Treating the soaring numbers of people living with diabetes in the UK is becoming increasingly complex. It’s little surprise, therefore, that the quality and processes of diabetes care around the country can vary. But with diagnoses expected to reach a record 4.2 million in the UK by 2030 – almost one in ten of the adult population – such variation in care, and the consequent variation in health outcomes, affects many thousands of people. This is a serious problem.
A few relatively small tweaks to care and commissioning processes may, however, yield big results. The iDEAL group, a panel of experts in diabetes care with backgrounds ranging from primary care and pharmacy to tech and academia, and bringing both personal and professional experience of diabetes to the table, was created to assess the evidence and make the case for change.
“I’ve worked with a lot of very passionate people in different groups over the years,” says Anne Phillips, iDEAL panel member and Associate Professor of Diabetes at Birmingham City University. “But there can be challenges in translating ideas into actual policy. The iDEAL panel is different; because we’re a small, agile, visionary group there’ll be a lot of outputs, fewer hurdles.”
Key to improving diabetes care across the board will be a whole range of stakeholders; GPs, DSNs, NHS commissioners, policymakers, researchers and various others all play a role. The iDEAL group must engage with all of them in order to make a real impact but, Anne says, for her the healthcare professionals on the front line are the most important audience for iDEAL’s work.
A salient issue the panel has raised with the NHS and with Government is access to ongoing structured education for diabetes professionals. Indeed, as the group’s recent white paper points out, certain healthcare professionals – pharmacists, for example – may see a person with diabetes up to eight times more often than a GP or Practice Nurse does, yet securing NHS funding to commission diabetes training for pharmacists and other non-clinical staff can be incredibly difficult at the moment.
“The group’s work is really important,” Anne says. “We’re hitting four key themes, but for me, as a academic and also diabetes specialist nurse, diabetes , education really is the big issue. Many practice nurses for example have little to no access to CPD or ongoing diabetes education, compared to the multi-conglomerate practices that can be much more motivated to train the people around them.
It’s about supporting those hard to reach professionals, the sole practice nurses in rural practices or in remote locations for example the Outer Hebrides and other such locations.
“They’re the ones that really make a difference with every person they work alongside. It’s a bit like a pebble in a pool; If you reach one person with diabetes you reach one person and as important as this is, if you can change one healthcare professional’s thinking, update their diabetes knowledge, then you can reach out to so many more people too. That’s where I’ve always taken a stance in my career; if I teach healthcare professionals I can reach far more people and have more of an influence.”
Equally important in supporting people living diabetes to better manage their condition is providing more accessible structured education for those people themselves. “We’ve highlighted as a group that the current [classroom based] structured education programmes are fine in terms of quality,” Anne says.
“But they’re not necessarily fit for current delivery, because people can’t take a week off work or take time out to attend them. We’ve got to be working in a much more person-centred way, encouraging practice nurses to learn how to be person centred and make every contact count. Encouraging more people to self-manage, is what diabetes care is all about.
Embracing culturally competent approaches and also using more digital technology to provide education can be enabled to reach more people with education about diabetes.
“Each individual’s experience with their diabetes is their own. We’re not drones or carbon copies, so it’s really important that healthcare professionals listen to what people are saying, work to find some common ground with them – because that can often be the trigger – and find out who might benefit from some updating, or a different approach, or some info about some aspects of their diabetes they may not have. People also don’t express how scared they are of living with diabetes. A lot of people are very scared, so they want to perhaps avoid rather than gain knowledge about it.”
The iDEAL group may only be in its infancy, but Anne and the other panel members have already gained traction in influencing care processes over just five months. The group brought together decision makers and thought leaders from every area of diabetes care at the recent iDEAL group round table, has published two papers and this week attended Westminster for discussions with senior policymakers including Diabetes APPG Chair Keith Vaz MP.
There’s a long way to go in enacting substantial change in NHS diabetes care – but momentum is building. Watch this space.