The specialist diabetes team at Cardiff and Vale University Health Board is taking a community-first approach to caring for patients with type 2 diabetes.
At that time it was standard practice for patients to be referred from their local GP to hospital outpatient appointments, which created long waiting lists. In response, the team began to develop a community-first model of care, aiming to ease the pressure on hospital sites, offer patients the opportunity to receive care closer to home, and save valuable time for both clinicians and patients.
The first step was for specialist diabetes consultants in secondary care settings to develop strong working relationships with a number of GPs across the region in order to share skills and knowledge.
As a result of this knowledge-sharing, the team found that many patients were being prescribed a type of laboratory-created insulin known as analogue insulin, which is genetically altered to act faster and last longer than ‘regular’ human insulin.
Analogue insulin is around 30% more expensive than human insulin, and in many cases patients had been receiving it on prescription for a long time without review. The vast majority of patients experience no extra clinical benefits from taking it.
Diabetes: The Facts
• Around 5.6% of the population of Cardiff and the Vale has diabetes.
• Approximately 9 out of 10 people with diabetes have type 2 diabetes.
• Type 2 diabetes is a lifelong condition that can lead to serious health complications. However, it can be managed by taking artificially-created insulin.
• The treatment and management of both types of diabetes currently accounts for around 10% of the NHS budget in England and Wales.
• Since 1996, the number of people diagnosed with diabetes in the UK has risen from 1.4 million to 3.5 million – a figure that is expected to increase.
Transformation in action
In 2015, the diabetes team applied for funding from the Welsh Government’s ‘Invest to Save’ scheme. They wanted to transform diabetes care based on what they’d learned from their time with GPs, starting with the appointment of two diabetes specialist nurses who would offer care in the community.
These nurses worked in partnership with primary care staff to:
a) identify patients who were struggling to manage their diabetes;
b) help those who were taking analogue insulin to make the switch to human insulin, where appropriate;
c) and provide help and guidance to patients in person and over the phone to ease the pressure on hospital sites.
Since the new model of care has been implemented, there has been a saving of £324,000 thanks to cost-effective prescribing. The additional resource and improved education has also resulted in lower mean blood glucose levels of 13.9mmol/mol, which means fewer complications in diabetes patients.
Primary care: the first point of contact in the healthcare system. Primary care includes GP practices, dental care, optometry and community pharmacy.
Secondary care: when a patient requires specialist knowledge or equipment for their care they are referred from primary to secondary care, which is normally based in a hospital setting.
Type 2 diabetes: a common condition that causes the level of sugar (glucose) in the blood to become too high (nhs.uk).
“By putting the holistic needs of the patient at the centre of everything they do, the team have not only been able to save around £324,000 in cost-effective prescribing, they have overseen a mean reduction of 13.9mmol/mol in patients’ blood glucose levels and, over the two and a half years this project has been run, not a single patient on our books has deteriorated in terms of their glucose control.”
Dr Lindsay George
Consultant Physician and Diabetologist, Cardiff and Vale UHB