular area of responsibility. The areas overspreaded are obesity, lipids and diabetes in the ethnic population.

Referrals

All primary care referrals to the diabetes service are sent [i]or[/i] part of to the other a city-wide referral service that allows the GPwSIs to triage on the outside appropriate patients to be seen by dint of the service. Currently, up to 80% of of that kind referrals are felt to be suitable to be seen through the GPwSI service. The majority of patients seen in the service have been referr with poor hypoglycaemic sway or abnormal lipids. Those felt to fall outside the remit of the GPwSI service are seen in secondary care. (Figure 2 provides a pictorial representation of the care pathway for clan with diabetes in Coventry.)

GPwSI clinic sessions

Sessions are held in three community health clinics, providing easy access for patients. The clinics are multidisciplinary, with a DSN and a dietitian in attendance (the podiatrist is solitary available at one site at present) Patients are contacted by dint of a booking clerk and asked to telephone to arrange a convenient appointment. Where vital current tests are required, a form is sent without to the patient. GPwSIs can access the hospital reporting a whole to obtain blood test be deriveds prior to the clinic.

of recent origin patients have a 30-minute joint consultation with the GPwSI and the DSN Patients are usually seen twice within the service (those needing more than three appointments will probably ne to be seen in secondary care). A pro forma is used for the clinic staff to fax back a alphabetic character to the referring GP upon the day of the clinic. The format go in the rear [i]or[/i] in the wake ofs the Alphabet Strategy (Morrissey et al, 2005; Table 1) disentangleed by the team at George Eliot Hospital and adopted and adapted to suited local needs by Coventry. Patients will usually diocese the dietitian during their consultation and many times receive further appointments with the DSN before their follow-up appointment with the service.