JUNE 2016

DIABETES

The West Suffolk Community Diabetes Nursing Service was initially piloted in the Forest Heath area. Following its success the service was subsequently commissioned in April 2015, until the end of August 2016. The Community Diabetes Specialist Nurses hold mentored clinics in conjunction with Practice Nurses in GP practices. Since the launch last April, clinics have been held in every practice in the WSCCG locality. As of 30/4/16, 261 clinics and 1531 appointments had taken place. The service also provides education and mentorship for healthcare professionals as well as group education for patients. Formal evaluation of the service was undertaken by Public Health Suffolk. This evaluation identified its impact highlighting the high rate of clinic attendance, the popularity of the service with the users, the reduction in the number of hospital appointments and the improvements in blood glucose control in those patients who accessed the service. Patient and staff feedback has been very positive with 99% of patients reporting that they would recommend the service. “The clinics have improved my knowledge, my practice and my confidence.” “Having the support of a Diabetes Specialist Nurse (DSN) allows me to make more effective decisions to improve patients’ health.”

“The DSN has so much knowledge that she can impart that she can usually sort out a difficult problem that myself and quite often the GP cannot , this results in a better outcome for the patient.” A Practice Manager says “We have had very positive and encouraging feedback from our patients, who are very happy to be able to receive this level of clinical care locally. Our doctors too have praised the service as we are now beginning to see some improvement in our patients’ blood glucose levels.” For more information please contact Mandy Hunt on 01284 713241 or Martin Bate on 01284 758036. See page 3 for details of education programmes available for patients and staff.

WEST SUFFOLK COMMUNITY DIABETES NURSING SERVICE By Mandy Hunt, Lead Diabetes Specialist Nurse & Kirsty Thompson, Community Diabetes Team Administrator, West Suffolk NHS Foundation Trust

FUTURE OF DIABETES CARE IN WEST SUFFOLK By Dr Jon Ferdinand, Associate GP, West Suffolk Clinical Commissioning Group

Welcome to JIGSAW

A newsletter for staff working in the health and social care system in west Suffolk.

PIECING TOGETHER CARE IN WEST SUFFOLK

From January to April 2016 West Suffolk CCG listened to stakeholders’ views and ideas about how to deliver the most appropriate set of diabetes services for the local area. Workshops were held in Bury St Edmunds, Haverhill, Newmarket and Sudbury to inform the process, taking into account evaluation of current services and available system data and information, to design the optimum service model. Following the stakeholder consultation, the CCG is producing a business case to support the continuation and expansion of the community diabetes service to support the 24 GP practices which look after the 13,000 people living with diabetes across west Suffolk and offer further opportunities for newly diagnosed and people with established Type 1 and Type 2 diabetes to be able to access education and advice about how to manage their condition. The CCG is aiming to mobilise the enhanced service from September 2016. A new Type 2 diabetes treatment pathway, revised to take account of national guidance published in December 2015, has been developed by the CCG in conjunction with consultants at West Suffolk Hospital. The pathway will be launched with an education event for primary care staff on 02 June 2016 at the hospital education centre.

In March 2015, WSFT launched the hypoglycaemia pathway, funded by the Eastern Academic Health Science Network, to help patients who have suffered a Severe Acute Hypoglycaemic Episode (SAHE) that was bad enough to require an ambulance call out. By providing support and education the team hope to reduce the chance of these patients having further collapses. The number of 999 call-outs for a SAHE is 10,000 annually in the Eastern Region, at a cost of £2 million. See page 3 for “how the pathway works”. The Clinical Educator will also verbally liaise with GPs, Practice Nurses, District Nurses, Family members/Carers, to ensure the patient receives adequate care to reduce the risk of a subsequent hypo.

Patients receive hypo education, which includes how to reduce the risk of a hypo, how to effectively treat a hypo and information on the DVLA driving regulations. During the education session with the patient we try to work out why the hypo happened. The pathway has provided a link between East of England Ambulance Service, primary and secondary care and helps to ensure safe and effective patient care. As part of the project we have also been working with local pharmacists to distribute a leaflet about hypos to patients when they are ordering repeat diabetic medication. If you would like any more information on the project please contact lisa.newdick@wsh.nhs.uk.

HYPOGLYCAEMIA PATHWAY PROJECT

By Lisa Newdick, Diabetes Clinical Educator, West Suffolk NHS Foundation Trust

DIABETES PRE-CONCEPTION CARE

By Lisa Newdick, Diabetes Clinical Educator, West Suffolk NHS Foundation Trust

Most women with diabetes have a healthy baby but diabetes does increase the risk of complications including:

Having a large baby – which increases the risk of a difficult birth, induction of labour or a caesarean section

Having a miscarriage, stillbirth (rare)

A baby with congenital abnormalities, particularly heart and nervous system abnormalities (rare)

A baby requiring neonatal care after birth

To reduce these risks it is important to ensure that the woman’s diabetes is controlled before becoming pregnant. Evidence has shown women who receive pre-conception care reduce their risk of complications from 1 in 10 to 1 in 50. However, the National Pregnancy in Diabetes audit (NPID) demonstrates that currently outcomes continue to be poor. The Eastern Academic Health Science Network’s ‘Pre-Conception Care project’ was launched to improve the outcomes for women with diabetes through educating women and healthcare professionals. The key messages, before conception are:

Encourage women to plan their pregnancy and to use contraception to avoid any unplanned pregnancies;

Ensure blood glucose is well controlled and HbA1c as close to 48mmol/mol or 6.5% as safely possible;

Women with Type 1 and Type 2 diabetes taking 5mg of Folic Acid daily as soon as they decide to start planning their pregnancy (before conception); and

Medications need to be reviewed, particularly blood pressure, cholesterol and diabetes tablets.

Within the pre-conception care project we have been working with GPs, practice nurses, health visitors, district nurses, children’s centres, midwives, pharmacists and welfare offices at colleges and universities to raise awareness and distribute leaflets to women with diabetes about pre-conception care. The Cambridge Diabetes Education Programme (CDEP) is an online education programme for healthcare professionals looking after patients living with diabetes. As part of the project, this education programme is being offered free to all Health Care Professionals. If you would like more information on this project or access to CDEP please contact lisa.newdick@wsh.nhs.uk.

The NHS spends £1 in every £150 on foot ulcers or amputations each year. Diabetic foot disease accounts for more hospital bed days than all other diabetes complications combined. In the UK, 100 people a week lose a lower limb because of diabetes. 1/20 people with diabetes will develop a foot ulcer annually, and up to 70% of people die within five years of having an amputation as a result of diabetes. The podiatry service aims to ensure patients with diabetes have access to appropriate foot care at the right time, delivered by the right people with the right skills, at the right frequency to help prevent and reduce the frequency and severity of long-term foot complications.

Key messages:

Any patient diagnosed with diabetes should initially have their feet checked at their GP surgery and should only be referred to podiatry if they have any foot problems e.g. thick callus, pathological nails

All foot ulcers should be referred to the multi-disciplinary diabetic foot clinic at West Suffolk Hospital

Podiatry has developed foot protection clinics across Suffolk for those patients who have had previous ulceration or amputation

Patients can self-refer

Podiatry does not provide simple nail care, even for those patients with diabetes

If you would like to know more about the podiatry service or if you would like to receive training on how to assess /screen diabetic feet please contact Andy Barker on 01473 275280 or email andy.barker@suffolkch.nhs.uk.

SUFFOLK COMMUNITY PODIATRY SERVICE By Andy Barker Clinical Specialist, Suffolk Community Health

GET INVOLVED If you have any news or views on any of these projects, please contact the partners through this email address: getinvolved@westsuffolkccg.nhs.uk

JIGSAW - THE EXTRA PIECE

DIABETES EDUCATION

By Mandy Hunt, Lead Diabetes Specialist Nurse & Kirsty Thompson, Community Diabetes Team Administrator, West Suffolk NHS Foundation Trust

Insulin initiation

Insulin management

Insulin intensification Modules are directly linked to the key elements of the Skills for Health Diabetes Competency Framework. The MERIT programme is currently being rolled out throughout the area. For more information on education for healthcare professionals please contact kirsty.thompson@wsh.nhs.uk Education for Patients: The West Suffolk Community Diabetes Service currently provides DESMOND (Diabetes Education Self-Management for On-going and Newly Diagnosed) for those newly diagnosed with diabetes and carbohydrate awareness sessions for those with established diabetes. For more information on DESMOND or carbohydrate awareness sessions please contact Judy Tarbun on 01284 713241. In addition, from July, WSFT plans to introduce DAFNE (Dose Adjustment For Normal Eating) for Type 1 patients.

MORE MESSAGES

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HOW THE HYPOGLYCAEMIA PATHWAY WORKS

East of England Ambulance service refers patient to Clinical Educator via Single Point of Access

Clinical Educator notifies GP/Hospital team of patient’s hypo (prior to the pathway the GP/Hospital Team may have been unaware their patient had a hypo)

Clinical educator will see primary care patients, either at their surgery or at home, and deliver hypo avoidance education

An outcome letter of the education session is sent to the both the GP and the patient

For further information please contact lisa.newdick@wsh.nhs.uk

Education for Healthcare Professionals: DINE (Diabetes Interest Nurse Education) is a series of education sessions designed to provide information, discussion and practical advice for nurses working in general practice. Each DINE event includes lunch/dinner and a presentation on a particular subject/s in relation to diabetes. The format of DINE facilitates learning in a relaxed informal environment and gives practice nurses opportunity for self-development. Topics covered so far include: Carbohydrate Awareness, Carbohydrates at Christmas, Focus of Feet, RCN Revalidation and MODY (Mature Onset Diabetes of the Young).

The MERIT programme (Meeting Educational Requirements, Improving Treatment) is an RCN accredited programme of modules for healthcare professionals to improve their diabetes management skills. The delivery of MERIT consists of two elements, classroom based education provided by a DINE Nurse Facilitator (funded by Novo Nordisk, although non-promotional) and mentorship for the attendee from a Community Diabetes Nurse, offering support and guidance as the attendee works through the competency framework. MERIT consists of the following modules:

Pre-insulin treatment options

GLP-1 initiation