Service redesign: The experience of Newcastle Diabetes Service 2001-2007

Abstract

The prevalence of diabetes is projected to rise substantially. National policy has introduced drivers to promote service redesign around patient needs. This paper describes how we have developed an integrated local diabetes service based on the community delivery of diabetes care, supporting primary care and interfacing with specialist care. The diabetes service is located in the Primary Care Trust and is based at the Newcastle Diabetes Centre. There is a service delivery plan agreed with all stakeholders for people with type 2 diabetes. The service supports primary care to deliver high quality care, provides community care in close proximity to patients' homes and delivers specialist care. Pathways of care for people with type 2 diabetes are based on level 1 primary care, level 2 community care and level 3 specialist care. Agreed district-wide guidelines, with referral criteria, support integrated pathways of diabetes care. Level 1 (primary care) is supported by district-wide podiatry, digital retinal screening and health care provider education. Level 2 (community-based service) includes a pathway for newly-diagnosed type 2 diabetes encompassing structured group education and a pathway for continuing care of more complex type 2 diabetes, supported by additional community services such as weight management groups, and community-based group insulin starts. Level 3 (specialist services) provided at the Diabetes Centre include preconception care, a medical foot clinic, a young adults clinic, an insulin pump service and a diabetes renal clinic. This paper shows how the redesigned service supports primary care to provide care closer to patients. Copyright © 2009 John Wiley & Sons.