Agenda item
Redesign and Investment in Diabetes Services in Brent
Members will remember that, at the last committee meeting in January, it received a report that outlined the range of diabetes services provided in Brent. The committee requested that a follow up report be provided to this meeting with more details on the planned changes to the way diabetes services are delivered that were mentioned in the original report. In response to the committee’s request, this report outlines the rationale for changes in services. The redesigned services will focus on providing integrated care in a community setting in line with national and local guidance and priorities.
A subsidiary report is also attached, which provides an update on the Diabetes Task Group recommendations which were reported to, and approved by, the committee in February 2013.
Minutes:
Dr Ajit Shah (Clinical Director, Brent CCG) introduced the report that provided an update of the redesign and investment of diabetes services in Brent and the case for change. Members noted that the recorded prevalence of diabetes in Brent according to GP records was 8.1%, higher than both the London and the national rate. However, Diabetes UK reported a higher prevalence in the borough, at 10.5% which included an estimate of undiagnosed cases and was the highest in the UK compared to a national rate of 7.4%. In terms of other complications arising from diabetes, however, Brent generally performed better than the national average. Dr Ajit Shah then drew members’ attention to the various schemes as set out in the report to address the comparatively high diabetes rates in the borough, such as the diabetes insulin local enhanced services (LES) and Brent CCG’s response to the recommendations made by the committee’s task group on diabetes.
During members’ discussion, reasons were sought as to why Newham had significantly more diabetic specialist nurses than Brent. Clarification was sought with regard to the £1.030m figure quoted as the new total cost of diabetes pathway costing and also an explanation of footnotes ‘c’ and ‘d’ on page 243 of the report. Another member enquired how many times would a diabetic patient be expected to attend a clinic and what treatment would they receive. The total number of patients who were taking insulin injections was asked and it was also queried why the total cost per patient for diabetes treatment had risen. A member also commented that they felt that secondary services appeared insufficient.
In reply to the issues raised, Dr Ajit Shah explained that about 15% of his practice’s patients had diabetes and most only required his support and that of the practice’s nurse. Members were informed that on average diabetic patients would visit a clinic between three to four times a year, although if the condition was particularly acute it could be more like 15 to 20 times a year. Typically a diabetic patient would be given a blood pressure check, have their feet measured and there would be a review of their medication and a discussion about their diet and the level of control they had over their condition. A change in medication would be undertaken if deemed appropriate. It was not known precisely how many patients in Brent were taking insulin injections. With regard to footnotes ‘c’ and ‘d’ in the report, Dr Ajit Shah explained that these were used as a way of identifying more patients to receive the appropriate treatment, although kidney disease in Brent was lower than the national average.
Isha Coombes (Assistant Director, Brent CCG) advised that the diabetic specialist nurses in LB Newham also carried out paediatric work, whilst in Brent patients could access the DESMOND scheme.
Dr Ethie Kong explained that the diabetic specialist nurses provided support resources for practices and would not necessarily have a direct, hands on role. She added that the administering of insulin in Brent was policed well by the CCG and she would provide members with more information on this in future.
Jo Ohlson confirmed that Brent CCG’s governing body had approved the new spend for diabetes pathway costing. With regard to rising costs per patient for diabetes, she advised that this could be attributable to a change to the mix of patients receiving treatment. The committee heard that an independent procurement panel carried out commissioning of secondary services for diabetes and that more information could be provided on this and on the strategy for commissioning out of hospital services.
The Chair also requested that the diabetic specialist nurse profile for Brent be mapped out and provided to members.
Supporting documents:
- 4-Diabetes - covering report, item 7. PDF 54 KB
- 4- Diabetes HOSC Report March 28th Feb SH Updated FV, item 7. PDF 367 KB
- 4-Update on the response to the OSC Task Group on Diabetes, item 7. PDF 91 KB