Download: Summary Success Story (PDF 166KB) / Full Success Story (PDF 138KB)

The challenge:

Before the project began, the diabetes centre was based at the hospital trust, requiring some patients to travel long distances to access the service. DNA rates were high, but despite this staff were still overwhelmed with demand and inappropriate referrals. As a result waiting time targets were not being met.  Additionally staff and patients felt the patient experience and journey was unclear and of poor quality.

The aim:

Western Sussex Hospitals aim was to introduce an integrated diabetes service closer to patients and to improve the patient experience and journey. They also wanted to help up skill primary care colleagues.

What did they do?

In collaboration with stakeholders from primary and secondary care and patients, the diabetes nurse consultant agreed that an integrated model of care was needed for people with diabetes. The consultant nurse began with a pilot project, setting up a monthly clinic in a GP practice, where she worked alongside the practice nurse to meet patients with diabetes and agree a care plan that the practice nurse could deliver. The positive findings from this pilot were used to present a business case to the PCT, who seeing the results approved two new substantive diabetes specialist nurse (DSN) posts.Once the two new posts were in place, the team rolled out the new model of care, establishing DSN clinics in local general practices, enabling patients to be seen closer to home. This freed up the time of the hospital based DSNs to focus on new hospital admissions.Practice nurses were up skilled by attending an RCN acrredited diabetes course before beginning working in the practice based clinics. A telephone hotline for patients and carers, staffed by DSNs, was established for patients and carers was an integral part of the project. It allowed patients and carers to have quick access to a DSN should a diabetic emergency arise. By making these changes the diabetes team hoped to prevent inappropriate attendances at A&E, ward admissions or readmissions, and reduce length of stay (LOS).

What happened?

Both the Trust and PCT agree this project has been very successful. In just one month avoidable/inappropriate A&E attendances were down from 21 to 7. A recent audit showed a 1.7 day reduction in length of stay and admissions have also been reduced. Savings have been achieved, through payment by results, from moving the clinics out to primary care. These savings totalled £133,000, which has been reinvested to fund two further DSN posts and an administrator post, allowing the service to be expanded even further.