1. Proposed Integrated Diabetes Care Model Tina Teague – Head of Locality Commissioning Trish Brown – Practice Nurse/Mid Devon Clinician to Clinician (C2C) Diabetic Lead Catherine Argyle – Specialist Diabetic Nurse

2. Proposed Care Model • Aims for equity of capability & capacity • Recognises the need for invest to save • Proposes 4 tiers of care provision& commissioning options • Identifies education (patient, community nurses, GPs) • Formalises the role of community DSN • Identifies local commissioning groups as being key to implementation

3. RD&E Diabetes Activity Trends – Mid Devon

4. RD&E Diabetes Activity Trends – Mid Devon

5. £245/Consultation £130 £70

6. Mid Devon DiabetesC 2 C and other Meetings Trish Brown 10/01/2011

7. Local Vision • To provide a world Class service, in which Primary and Secondary care is integrated. • Every patient will have access to the most appropriate team to provide care. • Quality will be measured and services modified with a view to improvement.

8. Restructuring Diabetes Services Entry Criteria Exit Criteria Initial management T1DM Self management - plan Complications Management stable Atypical Diabetes Established diagnosis - Plan Erectile Dysfunction Management Plan Young People Up to age 21- ? Adult Care Insulin Pump Therapy Established management Ante-natal No longer Pregnant Retinal Screening Continue as before New Referrals Stable / Management Plan Podiatry Integrated Foot service

9. Other Service Provision • Community Specialist Nurse • Structured Patient Education-all new T2 DM • Community Consultant / DSN clinics DGH • All Annual Reviews in General Practice • Education Programmes for PNs and GPs (Survey) • Updated Diabetes Formulary – Treatment Pathway • Protocol and Pathway Development • Telephone and Email advice • Accessible updated website