Diabetes care is growing and developing in general practice, so the challenges will only increase. Shortly after this, in 2004,4 with the introduction of the new GP contract, care changed yet again, and the Quality and Outcomes Framework (QOF) was introduced. General practices receive regular visits from members of the DSN team at tier 2 level. Diabetes UK, 2015. To maintain the level of care, GPs and nurses need education and resources. Today there are some 1300 diabetes specialist nurses (DSNs) working in hospitals, doctors’ surgeries and the community. Some drug manufacturers sponsor educational events in localities, often in evenings and at no cost to the participants. How can medical and safety technology manufacturers provide support during a pandemic? Tackling the biggest challenges in diabetes care – together. Improving the delivery of Adult Diabetes Care through integration: sharing Experience and Learning. This page highlights the resources and tools we have to help healthcare professionals and commissioners improve diabetes care. The National Health Service. Since the BPT was introduced, diabetes management among this group has improved for seven consecutive years. Background. This must include robust succession planning to bring more nurses into diabetes specialist nursing, now and in the future. The iDEAL group is supported by an educational grant from Ascensia Diabetes Care. 8. There are online courses that practice nurses can access, and a number of journals that help update nurses. The sheer size, scale and potential of our combined service is huge. 9. Over a quarter of a million people have already been referred to the DPP, with higher attendance rates among individuals from Asian, Afro-Caribbean and other ethnic groups, and equally high attendance among individuals from the most deprived compared to the least deprived communities – all of whom have historically been difficult groups to reach (Zeh et al, 2018). The Super Six Model of Care,8 which was introduced in Portsmouth by the diabetes team at Queen Alexandra’s Hospital, has sought to address some of the issues highlighted earlier. Initiatives like the DPP show much promise and additional funding is, of course, welcome news. It was envisioned that nurse-led clinics would offer patients organised and systematically delivered care, but this is not always the reality. However, training is necessary, which may require time out of the surgery. Key words: Role, Diabetes, Specialist, Nurse, DSN. Diabetes Specialist Nurses play an increasingly crucial role in educating patients and healthcare professionals . That’s why the iDEAL group is engaging with NHS commissioners, primary care professionals, policymakers, advocacy groups, research bodies and others, to reach a consensus on enacting change. Following the publication of the National Service Framework (NSF) for diabetes standards in 20012 and the delivery strategy3 in 2003, provision moved from predominantly hospital-based clinics, into the community. There is no way that practice nurses today can run all the chronic disease clinics necessary, and stay abreast of all the changes in diabetes care. Practice nurses Their primary goal is to help people self-manage their diabetes. With diabetes diagnoses rising rapidly across the UK, providing effective care for the nearly 4 million people who live with the condition is one of the biggest challenges facing our healthcare system. In diabetes care, home-care nurses stated that they treat their care receivers as patients instead of customers. Access verified, reliable company datasets for successful marketing campaigns! Giving people with Type 2 diabetes the skills and the knowledge to manage their condition effectively is paramount to reducing the likelihood of complications. A call for just two diabetes nursing titles has been made after the results of the first-ever, England-wide Diabetes Specialist Nurse (DSN) Audit revealed there were 117 job titles. Several CCGs have already developed models of excellence on increasing engagement with diabetes education and consequently, increasing the ability of people with diabetes to self-monitor their blood glucose accurately, at scale. The move to provide more services in primary care has brought care delivery closer to home, in an environment that is familiar to patients such as a local GP surgery. Why a reformed social care system in the UK cannot wait, Seamless Remote Hand Hygiene Training for Medical Colleges with SureWash, Continuous real-world monitoring of cardiorespiratory health, Voice biomarkers that identify driving skills. This suggests a gap in understanding and potentially, a lack of necessary support. A survey of 385 hospital trusts and primary care trusts (PCTs) by Diabetes … QOF specifies nine care processes (see table), to be undertaken in diabetes care. In 2011-12, only 17.4% of children and young people with diabetes had an HbA1c of <58 mmol/mol (<7.5%); by 2016-17 this figure had risen to 28.9%. The Diabetes Specialist Nurse and Health Promotion events… not just a day out of the office! While 77.3% of people with Type 2 diabetes are referred to structured diabetes education, typically delivered in group-based classroom sessions, attendance rates have been a challenge. It is becoming increasingly hard for nurses to access the necessary training, as practice managers may be reluctant to lose nurse appointments. The MERIT9 course was made available for practice nurses and GPs, to equip them to better manage their patients. • Infection control must not be at the expense of compassion, • DIY healthcare: the rise of testing and wound care at home, • Providing breast cancer support during the pandemic, © Cogora 2020Cogora Limited, 140 London Wall, London EC2Y 5DN Registered in the United Kingdom. The case, then, for introducing such a tariff for adult diabetes care is clear. And the diabetes population continues to grow rapidly. Pioneering nurse, Janet Kinson, was the first to recognise the need to train nurses to educate and support people with diabetes and their families some 70 years ago. Journal of Diabetes Nursing 2007;11(7):271-275. Approximately 700 people a day are being diagnosed, which is one person every two minutes. England National Health Service, 2004. Diabetes Specialist Nurse Location: Moorgate Primary care center, Bury Salary: £31,365 - £37,890. Facing today’s challenges in diabetes education Access to care is one problem facing diabetes education; solutions are out there, according to some educators. The specialized diabetes teams were composed of a nurse and a dietitian-certified diabetes educator who provided primarily patient self-management education, coaching, timely treatment adjustment (access to remote glycemic regimen optimization and monitoring via telephone and e-mail), and system navigation support to patients. The NHS is not recruiting enough diabetes specialist nurses (DSNs) to keep pace with the growing number of people diagnosed with diabetes, according to a new analysis published today by Diabetes UK, the Royal College of Nursing (RCN) and TREND-UK. 3. This is a great start, but we need to know that people with diabetes will benefit from this important investment. Our mission is to help 50 million people lead healthier and happier lives by 2025 by providing the best diet and lifestyle therapy through technology. 4, 5 DSNs may work in a variety of care settings such as hospitals, intermediate and primary care: this depends on local needs. Challenges in practice will be identified and discussed. Thorn PA, Russell RG. We examine whether hospital and community DNS currently support the integration of care, examine regional variation in aspects of the service relevant to the delivery of integrated care and identify barriers to service delivery and areas for improvement. 2147432, A fifth of childhood type 1 diabetes diagnoses ‘delayed during pandemic’, Covid-19: Nurses fear impact on care for elderly with diabetes, People with diabetes to get ‘life-changing’ technology. 2. Self-monitoring of blood glucose (SMBG) devices give users this understanding – yet only a minority of those who live with the condition are offered SMBG, and of those who are, the importance of understanding and making use of the data isn’t always made clear to them. Four out of five diabetes specialist nurses say their workload is impacting on patient safety and care, according to a report from a leading charity. Medical journals publications: medical trade shows seminars & hospital directories. Diabetes Nurse Training Details of training and courses specific for paediatric diabetes nurse specialist can be found on the National Children and Young People Diabetes Network site . Partha Kar. As a result of many discussions with the various stakeholders, the Super Six model was born in November 2011. When it comes to deciding on a drug, the pressure can be intense, as clinical commissioning groups (CCGs) may impose restrictions. Dr Rebecca Thomas says: “The challenge of the recruitment, retention and training of diabetes specialist nurses (DSNs) was highlighted at a recent All Party Parliamentary Group (APPG) for Diabetes last year.” “The DSN role is vital for people with diabetes and DSNs have been facing overwhelming challenges. Urgent action needs to be taken to recruit and develop more diabetes specialist nurses to avert a crisis of care for people with diabetes, warned Diabetes UK. There is a real need for backup from intermediate and specialist diabetes teams. Diabetes self management education is a critical component of diabetes treatment (Jack 2003).Diabetes health educator having several challenges in front of national health service system such as influencing to define the role, policy, promotion to adopt health education and acceptance of patients. The Best Practice Tariff (BPT) for Diabetes was created in 2012-13 (and updated in 2017) and sets the standard of care required for every child or young person with diabetes under 19 years old. The NSF, the new GP contract and QOF were moves to standardise care. Practical Diabetes International 2009a;26:314-315. This model overcomes the difficulty of referring from one team to the other, as all came under the same umbrella. This was triggered in 2009 by the recognition that something had to change in the way Portsmouth’s diabetes population was managed. You have entered an incorrect email address! GET CUSTOMIZED LIST. This type of service has been commissioned by the Surrey Downs CCG, and the service is run by Kingston Hospital. This model seeks to keep certain, more complex categories of diabetes care, with the secondary care specialist, while the majority of the remaining diabetes population is managed in primary care with specialist nurses and diabetes consultants providing regular support and education. A DSN is often the first point of contact for people, referring them to other specialist services. This first Consensus Report does not seek to address extensively the role of precision medicine in the complications of diabetes, which is a topic for future evaluation. Diabetes UK reminds us that one in seven beds in hospitals are occupied by someone with diabetes; 135 diabetes-related amputations are carried out every week. Having worked in a Portsmouth GP surgery, this author can testify to the success of this venture. Actions of DSNs Patient education . The Open Access Government site uses cookies, individuals from the most deprived compared to the least deprived communities, e-learning systems helps healthcare industry manage diabetes changes, Time for a rethink in healthcare: The treatment of diabetes, Type 2 diabetes in the UK: Priorities for improving patient care, Historic COVID-19 vaccinations begin in the UK, Equine Assisted Interventions: Enhancing mental health and wellbeing, Diabetes patients are three times as likely to have severe COVID, Infodemic: The other face of epidemics (COVID-19). National Service Framework for Diabetes: Delivery Strategy. The diabetes specialist nurse (DSN) works wholly in diabetes care and plays an integral part in diabetes multidisciplinary teams; the benefits of the role are well recognised. DSNs work wholly in diabetes care and may be employed in a variety of care settings. Department of Health. This opportunity will be rewarding as there are many challenges ahead. If we are to rise to the challenge of increasing diabetes prevalence, we need urgent action at both a local and national level to tackle DSN workforce shortages. Unlike classroom-based support, digital education on diabetes, delivered via a smartphone app, can be completed anytime, anywhere, removing a key barrier to access. Primary care needs specialist support, in whatever model is appropriate, so that those with more complex needs can have them adequately met. NHS England One, 2015. Incentives are produced to convince clinicians to use certain medications, to try to cut prescribing costs, and the clinician must select one that they believe will be most effective for their patient. Diabetes UK, 2014. Specialist support is vital in keeping general practice competent and able to manage their diabetes population. The NHS has seen considerable success in introducing KPIs for paediatric diabetes care. There must be enough appointments at appropriate times, so that problems and poor control are not overlooked. Pharmaceutical Waste reduction in the NHS. A diabetes specialist nurse occupies a central position in caring for and supporting patients and their families over the course of the disease. 6. This site is intended for health professionals only, Read the latest issue onlineBreaking the silence, Until recent years, the vast majority of diabetes care was conducted in secondary care, but the first GP mini-clinics were established as far back as 1971, – The need for more ‘joined-up’, long-term planning, – Models of integrated care – the way forward, Until recent years, the vast majority of diabetes care was conducted in secondary care, but the first GP mini-clinics were established as far back as 1971.1. Diabetes specialist nurse telephone helpline: A survey of incoming and out-going calls EP Birdsall,* G Nixon, J James, SO Oyibo Abstract Background: Numerous telephone calls for advice on diabetes-related issues are received by diabetes specialist nurses (DSNs), but resources required to deal with such calls are rarely formally identified. The survey was launched by TREND-UK, an organisation that represents all diabetes nursing groups, because the number of diabetes specialist nurses (DSNs) was previously unknown. Others will be developing, with elements of the models already in existence. For the more specialist and complex care, tier 3 multi-disciplinary clinics are run fortnightly in several of the local community hospitals, keeping the care close to home, with DSN, diabetes specialist, podiatrist and dietician. Reg. WHY NOT CONNECT WITH THOUSANDS OF … Drug manufacturers should not be demonised, as they are a valuable source of education and support. Over the period spanning 2017-18 and 2018-19, an additional £80 million has been allocated to improving access to structured education on diabetes, providing more interventions to achieve better blood glucose, blood pressure and cholesterol levels, offering better access to multidisciplinary foot teams when necessary, and increasing access to diabetes specialist nurse support when in hospital (NHS Long Term Plan, 2019). The Northern Care Alliance NHS Group was created by bringing together staff and services from two NHS Trusts, Salford Royal NHS Foundation Trust and The Pennine Acute Hospitals NHS Trust. Some may prove more effective than others. If the prescribed medication produces unpleasant side-effects, the drug may not be taken as prescribed or even at all, which is financially costly and clinically ineffective. In 1997 the second consultant was appointed and the two worked closely together, taking every opportunity to inform people of the dire local diabetes situation. Previously, diabetes ‘mini-clinics’ consisted of one-stop shops where patients were reviewed by a nurse, a podiatrist, a dietician and then their GP. Drug manufacturers should not be demonised, as they are a valuable source of education and support. According to Diabetes UK6 there are now four million people in the UK living with diabetes and 549,000 people who are not yet diagnosed. There is an expansive range of medications available for managing diabetes, but many prove costly in the short term. National Service Framework for Diabetes: Standards. 5. Sharing these models of excellence with other NHS organisations could drive a marked improvement in clinical, psychosocial and financial outcomes at very little if any, financial cost. New study shows CBD treatment may help treat pain, anxiety, and... COVID-19 and Africa’s volatile changing epidemics landscape, Bridging the gap between clinical trials and clinical care, Battery Safety: Accelerating rate calorimeters for the renewable energy sector, Bio-based smart packaging for enhanced preservation of food quality, Improved forest management through new technologies and digital transformation, Climate risk information: An essential service for planning. They work alongside the practice nurses, often running separate clinics to help those whose diabetes is more complex. Department of Health. The solution, as in many facets of life, may be found in our pockets: mobile health. Diabetes care is growing and developing in general practice, so the challenges will only increase. If you are interested in discussing this post and also consider taking the specialty forward we would like to hear from you. Diabetes prevalence in the UK can be anywhere between 6.5% and 11.5% depending on location – with communities with more socioeconomic challenges almost invariably seeing a higher prevalence of Type 2 diabetes. Another model of care is the intermediate care team of diabetologists, GPs with special interests and specialist nurses. A diabetes specialist nurse occupies a central position in caring for and supporting patients and their families over the course of the disease. District Nursing in 1990 and took up the first Diabetes Specialist Nurse post in Hull. The BSPED provides funding for the London Southbank University module: Principles of care for children and young people with Diabetes . This is a ‘pay for performance’ programme, offering incentives to general practice5 for meeting targets in care provision. Monogenic diabetes is one of few areas where precision diabetes medicine has been proven feasible and is practiced (as discussed at a recent Diabetes Care Editors’ Expert Forum; M.C. Patients are more likely to know the clinician, and hopefully receive greater continuity of care. Diabetes Clinics Today and Tomorrow: Mini-Clinics in General Practice. This could diminish if patients received the most effective drug at the right time and were supported to take it. Medicoleads’ Diabetes Nurse Email database is collated from. To contain what could soon become a major national health crisis, the NHS has made vast investments in diabetes care; UK spending on the condition totals 10% of the total healthcare budget, amounting to some £10 billion per year. Evidence suggests that in 97% of services in the United Kingdom, DSNs provide education to people with diabetes and staff in both primary and secondary care settings . 19 sept. 2014 - An idea shared can change the world. Conclusion There is a desire by DSNs to be close to persons with type 2 diabetes, although they have several challenges to fulfil, which makes it difficult to uphold a relation with proximity; thus, distance is also present. A diabetes specialist nurse (DSN) was accessible for advice or support by phone or in person any weekday during standard working hours, and the consultant team answered calls for emergency advice in the early evening. (General Medical Services Contracts) Regulations. 4. ... Pharmaceutical companies provided initial funding for staff-grade and diabetes specialist nurse posts. Join Chris Askew and Partha Kar for North of England team's end-of-year quiz Chris Askew (Chief Executive, Diabetes UK) will join Professor Partha Kar (National Specialty Advisor for Diabetes, NHS England) for the team's online Quiz of the Year on Wednesday, December 2nd (8pm-9pm). Equally important, is the Diabetes Prevention Programme (DPP), launched in 2016 and now available across 100% of England – the first such nationwide programme in the world. Coronavirus (COVID-19) information and resources Find a summary of resources and information to support you in caring for your patients with or affected by diabetes. 7. Diabetes Specialist Nurses (DSNs), also called Community Diabetes Specialist Nurses, are the backbone of diabetes treatment and care in the UK . It is estimated that primary care provides 75%5 of all diabetes management. In 201410 these included projects in Derby, North West London, Wolverhampton and Leicester. There must be enough appointments at appropriate times, so that problems and poor control are not overlooked. No. Often this imposition reduces spending in the short term, but doesn’t necessarily deliver the best outcomes. The problem of prescribing costs will not go away but there needs to be more joined up perspective on this, and consideration of long-term outcomes, in order to deal with this and other costly issues. Also, there may be costs involved. Understanding how diet, stress, sleep and exercise impact on diabetes management can be the most valuable ‘tool in the box’ for people with Type 2 diabetes. Diabetes UK. Boost your marketing campaign with our Medicoleads’ Diabetes Nurses Database. Diabetes and Primary Care 2012;14(5):277-283. We, that is, all of us involved in diabetes care, must share more of our knowledge, insights and experiences – CCGs with each other, frontline health professionals with patients, and groups like our own with our colleagues in the NHS and beyond – to better understand how we can help people with diabetes live longer, happier, healthier lives. Hicks D, McAuley K. Meeting the Educaitonal needs of primary care practitioners: MERIT. April saw the first ever national NHS Diabetes Prevention Week; to raise awareness of Type 2 diabetes and how to prevent it. Facts and Stats. Objectives International evidence suggests the diabetes nurse specialist (DNS) has a key role in supporting integrated management of diabetes. Clearly, a new approach is needed. Department of Health, 2001. Other models of integrated care are being developed and used in various parts of the UK. Where additional training was needed, the specialist team offered this informally as hands-on learning. The Super Six Model: Integrating diabetes care across Portsmouth and south-east Hampshire. Author(s): Susan Josephine Cable Diabetes Specialist Nurse, Ashford and St Peters NHS Foundation Trust, UK Correspondence: Susan Cable [email protected] Abstract The following article focuses upon the essential role of the Diabetes Specialist Nurse (DSN) in the care and management of patients with diabetes. These include insulin pump clinics and specialist input for people with poorly controlled diabetes or multiple co-morbidities. Ultimately, delivering more effective diabetes care across the board can be achieved only one way: by bringing together all of the numerous stakeholders in diabetes care. One of the most effective ways to reduce variation in diabetes care processes may also be the simplest: sharing successes. To maintain the level of care, GPs and nurses need education and resources. Informal enquiries contact Sandra Wilson, Senior Diabetes Specialist Nurse, ext 58175 How can nurses deliver care without the skills and competencies required? Diabetes has become an increasingly serious health issue on a global scale, with the number of people living with diabetes rising significantly over the last 35 years. Riddle, personal communication). Nurse prescribing has been an asset, as nurses can then work without so much reliance on medical colleagues. There are now reported to be 422 million adult diabetics (1 in 11) internationally, the majority having type 2 [1]. Diabetes UK. People with diabetes tend to report using SMBG so their health professional can advise them how to act on that information, but healthcare professionals tend to report prescribing SMBG as a tool to improve the individual’s own self-management. Managing the cost of prescribing is one of the fastest growing challenges. Yet consistency in standards of diabetes care processes and equal health outcomes, throughout the country, remain a goal, not a reality. The Care Challenge is an international online initiative dedicated to showcase nurse creativity. Crossing boundaries. The workforce is getting smaller while the demand and case complexity is getting bigger.” Department of Health, 2003. Gadsby R. What has QoF ever done for diabetes? A real sense of joint working developed. DSNs and diabetologists bring a depth of knowledge that enables the primary care team to concentrate on delivering routine care and working towards QOF targets. The majority – around 90% – of people with diabetes live with Type 2, and consequently, 80% of all diabetes care funding is consumed by treating complications which are largely avoidable. Average uptake in England, according to the National Diabetes Audit, is just 7.4% – less than one in ten of those offered support. B Hazell, R Robson. The number of diabetic specialist nurse (DSN) posts unfilled across the service has doubled within a year. Patients with type 2 diabetes usually see both a practice nurse at their local GP’s in addition to a diabetes specialist […] In 2005, I undertook a new challenge in taking up the position of Nurse Consultant in Enfield, North London, where I continue to work today. 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2020 diabetes specialist nurse challenges