Introducing group consultations for adults with Type 2 diabetes

NHS England | March 2019 | Introducing group consultations for adults with Type 2 diabetes

General practice nurses (GPN) in the Premiere Health Team, Leigh (Wigan CCG) and West Gorton (Manchester CCG) medical practices introduced group consultations for adults with Type 2 Diabetes. This new approach has led to better outcomes, experiences and use of resources locally.

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The GPNs recognised a significant proportion of time was in consultations with patients about managing their diabetes, this advice was not impacting on health outcomes. Group consultations were identified as providing a potential opportunity to improve outcomes and access, engaging patients through a more social and less medical model of planned care. Experience in other parts of England suggested that it could also improve staff experience by reducing repetition and creating more time to care and support patients.

The programme was set up to reflect the drive in primary care to support patients through new consultation approaches. The aim being to improve continuity and convenience for the patient, and connect them directly with the most appropriate professional through new ways of working.

The first session focused on HbA1c, blood pressure, cholesterol, Body Mass Index (BMI), eye and foot checks and medicines. The second session centred around issues that patients wanted to explore further, which they identified at the first session.

As part of the session weight and blood pressure measurements were taken and it became clear that weight control was the group’s biggest issue.  At the follow-up consultations, the team prepared healthy recipes to encourage more home cooking and ran a food quiz to identify hidden sugars in common shopping basket foods. Alongside this, clinical aspects of diabetes such as impact on the kidneys and blood pressure were discussed.

This led to better use of resources, West Gorton practice calculated significant efficiency gains in clinician time. The nurse consulting saw 8-9 patients in one hour, which under the previous model four patients would have been seen in a 1:1 clinic (Source: NHS England).

See the Atlas of Shared Learning

Supporting the management of type 2 diabetes with pharmacist-led reviews and implementing NICE recommended nine key care processes (NICE Shared Learning)

A case study from Slough Clinical Commissioning Group (CCG)  has been published on NICE Shared Learning. 
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The case study looks at supporting the management of type 2 diabetes, using pharmacist- led reviews and implementing NICE’s nine key care processes annually.

These are:

  • Glycated haemoglobin (HbA1c) measurement, with a suggested target of 59 mmol/mol.
  • Blood pressure (BP) measurement, with a suggested target of 140/80 mm Hg.
  • Cholesterol level measurement, with a suggested target for total cholesterol (TC) of 5 mmol/L.
  • Retinal screening.
  • Foot checks.
  • Urinary albumin testing.
  • Serum creatinine testing.
  • Weight check.
  • Smoking status check.

Context: A pharmacist team worked with GP practices in Slough Clinical Commissioning Group (CCG) to identify patients missing any of the NICE-recommended 9 key care processes, or whose care processes indicated poor Type 2 Diabetes (T2D) control.

Aims: The project aimed to reduce the number of missing care processes and optimise pharmaceutical treatment (NICE Guideline 28) of patients whose treatment targets for glycated haemoglobin (HbA1c), blood pressure (BP) or total cholesterol (TC) readings were not being achieved.

Results: The proportion of patients receiving all the NICE-recommended 9 key care processes increased from 46% at project outset in April 2013 to 58% on completion in April 2014.

The percentage of patients achieving HbA1c, BP and TC targets all increased (65%-70%, 70%-76%, 78%-82%, respectively). Quality Outcomes Framework data for Slough CCG showed the percentage of diabetic patients achieving target HbA1c, BP and TC readings increased from April 2013 to April 2014, but then diminished in the year after project completion.

Key Findings:

  • Pharmacist-led reviews supported by a multidisciplinary team increased the number of key care processes administered and improved diabetic control during the year of programme delivery.
  • The project worked well as it combined the strategic drive and project facilitation skills of Slough CCG, the general practice teams’ knowledge of their patients and the clinical and information technology skills of an experienced pharmacist team and is a positive example of the ways in which multidisciplinary teams can work pro-actively to implement NICE guidance.
  • Whist the outcomes of the project were positive, the improvements diminished in the year following project completion, suggesting that such programmes should be ongoing rather than fixed term. This would be a key learning point for other organisations to consider when implementing a similar programme.

Further information is available from NICE Shared Learning

NHS Slough Clinical Commissioning Group| Supporting the management of type 2 diabetes with pharmacist-led reviews and implementing NICE recommended nine key care processes | February 2018 |NICE Shared Learning|

A paper regarding this project has been published on BMJ Open, it can be read here