Outcomes…at the end of the day, thats what it must be all about. Has to be. Everything else in a healthcare setting is worth little, little more than waffle, colourful powerpoint slides, clever words, analogies- but sadly little else. Even the words of empowerment & empathy- words derided by some - is driven towards outcomes- whether they be happier patients or staff- they all lead to one thing- better outcomes. What exactly are we doing this job for?
I am yet to meet a single diabetes specialist who went to medical school to improve an HbA1c- and in a way, quite rightly, that same question is being raised, louder by the day- as to the medications and the outcomes. its never been about surrogate markers- but always about outcomes.
So to the Super Six diabetes model- and it is with significant pride we looked at and finally have published the 5 year data. Is it the ultimate model of care- not by a far stretch of imagination- and to be fair, we are in discussions about adapting to changing times, adapting to new structures…but the principle? Sound as much today as it was all those years.
The model was always very simple. Specialists use the hospitals for high end stuff- and the rest to be managed in primary care- but with one little tweak- be there in primary care too- visiting surgeries, physically seeing patients with GPs/Practice Nurses- as well us being accessible via phone/email etc
It cut across 80 odd GP surgeries; 3 provider Trusts, 1 ambulance service - and it held its own- bound by a very core strategy- the SAME group of specialists working in BOTH community & acute settings. It is my steadfast belief that the term "Community Diabetologist" is nothing but a tautology. The community has a hospital as PART of it- the hospital is not a separate entity and back in 2009/2010 when the word Vanguards and STPs did not exist- we ventured forward and tried to fuse all of primary and secondary care together.
Problems? Of course many- a lack of a unified IT, variation in degree of enthusiasm amongst primary care, community & acute providers with different financial drivers and targets to attain ("How many phone calls did you receive" - rather than "How many hypo admissions have we prevented") but then again, no one said it wouldn't be a challenge- and I love a challenge- so here we are.
I won't say more about the details of the results (have left relevant links at the end of the blog) but this is more about being very grateful to so many who have taken this so far. I have never trained to be a leader, never declared myself as one either- and a leader is only as good as those standing next to him or her. Without my colleagues -whether they be in the department- or in GP surgeries- nothing would have happened. Why is integrated care so difficult- because its tough to get a collective view together cutting across so many providers- by effort, default, and a significant help of luck- we got there- and 5 years later, its been worth it
Whatever be the next versions- the model of care will change now- but 5 years of working differently has been really helpful-both for education as well as building relations with primary care. How DO you improve diabetes care- if you don't stand by; help; support and build relations with colleagues who look after 90-95% of those you purport to look after?
Today, it is with a lot of pride we see similar models coming up, being discussed and indeed versions being created. We,as a team, never had any monopoly on this- so if you want to know mores ever, just ask.
And to so many across the South East Hampshire & Portsmouth area- Consultants; GPs, Nurses, Managers, Commissioners- thank you- its been worth every single moment.
To others reading it, my tip? Keep trying. Failure is normal- try again. And then try some more. Persist and keep focus. Build a team around you. And keep trying. Keep focus- keep at it and judge your efforts on outcomes.
As the saying goes…"If Plan A doesn't work, there are 25 other alphabets. Stay cool"
Special thank you to:
- Sarah Malcolm, Melissa Way, Lyn Darby(Commissioners/Managers)
- Gwen Hall, Jane Egerton, Debbie Fishwick, Sarah Moutter, Ali Tier (Nurse specialists)
- Jim Hogan, Paul Howden, Andy Douglas, Barbara Rushton (GPs)
- Sue Harriman, Katriona Percy,Ursula Ward (CEOs)
- Simon Holmes (Medical Director,Portsmouth Hospitals)
- Bruce Keogh
- And of course- the super-duper awesome legends /colleagues I work with everyday in Pompey
To read about the 5 year data:
To read more about Super Six Model of Diabetes Care: