Saturday, January 26, 2013

The Super Six Diabetes model

Leicester. Gateshead. Bristol. Hackney. Harrogate.Barnet. Just among the areas who have asked about the local model of diabetes care..expressed an interest, wanting to know more about this, perhaps a consequence of it winning awards, perhaps a reflection of it being published in journals...whatever be the reason, its been a pleasant surprise to be contacted by CCG leads, fellow professionals enquiring about this, asking about the financial modelling and what has stood out has been the warm compliments and the realisation that all areas face the same basic challenge while trying to integrate do you define what needs to be sitting inside an acute Trust and what in the community? And for that in the community, how do you address the challenge of not asking simply the GP to take on more work, address the variability, challenge the naysayers etc?

Our journey possibly started with the first article written on this topic- where the concept of "let's define what needs to be in the hospital" was fleshed out. In simple terms, the question to be answered was this "Would the patient benefit from coming to the hospital?" OR as I always ask my trainees when they review patients "Can you do something HERE within the hospital that can't be done elsewhere?" Thereby, the "Super Six" was born. In short, either it was the expertise of the diabetes Consultant concerned eg: insulin pumps etc or the multidisciplinary nature of the clinic whereby the presence of multiple professionals together was easier and financially more viable to achieve within the hospital eg: antenatal diabetes care. I am not going to spend time discussing the multiple negotiations, discussions that had to be put in place- not only with Commissioners from PCTs at that stage, newly emerging GP leads for CCGs- but also with the acute Trust- along with the Community Providers. Suffice to say it took some time, lots of coffee, explaination etc but as a testimony to what can be done when you have people willing to listen and the basic intention to change...the model was put in place. 
At this stage, let me do some myth busting. To those who say that doctors are the only ones who understand patient care, that's not my own experience. I have met plenty of doctors who refuse to see the bigger picture and are more concerned about what will happen to their job plans, think of their own convenience (leave the hospital grounds!! Blasphemy I say!!!) rather than the basic question.." Would the patient benefit from coming to you in your hospital clinic?" Some of the biggest players concerned in making this model work have indeed been managers (thank you Melissa, Lesley and Gethin!) as well as GP colleagues (Tim, Jim, Koyih and Barbara- do take a bow), nurses (Jane, Debbie...ever grateful) and Trust Executives- and for that I will always be grateful. Beyond all, as always said, am just darned lucky to have 3 awesome colleagues - who although senior, have put nothing but utmost faith in the new kid on the block. D'Artagnan had arrived.

What about the community? Well, little point in doing clinics out there...that has been tried and all that has been achieved is shifting of clinic rooms from the confines of a Trust to somewhere else. How do you tackle the issue of education and support for primary care? So we changed it. Lots of meetings and opinion seeking from patients,GP colleagues and practice nurses want a designated hotline at the end of day? Got it. You want an email address with guaranteed 24 hour response time? Done. You want visits to surgeries to discuss patients, go through audits, have a general chat, build relations with each GP surgery in region? Done. Want to know how its been all going? Pulse and Primary Care & Diabetes journals kindly accepted our on!
Did we do anything amazing? No- in fact all these plans have been there before. They just haven't been implemented either due to the intransigence of a few or a failure to convince of its worth. Perhaps a case of being in the right place at the right time...either way, we are where we are. A happy position- without threat from within the Trust or from CCGs. Time then to deliver.

In short, we,as a community, are working to get this right. I am tired and fed up about the word "impossible". We live in Portsmouth- and wouldn't say we have solved everything- but improved relationships and working together we most definitely are doing. I also hear the issue of multiple providers and how it can fragment care- and no doubt there are multiple examples of this. But you know what? In our region, we have 3 providers in the main- Portsmouth Hospitals NHS Trust, Southern Health Foundation Trust and Solent NHS Trust. As far as diabetes goes however in the South East Hampshire and Portsmouth CCG, there is one model of care- which all 3 organisations have signed up to and work together to deliver. Utopia? Unbelievable? Come down and see us- any time you choose.

More things to come- some just started such as the "Hypo Hotline" for paramedics, some in the pipeline such as a structured Diabetes education programme for all professionals in region...and beyond the patients, its based on 1 thing and 1 thing only. Respect for each other. I can't do what a specialist nurse can do, can't do what a manager can do or a GP can do and am open and honest about it. And when I say I respect and understand what GPs are going through, that's not me being condescending. I work with them. They are my friends who I go out for drinks with. And I know and respect that. And all my trainees are very well aware of my response when any one publicly or privately denigrates a fellow colleague. Spend time with them- and then make your judgement. In return, I suspect the diabetes specialist community wants the same. Respect. For the CCG leads who now have to decide about diabetes care, perhaps spend some time with your local diabetes specialists and see first hand their challenge too. 

So my tips after setting this all up with support of friends, colleagues etc, my tuppence to all involved in diabetes care? 3 simple words. Respect. Engage. Change. 

And oh yeah, leave the word "impossible" out. You know whose dictionaries they belong to.
Now go break a leg.

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