Wandsworth tPCT

1. Wandsworth tPCT Diabetes Service Provision An overview Neil Bamford, GP and PCT diabetes lead

2. An inner city borough with distinct social and geographical areasDifferent solutions for its different constituents St G St Georges Hospital QMH Queen Mary's Roehampton C&W Chelsea and Westminster G&StT Guys and St Thomas’ C&W G&StT QMH St G

3. Activities Level 4 Transitional care for young people and adults Accident and emergency Children’s services Activities Level 3 Peri-operative care Group and individual insulin initiation Type 2 High clinical risk Activities Level 2 Pre-pregnancy and gestational care Multi-disciplinary support; input from podiatry, dieticians, retinal screening service etc One to one support for primary care Pre-conception advice Type 1 support in the community Activities Level 1 Type 1 insulin management Type 2 routine insulin management Prompt attention to new complications and concurrent illness Complex co-morbidities Annual GP/PN review Acute illness Person with Diabetes. Self care with personal care plan, including healthy schools, obesity and exercise strategies, smoking cessation, structured health and other public health initiatives Accredited and structured education occurs at all levels Care planning according to the National Service Framework and local guidelines occurs across all levels Psychological support Uncontrolled symptoms Complex or new pharmacology Telephone and email advice QOF Hard to reach patients; working with district nurses and care homes etc. Assessing and co-coordinating QOF & NSF delivery Good clinical records Disease register Hard to reach patients with more complex needs Inpatient assessment and management Multi-agency support; working with social services, occupational therapy and voluntary agencies etc. Pump services Extended type 2 insulin management Newly diagnosed type 1 More complicated primary care patients Diabetic complications, vascular, feet, eyes, renal etc Protracted vomiting Metabolic emergencies Diabetes – levels of care Mark Hannigan and Paula Dearing of Leeds PCT for permission to refer to their work.

4. Level 1a – Enabled self care • Desmond, Dafne and Bertie • Piloting hand held records containing a personal care plan Diabetes Education and Self Management for Ongoing and Newly Diagnosed Diagnosed, Dose Adjustment for Normal Eating Broomfield’s Education Resources for Training in Insulin and Eating

5. Level 1b – Basic Diabetes CareStandard care that all patients, regardless of type, complications or place of care should expect to receive • Guidelines 2006 and 2009 (waiting ratification) • Referral, housebound and absolutely everything manuals Distributed to all GPs and on line at http://www.thewig.eu/ • Admin guidance, support and performance monitoring- thanks Vanessa, Lucy and all Linking to the long term conditions reference groups give us admin help, ability to commission services and being top of the queue for IT.

7. Ten sessions introducing clinicians to diabetes care, including examination technique, therapies, introduction to insulin, complications and providing psychological support. Graduates have support from secondary care and reach out clinics in their practices. Adapts to our needs so this year will include a renal module and refresher courses.. Insulin management Courses for GPs and PNs leading to Warwick certification in insulin competency did not result in sufficient practicing clinicians to be worthwhile. We are moving to insulin management courses so GPs and PNs have the skills to adjust insulin regimes backed by group starts where interested clinicians can learn skills. Level 2 – Extended diabetes careSupport and follow up for patients that requires additional training and/or multidisciplinary working Accredited by RCGP, for our GPs and practice nurses

8. Level 3 – Specialist diabetes careSupport and follow up for patients with more complex needs. Community Diabetes Specialist Nurses • Support and develop the skills of GPs, Practice Nurses, and District Nurse teams in Wandsworth in the management of patients with diabetes by providing:- • Interventions for individuals to optimise glycaemic control • transfer to insulin for people with type 2 diabetes • Joint clinics with GPs and Practice Nurses • Joint visits with District Nurses • Joint clinics/regular liaison with secondary care diabetes teams • Telephone advice for healthcare professionals and patients • Insulin Start Groups for patients with T2DM • Education for newly diagnosed patients with T2DM – (DESMOND) • Education for patients with existing T2DM – (Conversation Map Education) • Education for healthcare professionals: – • Wandsworth Insulin Management Programme • Blood Glucose Monitoring training for Community teams • Diabetes study days for Community teams, Nursing/Residential homes/Wandsworth Prison

9. Wandsworth Diabetes Intermediate Team Jo Butler Diabetes Consultant Nurse 07717 158733 Fleur Norwood Head of Community Nursing Neil Bamford GP Lead Earlsfield Practice 0208 946 5681 Lucy Chadder Clinical Team Leader Community Diabetes Specialist Nurses 020 8812 4049 07717 541 296 Diabetes Team Administrator  020 8812 4049 Judith Nelson CDSN Wandsworth South area 020 8725 0928 07789 867923  020 8725 3572 nr Thomas Addison Unit Lanesborough Wing St George’s Hospital Blackshaw Road Tooting SW17 0QT Maggie Dixon CDSN Wandsworth South area 020 8725 0928 07826 513899  020 8725 3572 nr Thomas Addison Unit Lanesborough Wing St George’s Hospital Blackshaw Road Tooting SW17 0QT (Lucy Chadder) CDSN Battersea area  020 8812 4049 07717 541 296  020 8812 4051 St John’s Therapy Centre 162 St John’s Hill SW11 1SW Dave Gammon CDSN Battersea area  020 8812 4049 07824 695074  020 8812 4051 St John’s Therapy Centre 162 St John’s Hill SW11 1SW Yvonne Bornemann CDSN Putney & Roehampton area  020 8789 5511 07825 193454  020 8789 5577 Westmoor Community Clinic 248 Roehampton Lane London SW15 4AA Helena McKeever CDSN Putney & Roehampton area  020 8789 5511 07717 347337  020 8789 5577 Westmoor Community Clinic 248 Roehampton Lane London SW15 4AA

10. Level 4 – Consultant led specialist services Care closer to the patient • Data sharing: Emis web and Emis diabetesview allow hospital specialists and CDSNs to read and write into GPs records from their laptops.

11. Polyclinics and polysystems A piloting and then a bidding process as to who commissions these services and who provides these services Battersea Polyclinic system Roehampton Polyclinic North Wandsworth Polysystem Balham Polysystem Central Wandsworth Polyclinic

12. Thanks to all