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March 14, 2016

Improving the Delivery of Adult Diabetes Care Through Integration: Sharing Experience and Learning

Region: Europe Other Empowering and engaging people and communities, Reorienting the model of care, Coordinating services within and across sectors Source: Diabetes UK

In October 2014 the charity Diabetes UK published a report titled "Improving the Delivery of Adult Diabetes Care Through Integration: Sharing Experience and Learning".  The report identifies five key enablers for integrated care and outlines specific local initiatives in the UK which deliver integrated care for patients with diabetes. For example, the Royal Wolverhampton Hospitals NHS Trust (which delivers community and hospital services in Wolverhampton) along with the local Clinical Commissioning Group and various GP practices have been involved in an integrated and patient-centred model of diabetes care for many years. The model is characterised by partnerships between primary and specialist care that aim to increase the proportion of services delivered through primary care. All key enablers for integrated care that were identified by the report are present in Wolverhampton. Examples of these include:  1. Integrated IT. The CareCentric patient portal has allowed GP practices and the trust to integrate electronic records.  2. Aligned finances and responsibilities.  Integrated care pathways involving multidisciplinary structures provide clarity about who provides which services. 3. Collaborative care planning.  After having thought about their priorities using a provided questionnaire, patients collaborate with clinicians to devise an action plan. 4. Effective clinical engagement and leadership. Multidisciplinary groups organise care pathways, education and training. 5. Clinical governance. There is a Diabetes Programme Board, comprising representatives from across multiple care settings, which oversees all the services involved.