6th April 2016

Dear Colleagues and DUK Members,

29/3/2016 CCG Meeting Notes

DUK Services Champion Huw Alban Davies and Roy Izatt (as local patient representative) had a very cordial meeting with Dr Sanjay Singh (Chief GP Commissioner) and Nazeem Chauhan (CCG Commissioning Manager – Long Term Conditions) from 4.30 pm to 6pm in Maidstone on 29th March.

We were given a precis of the background and thinking behind the now proposed service specification and pathway documents (previously circulated).

One of the main points to come out is that (or perhaps not previously fully understood) is that the new Service Provider to be appointed will be contracted to provide service in the spokes within hosting GP practices. This will be without additional workload on GP’s who are now providing General Medical Services which includes patients with diabetes presently at L1.
(No doubt that cohort in itself will be enlarged following triage of all existing referrals to L2 and L3).

GP practices will be arranged in ‘clusters’ of approximately 4-5 practices, serving a population of 40 -50,000. The clusters will combine their resources overall, not just for diabetes, and each cluster will have a ‘wrap’ of community resources around it, including district nurses, podiatrists, pharmacists and dietitians. Each spoke of the new diabetes service will support a cluster, providing specialist support from GPwSI1, consultant diabetologist and diabetes specialist nurses. GPs within the cluster who have developed their skills to level 2 (injectable therapy starts, etc.) will continue to do this and will be supported by the spoke. The spoke will educate GPs and work to reduce the variations in care between practices. The community wrap in each cluster will provide a service to house-bound and institutional diabetics.

We asked if the new service provision would be a matter for tender and were advised that the changes proposed would not require tender in the first instance but hoped that the services would be provided jointly by the preferred two Federations of GP’s. We need to point out that the two GP federations are not yet in existence although discussions are taking place. The Maidstone-centred federation is further ahead in its development than that of T. Wells.

On our question on who would carry out triage? The answer was (as in service spec) that it would be qualified clinicians but amplified that Consultants were not expected to be directly involved. Services in the spokes at L2 and L3 would be carried out by Multi Discipline Teams (MDT’s) with services on rotation from Diabetologist, DSNs, upskilled PN’s and regular access to dieticians and psychology services. Referrals would be made to the two Hubs for more complex cases requiring Consultant attention.

Dr Singh promised an uplift in funding for diabetes services, reflecting the priority that the CCG gave the condition. New funding would go towards additional DSNs, psychological support and also podiatrists and dietitians.

The new funding is estimated to be approx. 10% over present allocation.

Dr Singh also promised to look at funding to support Year of Care planning and recognised that if the new system was to be successful, it was essential for people with diabetes to have the knowledge and skills needed to fully participate in the management of their own care.

We repeated the case (which was accepted) that this “joined up service” would be a fundamental change for previous primary and secondary care providers in light of present clear divisions which stemmed in the main from funding factor drivers being different.

In response it was outlined that the service contract funding would have a strong focus on “outcome” KPI’s rather than the activity based methods as in existing secondary care services.

We all agreed that the aspirations of the model were laudable but the resources required and education processes had a long way to go.

Finally, we would like to remind you that Diabetes UK Local Volunteer Group are hosting a public meeting on 19th April at the Angel Centre, Tonbridge commencing 1930 hrs., where these prospective developments will be discussed with a representative from the CCG.

With our best regards,

Roy Izatt Huw Alban Davies

DUK TW Volunteer Group Diabetes UK Service Champion

Patient Representative

TWADRA Chairman