Health Service Focus

One-size-fits-all approach not right for diabetes prevention

Jim O’Brien, national programme director on the NHS Diabetes Prevention Programme at Public Health England, talks about the need for a ‘culturally sensitive’ programme.

More than 60% of CCGs and local authority partnerships have submitted expressions of interest to become first-wave implementers of the national NHS Diabetes Prevention Programme (NHS DPP), NHE has learned. 

The NHS DPP is a joint commitment from NHS England, Public Health England (PHE) and Diabetes UK to deliver an evidence-based behavioural programme, at scale, to support people to reduce their risk of developing type 2 diabetes. 

The call for expressions of interest asks potential local partners to set out details of the infrastructure they have in place, or plan to develop, for diabetes prevention. Phase 1 of the programme is planned to start in April 2016. 

Positive steps 

Jim O’Brien, national programme director on the NHS DPP at PHE, told NHE: “It has been very interesting. Well over 60% of local authorities and well over 60% of CCGs have expressed an interest. 

“If anything, our problem is that there will be too many people wanting to join in the first wave. That is a very positive step for the programme.” 

The quality of the submissions so far has been “extraordinarily high” and the programme directors are going through a sifting process to decide which CCGs and local authorities to involve in the first wave. 

Although O’Brien could not say how many will be involved in the first phase, he did say there would be an effort to deliver “geographic equity” and having some programmes that are focused particularly on black and minority ethnic communities and rural communities.

The NHS DPP has three distinct phases, which have been designed to develop the evidence in a staged way and to enable checks and balances to be built into the procurement as it is implemented: 

• Pre-procurement phase: Work with seven demonstrator sites to test implementation of the NHS DPP. This phase is already underway and will be completed in 2015-16.
• Phase 1 procurement in 2015-16 to go live 2016-17: Between 10,000 and 30,000 behavioural interventions across England are identified.
• Phase 2 procurement in 2016 to go live 2017-18: Will aim to deliver long-term contracts providing for incremental scaling up of services with a view to full coverage across England by 2019-20 – subject to final decisions about the pace of implementation. 

Demonstrator sites 

Each of the seven demonstrator sites (see below) are working on slightly different things. “They have all been up and running since around April/May and we’re hoping that by the end of this year that they will have close to 10,000 people on an intervention programme,” O’Brien said, adding that the NHS Health Check is going to be the major route for identifying borderline diabetes or non-diabetic hyperglycaemia. However, some of the demonstrator sites are using GP registers to identify people in this group and then refer them onto a programme – mirroring the work of the Health Check (which was covered in our July/August 2015 edition). 

Culturally sensitive 

However, NHE was told that there have been challenges. “The challenge starts, I suppose, when you are trying to incentivise people to come on the programme at the very start. Many of the previous diabetes prevention programmes were getting uptake levels of 50%,” said O’Brien. “Many of the demonstrator sites are doing innovative things to encourage people to stay on the programme and to make sure the programme is culturally sensitive to that particular city or area. That is one of the key lessons we’re learning: that a one-size-fits-all diabetes prevention programme doesn’t work.” 

Asked why, he again mentioned cultural sensitivities, and said that although there will be a national procurement for  the NHS DPP, the programme directors say they will allow for “innovation” and “slight deviation” from the national plan if it is “appropriate in particular areas”. 

O’Brien pointed to the Bradford demonstrator site as an example. “Because they have such a [large] south Asian community in the city, their dietary intervention programmes are going to be different from those in other areas,” he said. “We are going to nationally procure, but we are going to allow some innovation and change in areas as well.” 

The programme directors are optimistic they will be able to roll out NHS DPP faster than expected, but this will depend on money. “It is not that people aren’t interested,” said O’Brien.

The demonstrator sites are: 

• Birmingham South and Central CCG
• Bradford City CCG
• Durham County Council
• Herefordshire CCG/LA
• Medway CCG/LA
• Salford CCG/LA
• Southwark Council and CCG

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