NDPP in Salford Dr Sheila McCorkindale, Clinical lead for diabetes - - PowerPoint PPT Presentation

Preventing type 2 diabetes in England

NDPP in Salford

Dr Sheila McCorkindale, Clinical lead for diabetes NHS Salford CCG Helen Slee, Project Manager, Salford NDPP

Salford City Challenges

Population 237,000

• 47% of people live in the most deprived

5th of areas in England. Unemployment 5.5%

• >12,000 people diagnosed with diabetes.

Estimated further 2000+ undiagnosed

• Over 50% of the population have a

recorded BMI in the overweight or obese category

65+ 14.6%

OF POPULATION

Estimated prevalence of NDH in Salford = 10% over 16s (19,693 people)

Existing assets in Salford

2 existing NDH programmes

• Telephone based service (IGR2) commissioned mainstream in April 2014.
• Exercise for IGR innovation pilot

Commitment to partnership working

• Joint working with Public Health – health checks, development of centre of

contact, innovation projects

• Partnership with Hitachi to develop telephone/web-based intervention
• Salford/ DUK partnership – city wide ‘ Healthy City for Diabetes Initiative’

Funding for practices

• IGR activity incorporated into Long Term Conditions Locally Commissioned

Service

‘Team Salford’ approach

• Joint working – SCCG, public health, hospital trust, Hitachi,

community groups

• IGR work in practices funded within ‘Salford Standards’
• ‘Hands on support’ for practices by nurse facilitator
• Regular NDPP steering group and operations group
• Community case finding and direct referral
• Data from all sources collated in GP EPR
• Full evaluation by NIHR GM CLAHRC
• Patient stories and feedback
• Branding developed by patient groups

Marketing and Campaigns Plan

Various activities across the city using engagement materials including:

• Health Bus
• Newspaper and online

advertising and news articles

• Ad vans
• Phone booth and bus shelter

advertising

• Targeted social media campaign

New community engagement projects

• Unique Improvement and Health Improvement Team working within the

community

• Process established for direct referral of patients from community teams into

NDH programmes – data only sent to practices

• Community Team Approach:
• 20 Community Champions recruited
• Mixture of opportunistic engagements and planned rolling local campaigns

in 8 neighbourhood areas

• Clear and planned pathway developed with built in follow up and brief

advice at each stage

• Peer to peer engagement using Diabetes UK Risk Assessment tool
• Health Improvement Service offer point of care ‘pin prick test’ (HbA1c) at

Health Bus and in variety of community locations

Practice Nurse Facilitator

‘Hands on’ support for practices by CLAHRC Nurse Facilitator to:

• Raise awareness of programmes/referral process across all practices
• Work in individual practices involving:
• FARSITE search of existing records (last 6 months) for people with IGR

who are potentially eligible for programmes.

• FARSITE/ DOCMAIL invitations sent to those suitable
• Specific NDH review clinics set up for people who respond run by the

Nurse Facilitator to discuss NDH, explain risk and refer if appropriate

Diabetes Prevention: IGR Care Call

• Provided by Salford Royal Foundation

Trust

• 9 month MI type behaviour change

programme

• Education, goal setting, action planning

and regular review

• New web-based/ telephone programme

developed in partnership with Hitachi/ SRFT Service trial (CATFISH)in progress. Recruited 200 people

• Works collaboratively and signposts to

Exercise for IGR and other relevant services

• 8 week membership /access to all Salford Community Leisure Centres and
• ther specialist activities
• Initial one to one consultation with an Active Lifestyles Trainer who will

design a personalised fitness programme for the client.

• Available activities include the gym (including supervised sessions),

swimming, exercise classes and other sessions, specifically designed around clients who have been found to have IGR.

• Clients are referred from GP’s, Diabetes Care Call Team and other health

care services.

• Works collaboratively and signposts to other relevant services including

Care Call

Exercise for IGR Programme

Salford NDPP Demonstrator Site Lessons Learned

Case Finding: General Lessons

To succeed you must:

• Raise public awareness of the risk and the importance of taking action
• Advertise programmes and ensure easy and equitable access
• Engage with individuals and communities, encourage self assessment and

enable all to make a positive choice

• Work together to build capacity at all levels
• Systematically identify high risk patients using existing GP records, health

checks, long term condition reviews, targeted community engagement

• Evaluate impact and ensure sustainability
• Contact a large number of individuals to be able to counteract the number of

drop outs prior to intervention.

• Providing interventions is easy – the main challenge is enabling people to

make positive choices and engage with diabetes prevention programmes.

Case Finding: Community Engagement

• Setting up new processes requires time and resolution of technical and
• perational issues
• Marketing and engagement materials are essential for effective community

engagement work – consider timeliness of material development and distribution

• Clear referral processes into interventions need to be established before

engagement work ‘goes live’

• Ensure there is enough capacity to meet the demand of the programme of

engagement activities

• Targeted approaches to high risk populations yields the best conversion

rates from engagement to recruitment into interventions

• One stop shop with opt in at every stage – making every contact count

Case Finding: Nurse facilitator

• Providing support/ ‘ hands on help’ for practices appears to be a good

investment:

• Despite LTC LCS, initially very variable data quality, activity, enthusiasm / support

for programme between practices BUT the Nurse Facilitator was welcomed by all and help appreciated. Coding and quality and quantity of ‘ natural‘ referrals significantly improved

• Due to Nurse Facilitator’s work, the number of referrals to IGR services

significantly increased

• Extra help in searching existing records / correcting coding / specific clinics

for people found to have IGR from existing records likely to be needed in medium term only

• Salford is investing in a nurse facilitator role to support practices in

identification of people with IGR from existing records for a further year

Interventions

• Match programme capacity to demand ensuring cost effective service
• Establish at the beginning of the programme:
• Operational instructions
• Clear referral pathways
• Data recording requirements
• Collaborative approaches with other providers
• Signposting to relevant complementary services
• Evolve and continuously improve from lessons learned

Programme Management

• Governance structures and key stakeholders to be identified and agreed

before the pilot begins

• Meeting regularly and defining a shared aim
• Dedicated Project Manager resource is beneficial to coordinate the

programme

• Establish a marketing plan to support with case finding and recruitment

into interventions

Patient Stories

“It really did me well, now I try and have an outdoor walk in the mornings if the weather is fine and I get up in time” Patient A is 62 and increased his exercise capacity from 1km on the treadmill to doing 3km on the treadmill and 2km on the exercise bike. “I remember when I started I was 85.7 kg and last month 81.5kg. My target was to shed at least 5kg in 6 months and I think that will be achievable. I still walk into town for my work every day. I would definitely recommend this programme to other people” Patient C joined both IGR Care Call and Exercise for IGR “It was a bit of a shock but I enjoyed it! Proper chuffed” Patient B is 66 and has been on warfarin since a stroke in 2010. In the 8 weeks of the programme he lost 8kg in weight and regained his confidence in exercising.