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tackling variation all party parliamentary group dr karunakaran vithian n.
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Tackling Variation All Party Parliamentary Group Dr Karunakaran Vithian

Tackling Variation All Party Parliamentary Group Dr Karunakaran Vithian

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Tackling Variation All Party Parliamentary Group Dr Karunakaran Vithian

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  1. Tackling Variation All Party Parliamentary Group Dr Karunakaran Vithian

  2. Background • Rising demand – 2014/15 prevalence NEE 6.7% v 5.8% (I&ES) & 6.2% (WS) • Relatively high deprivation e.g. Jaywick • In 2013/14 - North Essex lower quartile outcomes: • Care processes – 125th of 206 CCGs • HbA1c <64 – 168th • High rate of amputations • ‘Hospital model + outreach’ seen as unsustainable & fragmented

  3. 5 Year (+2) contract – commenced 1/4/15 • Diabetes & podiatry, outpatients & education – adult only • Separate agreement with CHUFT for inpatient specialist nursing • Approx. £2m per annum – existing budgets & no additional investment • Fixed budget with 25% contingent on delivering KPIs – no exception coding. 2015/16 focus on: • 8 care processes • Clinical – HbA1c, BP & Chol • Newly diagnosed offered education • Feet – T1s with check, foot ulcers & high risk feet referred to podiatry • Patients with care plans

  4. The strategy • Diabetes Service Board to manage the services • 3 legged model • Patient involvement – Year of Care planning & service delivery • Investment in primary care capacity & expertise • Practice Enhanced Service – outlined on next slide • Monthly extract of data from practice clinical systems • Diabetes Specialist Team – working in the community • Consultants on secondment – Contracted on a PA basis • Specialist nurses, dieticians , specialist midwife & admin • Podiatry – sub-contacted back to community provider

  5. Primary care PES - £6.44 over five years • Governance • Practice lead GP & nurse • Quarterly meetings with consultant & Link DSN • Referrals triaged via Specialist Team • Monthly primary care data extract • Case finding e.g. IGR • Implement Year of Care • Manage wider range of patients – stable T1 & T2 discharged from hospital • Involve partially engaged • Focus on KPIs – moved to 100% on outcomes from 2015/16

  6. Achievements

  7. 8 care process achievement 01/04/2014

  8. 8 care process achievement in 01/04/2016

  9. 8 Care processes