National Diabetes Prevention Programme Planning Workshop (South West Cardiovascular Clinical Network) SE CVD CN Diabetes Lead: Abbey Kitt KSS NDPP Project Lead: Nicky Jonas 7th July 2016
First Wave Expressions of Interest The Story Begins. We had been working with the Medway Demonstrator site 15 th of August 2015: Letter from NHS England circulated by the Clinical Network to all the CCG Diabetes Leads and Public Health Leads Submissions in by the 18 th of September Tight turn around Lots of submissions popular free service known issue Need for large volume of referrals A lot of form filling We have to all be a part of the programme by year 3
Doesn t Hurt NHS Mandate Objective 4: 2.8 - doing more to reach the five million people at high risk of diabetes and improve the management and care of people with diabetes. NHS Business Plan STP/5YFV Plans
Figures (Cardiovascular Intelligence Network August 26th 2015) Name Number Prevalence Brighton and Hove 20,190 8.5% East Sussex 57,645 12.9% Kent 139,791 11.4% Medway 22,916 10.4% Surrey 106,549 11.3% West Sussex 83,089 12.2% South East Total 430,180 11.1% England 5,047,891 11.4%
EOI Projections Finger in the wind Rationale By the end of year 3 there will be 9,000 places available on the NDPP across the South East To get 9,000 people attending we probably need to have 180,000 conversations resulting in a 20% referral and uptake Then we worked backwards so that for the first year we projected 2,000 people being referred
Primary Care workload was our main concern We deliberately projected a low number of referrals and on a big scale to reduce the impact, particularly as we get established on workload for primary care.
An Example Coastal West Sussex CCG our largest CCG 475,500 population 52,781 at risk 56 practices Based on our projections in year 1 we have asked for 676 referrals and in year 2; 2,370 Therefore 12 referrals per practice in year 1, and 42 in year 2. We are hoping to do even better and there is no cap to the number of referrals but we wanted to make it easily achievable and not to put huge pressure on primary care.
What else went into the EOI Baseline assessment working with the Healthchecks Network Who already had an at risk or diabetes LES/LCS/LIS in place What GP clinical systems are being used Audit tools in place What current pre diabetes services are available (including weight management) How many referrals could we expect from healthchecks Who participated in the NDA A named lead with email confirmation of sign off
Selling NDPP - Engagement Adults with NDH (non-diabetic hyperglycaemia) now have an alternative to just an annual GP review Avoidance/delay in onset of diabetes Cash releasing / break even at 5 yrs (RoI tool) Course is free( ) for patients and commissioners
Stakeholders Set up a steering group GPs Diabetes specialists Commissioners Public health Diabetes charities Biochemists Service users People on your side!
Coordinating project introductory meeting Call to arms Stakeholder meeting- make sure it sounds important to attend! National Overview Local Overview Tasks and timescales Q&As Reconfirm interest from organisations Nomination of Lead Organisation (everyone was delighted for the CN to take this role!) Appointment of Steering Group Chair choose wisely! Appointment of Clinical Lead Next steps Next meetings
Perspectives NHSE pay for the intervention not GPs, not patients There is no extra money for LCS and/or additional CCG costs Funds for diabetes prevention may come to CCGs via STP NHS South, Central and West CSU will monitor the national contract No fines/sanctions if we don t hit targets a.k.a profile projections
Role of Lead Organisation (1) 1. Appoint project lead - >3 days: week until provider chosen then (maybe!) can reduce 2. Project management ensuring key milestones are met (profiles, MoU, prospectus, mini competition) 3. Act as conduit between National Team and CCGs/LAs/primary care 4. Keeping CCGs/LAs informed (but not overwhelmed) with information and requests 5. Escalate problems/issues on the ground to National Team 6. Aim to answer all questions (honestly) even if they are tricky
Role of Lead Organisation (2) 7. Organising Steering group meetings (4-6 weeks) 8. Organising telecons/webinars etc. to discuss single issues 9. Identifying areas where single approach is useful (referral templates, biochemistry matters, case finding) 10. Help and support (answering queries quickly, finding information, giving examples, phone chats, visits, presentations) 11. Making life easier (checklist, FAQs, information slides, putting people in touch) 12. Coordinating mini competition
Developing Referral Projections for the DPP Methodology as per national team guidance Provide templates for CCGs to make it easy give clear guidance on numbers. Confirm CCGs final agreement prior to submission Put numbers on a master referral sheet Provide CCGs with simple slide of annual referral number.just one number to remember!
Memorandum of Understanding What it is Fill in the blanks before you send it out! Get all CCGs LAs to sign Written commitment, and it means that a CCG/LA senior officer will sign off giving local leads a chance to highlight NDPP
Local prospectus Look at someone else's first! (ours!) Its got to be good Providers will use this document to plan configuration of services Populate as much as you can centrally PHE (SE) did much of ours Provide straightforward guidance and examples Short and sweet/key points only/bullets ok Amalgamate together and add generic text/tie sections together Terminology! KSS Partners would like the Behavioural Intervention Provider to consider the following in their preparation for providing services in Kent, Surrey and Sussex: KSS partners would be interested in working with BI Providers over the span of the framework agreement towards.
Mini competition What is it? What's the process and timeline Time commitment Panel of 3 GP /PH/Commissioner
Preparing To Mobilise What is Helpful 1. Briefing paper can be used to brief meetings, organisations etc 1. RoI tool help with business case/case for change 2. Finding out about local health check and weight management services 3. CCGs start early on referral pathways/alignment with other services 4. CCGs to consider incentivisation and working with LMC 5. Biochemistry Matters narrative highlighting NDH could be useful 6. Case finding audit tool 7. Referral templates 8. NDPP Guidance and documents package 9. Ben and David for technical/ clinical expertise
Referral pathway this is how it works! GP NHS Health Check or opportunistic detection External provider NHS Health Check or diabetes risk assessment Existing cases of NDH on GP register Code Non-diabetic hyperglycaemia Search GP records for range of hyperglycaemia codes Automated add patient to NDH register Informs GP and sends data electronically NHSHC Provider performs or arranges blood tests Automated add patient to NDH register Inform individual and refer DPP Inform individual and refer to DPP Provider invites individual Generate list of patients for provider Provider arranges confirmatory blood test Progress through DPP Provider sends interim clinical data to GP Completes DPP Does not complete DPP Provider pathway See next slide Automated entry clinical data to EPR Discharge to GP with final clinical data Annual review of glycaemic status, weight and CVD risk Automated extraction of anonymised follow up data to DPP commissioners for evaluation
Where is the balance? Need for large numbers of Referrals Provider having the courses available variation in readiness
Heading towards October Proof will be the pudding Taken a year to go from EOI to first referrals We will have to work closely with Ingeus and with contract management to ensure places are available where referrals are being made
Thank You Any questions?