Sunday, April 15, 2018

Across the divide

August 2010. Its always a tad nostalgic to skim through old emails- but that's how long back was the 1st meeting to discuss how we wanted to change diabetes care in South East Hampshire & Portsmouth. Many late nights, many meetings later- it was around September 2011 that the redesign of the diabetes model came to being. In between that, there were the nervousness of contracts teams in hospitals, the debates with one's own Trust, the financial calculations involved, a lengthy conflict of interest panel, multiple negotiations,convincing colleagues....yet finally we got there -the birth of the Super Six Diabetes Model. Much has been written, many papers have been published- and the mists of time make one forget who did help along the way.

Those were the days of Jim Hogan and Koyih Tan as GP commissioners, Lyn Darby as the local Commissioner, Melissa Way as the Strategy Implementation manager, Richard Jones as the Medicine Chief; Lesley Munro as the manager from the local community provider....some steadfast supporters-and of course, 3 fabulous colleagues within the department who let you get on with it. The course of time has been kind to us- and about 6 and a half years later, the model continues as we discuss the next steps- ready to tweak and evolve as per local structural changes- whether they be Accountable or Integrated care organisations or Vanguards or Hubs. 2011 was the time the South East Hampshire & Fareham/Gosport CCGs came on board- another long process followed post that and  in 2012 we got Portsmouth to join- post a tendering process with 5 bidders...and what an experience that was too!

As of 2012, we finally had all 3 CCGs under one pathway, all 3 local providers under one pathway- with one fundamental aspect to it- the same team delivered care across the secondary and primary care- same Consultants- no different, no one to "compete" with- but be responsible for the outcomes across the whole sector. Which- to be honest, is how a long term condition should operate. Without having to think of competing bottom lines; competing for resources, trying to expand a community service at the expense of the acute...nope, that is NOT how you can improve care in a long term condition.

Results have taken their time to come through- and much kudos to local commissioners etc- present times having folks such as Paul Howden, Sarah Malcolm- holding their nerves with the model of care. It has been and continues to be one of the longest standing models of care- referenced in the NHS Right Care pathwayKings Fund ; Diabetes UK documents etc
Documented papers on reduction of admissions have been published- which have been greeted with as most things in modern times. Respect and cheer from those who have believed in the principle; a look for conspiracy theories or flaws in the datasets from those who haven't liked this approach towards diabetes care.

Recently NHS England has published the Diabetes CCG Improvement & Assessment Framework (IAF)- based on a few agreed principles nationally with clinicians and patient organisations- such as participation in national audits, attaining targets, people attending education programmes, amputation rates etc. Grading has been given as Outstanding, Good; Requires Improvement and Inadequate- similar to how CQC look at providers.

Taking Wessex and Dorset region as a pack, there are about 8 CCGs or 2 STPs. Of those 8 CCGs, 2 have been Outstanding (Fareham/Gosport & South East Hampshire); 4 Requiring Improvement (Portsmouth, Dorset; Isle of Wight & North Hampshire) with 2 rated as Inadequate.

I absolutely make no bones about the pride it gives us to see the fruition of many years of hard work to see this- and the vindication of the principle to which we and the model of care has worked. It also shows work to be done in 1 of the CCGs we cover- and focus will be on that area for sure. The workforce has been a fraction of what other systems have used- thus showing its not just about the sheer personnel but also about the ethos of having one team across the divide. When we work as a community team, we have no dispute with the acute team-….we are it.

Lessons to take away for us- or even to pass on? As this is the Super Six Diabetes model- here are 6:

  • Use acute hospital for high end stuff such as antenatal diabetes, foot MDTs etc
  • Access, access and more access to primary care- whatever means possible- physical or virtual
  • You don't need fancy tech or Apps to do all that- simple old school relation building with primary care is where it sits
  • One team across the "divide". No distinction between acute or community teams. The term "Community Diabetologist" is a tautology- the hospital is part of the community.
  • Have patience, a lot of it- and give things time. Most importantly find Commissioners who are willing to give you that time too.
  • Have a good team with you- who will look after you- and each other.
What next? Have a read if you want..time changes, so does every model need tweaks. However, the principle stands- one team across the divide- and as Sir Muir Gray always says to me: "You, Partha, are a Diabetologist for the population, not for the hospital. Or the Community.
You serve the population."

And I can't put it any more succinctly than that.

* If you want to know more about the Diabetes CCG IAF- and how your CCG is doing:

** If you want to know more about the Super Six Diabetes model: 

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