Summary

In 2007, the borough became a pilot site for the “Year of Care” Project. This involved clinics “redesigning” the annual review that they undertook with patients. The newly-redesigned annual review took the form of a co-productive care plan, where patients were asked what was important to them, and what health outcomes they themselves would like to achieve.                                                 

In 2010, it was decided that ALL general practices in the borough should offer a core Service to people with type-2 diabetes. This involved creating additional packages of ideal care for people with type 2 diabetes across four clinical subgroups: newly diagnosed, controlled, off target and complex, with a clear outline of staff competencies required for each aspect of the process. Role delineation was also a feature, with Health Care Assistants (auxiliary nurses) trained in checkups.  

Description of practice

The problem

Tower Hamlets is an inner-city borough of London, with high levels of social deprivation. It had had some of the worst diabetes outcomes in England. The prevalence and incidence of diabetes in this borough rapidly rose between 2005-2011. On average 7 life-years were lost due to mortality from diabetes in Tower Hamlets (compared to an average of approximately 4 life-years in both London and England.)

Meanwhile, the diabetes care was fragmented and of an inconsistent quality.

Patients also reported feeling unengaged with their healthcare and care providers, likening attending appointments to “being dragged to the headmaster for telling off,” and being afraid to complain lest it be held against them.

The solution

In 2007, the borough became a pilot site for the “Year of Care” Project. This involved clinics “redesigning” the annual review that they undertook with patients. The newly-redesigned annual review took the form of a co-productive care plan, where patients were asked what was important to them, and what health outcomes they themselves would like to achieve.                                                 

In 2010, it was decided that ALL general practices in the borough should offer a core Service to people with type-2 diabetes. This involved creating additional packages of ideal care for people with type 2 diabetes across four clinical subgroups: newly diagnosed, controlled, off target and complex, with a clear outline of staff competencies required for each aspect of the process. Role delineation was also a feature, with Health Care Assistants (auxiliary nurses) trained in checkups.  

Implementation of practice

What stage is the practice currently in?

Ongoing

Who was/is responsible for the implementation of the practice?

This practice involved buy-in from local government, clinical commissioning groups, and secondary care providers.

Impact

The programme has been successful: Tower Hamlets as a borough now has the best diabetes outcomes in England, when previously it had the worst.

Qualitative evaluation demonstrates that patients feel more engaged with their care – “I’m happy that I get more of a say in my care,” and, likewise, staff report increased job satisfaction, finding the “engaging with patients… more rewarding” than “ticking boxes.”

Diabetes outcomes have improved against biomedical markers. For many clinical indicators, including diabetes cholesterol levels, Tower Hamlets now ranks in the 1^st, 2^nd or 3^rd places out of 211 clinical commissioning groups in England.

Additional information

Contact information

Name:

Isabel Hodkinson

Organization:

Tower Hamlets Clinical Commissioning Group

Email:

isabel.hodkinson@nhs.net

Phone:

020 3688 2500

Role:

Health care provider

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