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Excellence in diabetes care commissioning

Julie Wood 20160428 editJulie Wood, chief executive at NHS Clinical Commissioners, considers how national bodies can support CCGs to take further action to improve diabetes care and reduce costs.

Since 1996 the number of people living with diabetes in the UK has more than doubled. The NHS spends more than £9.8bn each year on treating the condition and its complications. 

Clinical commissioners across the country were recognising diabetes as a priority long before the decision was made to assess them on their performance through the CCG Improvement and Assessment Framework. But making diabetes one of the six clinical areas assessed does emphasise the importance being placed on providing high-quality care for those with, or at risk of, diabetes. 

Our recent report, ‘Excellence in commissioning diabetes care’, demonstrates the innovative ways that CCGs are finding to help patients with this condition, as well as focusing on prevention through supporting those at risk of developing Type 2 diabetes. Through sharing case studies of CCGs leading the way, and drawing out lessons from those involved in the projects, we hope that it will help others improve care for their population with diabetes. 

Patient-centred care 

Our report was based on discussions at a roundtable event held in March this year, which brought together a group of leaders from top-performing CCGs for diabetes, along with other stakeholders.

One of the common themes raised was the importance of involving patients in their own care – whether through supported self-management or engagement in service design. This, as Dr Adrian Hayter, chair of Windsor, Ascot and Maidenhead CCG, points out in the report “is a fundamental thing we need to take into account”. In his area, the ‘HealthMakers’ concept is being rolled out to enable local people with long-term conditions to help improve their own health as well as local healthcare services, empowering those involved to be patient leaders.

Aylesbury Vale and Chiltern CCGs are also ensuring their diabetes services are person-centred, recognising that while blood sugar levels may be the important marker for clinicians, what motivates a patient will likely be quite different. It could, for example, be a desire for their foot problem to heal so that they can play with their grandchildren. They’ve commissioned services in a way that reflects this – including making sure that psychology services are involved to help patients. 

Use the data to illustrate the problem and encourage action 

A number of other key lessons were drawn out by the report, including the need to collaborate with providers on the move from activity to outcomes-based approaches; the importance of strong leadership; and using data to illustrate the problem and encourage action.  

Dr Nithya Nanda, diabetes GP lead for Slough CCG, emphasised the impact of the latter, saying that the diabetes outcomes versus expenditure data showing the area had poor outcomes was enormously helpful “in selling the story both to local GPs and to the senior leadership”. The CCG has carried out an enormous amount of work using different approaches, including targeted support to patients and enhanced education to local GPs on how to better manage people with diabetes. As a result of this, Slough now ranks second in the country on delivering the eight NICE care processes representing good practice in diabetes care. 

self-medicating edit

Delivering more 

Despite the excellent work taking place across the country, commissioning effective diabetes services can be complicated. Sometimes there are national obstacles CCGs need to negotiate when doing so.  

This is why we’ve also identified a number of ways in which national bodies can support CCGs to take further action to improve care and reduce costs in this vital area. 

The first of these is for NHS England to work with CCGs to identify top-priority patient outcomes measures. There remains a need for clarity on the top-priority patient outcomes that CCGs should take action to address. Commissioners we spoke to also argued there is a need for improved clinical outcomes measures, giving a more accurate insight into the quality of diabetes care. 

Secondly, national bodies can help by promoting new contracting mechanisms which better reflect population-based care. CCGs are looking to develop new pathways that focus more on care for a whole population rather than simply activity – this necessitates a different and less traditional type of contract. 

Finally, clearer rules of engagement are needed on collaborations between pharmaceutical companies and CCGs. The former can provide practical and financial assistance resulting in better care for patients, but CCGs can understandably be nervous about being seen to involve industry inappropriately. A new framework to facilitate and accelerate appropriate collaboration between industry and the NHS in diabetes is in development which we hope will help with this. 

Through addressing these issues, national bodies could significantly aid commissioners in their work to provide the best possible care to people with diabetes. With ever-growing spend and prevalence, this is an issue, which we need to give our utmost attention.

The ‘Excellence in commissioning diabetes care’ report can be accessed at:

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