PIECING TOGETHER CARE IN WEST SUFFOLK JUNE 2016

DIABETES Welcome to JIGSAW A newsletter for staff working in the health and social care WEST SUFFOLK COMMUNITY system in west Suffolk. NURSING SERVICE FUTURE OF By Mandy Hunt, Lead Diabetes Specialist Nurse & Kirsty Thompson, Community Diabetes Team Administrator, West Suffolk NHS Foundation Trust DIABETES CARE The West Suffolk Community Diabetes “The DSN has so much knowledge that she Nursing Service was initially piloted in the can impart that she can usually sort out a IN WEST SUFFOLK Forest Heath area. Following its success the difficult problem that myself and quite often By Dr Jon Ferdinand, Associate GP, West service was subsequently commissioned in the GP cannot , this results in a better Suffolk Clinical Commissioning Group April 2015, until the end of August 2016. The outcome for the patient.” Community Diabetes Specialist Nurses hold From January to April 2016 West Suffolk mentored clinics in conjunction with Practice A Practice Manager says “We have had very CCG listened to stakeholders’ views and Nurses in GP practices. positive and encouraging feedback from our ideas about how to deliver the most patients, who are very happy to be able to appropriate set of diabetes services for Since the launch last April, clinics have been receive this level of clinical care locally. Our the local area. Workshops were held in held in every practice in the WSCCG locality. doctors too have praised the service as we Bury St Edmunds, Haverhill, Newmarket As of 30/4/16, 261 clinics and 1531 are now beginning to see some and Sudbury to inform the process, appointments had taken place. improvement in our patients’ blood glucose taking into account evaluation of levels.” current services and available system The service also provides education and data and information, to design the mentorship for healthcare professionals as For more information please contact optimum service model. well as group education for patients. Mandy Hunt on 01284 713241 or Martin Bate on 01284 758036. Following the stakeholder consultation, Formal evaluation of the service was the CCG is producing a business case to undertaken by Public Health Suffolk. This See page 3 for details of education support the continuation and expansion evaluation identified its impact highlighting programmes available for patients and of the community diabetes service to the high rate of clinic attendance, the staff. support the 24 GP practices which look popularity of the service with the users, the after the 13,000 people living with reduction in the number of hospital diabetes across west Suffolk and offer appointments and the improvements in further opportunities for newly blood glucose control in those patients who diagnosed and people with established accessed the service. Type 1 and to be able to access education and advice about how Patient and staff feedback has been very to manage their condition. The CCG is positive with 99% of patients reporting that aiming to mobilise the enhanced service they would recommend the service. from September 2016.

“The clinics have improved my knowledge, my A new Type 2 diabetes treatment practice and my confidence.” pathway, revised to take account of national guidance published in “Having the support of a Diabetes Specialist December 2015, has been developed by Nurse (DSN) allows me to make more the CCG in conjunction with consultants effective decisions to improve patients’ at West Suffolk Hospital. The pathway health.” will be launched with an education event for primary care staff on 02 June 2016 at the hospital education centre. HYPOGLYCAEMIA PATHWAY PROJECT SUFFOLK

By Lisa Newdick, Diabetes Clinical Educator, West Suffolk NHS Foundation Trust COMMUNITY

In March 2015, WSFT launched the Patients receive hypo education, which PODIATRY hypoglycaemia pathway, funded by the includes how to reduce the risk of a hypo, Eastern Academic Health Science Network, to how to effectively treat a hypo and SERVICE help patients who have suffered a Severe information on the DVLA driving By Andy Barker Clinical Specialist, Suffolk Acute Hypoglycaemic Episode (SAHE) that regulations. During the education session Community Health was bad enough to require an ambulance call with the patient we try to work out why the out. By providing support and education the hypo happened. The NHS spends £1 in every £150 on team hope to reduce the chance of these foot ulcers or amputations each year. patients having further collapses. The pathway has provided a link between disease accounts for more East of England Ambulance Service, primary hospital bed days than all other The number of 999 call-outs for a SAHE is and secondary care and helps to ensure diabetes complications combined. In the 10,000 annually in the Eastern Region, at a safe and effective patient care. As part of UK, 100 people a week lose a lower limb cost of £2 million. See page 3 for “how the the project we have also been working with because of diabetes. 1/20 people with pathway works”. local pharmacists to distribute a leaflet diabetes will develop a foot ulcer about hypos to patients when they are annually, and up to 70% of people die The Clinical Educator will also verbally liaise ordering repeat diabetic medication. within five years of having an with GPs, Practice Nurses, District Nurses, amputation as a result of diabetes. The Family members/Carers, to ensure the If you would like any more information on podiatry service aims to ensure patients patient receives adequate care to reduce the the project please contact with diabetes have access to risk of a subsequent hypo. [email protected]. appropriate foot care at the right time, delivered by the right people with the right skills, at the right frequency to help prevent and reduce the frequency and DIABETES PRE-CONCEPTION CARE severity of long-term foot complications. By Lisa Newdick, Diabetes Clinical Educator, West Suffolk NHS Foundation Trust Key messages:

Most women with diabetes have a healthy  Ensure blood glucose is well controlled baby but diabetes does increase the risk of and HbA1c as close to 48mmol/mol or  Any patient diagnosed with diabetes complications including: 6.5% as safely possible; should initially have their feet checked at their GP surgery and  Women with Type 1 and Type 2 should only be referred to podiatry if  Having a large baby – which increases diabetes taking 5mg of Folic Acid daily they have any foot problems e.g. the risk of a difficult birth, induction of as soon as they decide to start planning thick callus, pathological nails labour or a caesarean section their pregnancy (before conception);  Having a miscarriage, stillbirth (rare) and  All foot ulcers should be referred to the multi-disciplinary diabetic foot  A baby with congenital abnormalities,  Medications need to be reviewed, clinic at West Suffolk Hospital particularly heart and nervous system particularly blood pressure, cholesterol abnormalities (rare) and diabetes tablets.  Podiatry has developed foot protection clinics across Suffolk for  A baby requiring neonatal care after those patients who have had birth Within the pre-conception care project we previous ulceration or amputation have been working with GPs, practice To reduce these risks it is important to nurses, health visitors, district nurses,  Patients can self-refer ensure that the woman’s diabetes is children’s centres, midwives, pharmacists  Podiatry does not provide simple controlled before becoming pregnant. and welfare offices at colleges and nail care, even for those patients Evidence has shown women who receive pre universities to raise awareness and with diabetes -conception care reduce their risk of distribute leaflets to women with diabetes complications from 1 in 10 to 1 in 50. about pre-conception care. If you would like to know more about However, the National Pregnancy in the podiatry service or if you would like Diabetes audit (NPID) demonstrates that The Cambridge Diabetes Education to receive training on how to assess / currently outcomes continue to be poor. Programme (CDEP) is an online education screen diabetic feet please contact Andy programme for healthcare professionals Barker on 01473 275280 or email The Eastern Academic Health Science looking after patients living with diabetes. [email protected]. Network’s ‘Pre-Conception Care project’ was As part of the project, this education launched to improve the outcomes for programme is being offered free to all women with diabetes through educating Health Care Professionals. women and healthcare professionals. If you would like more information on this The key messages, before conception are: project or access to CDEP please contact GET INVOLVED [email protected]. If you have any news or views on any  Encourage women to plan their of these projects, please contact the pregnancy and to use contraception to partners through this email address: avoid any unplanned pregnancies; [email protected] JIGSAW - THE EXTRA PIECE MORE MESSAGES HOW THE HYPOGLYCAEMIA PATHWAY

WORKS For further information please contact [email protected]

East of England Ambulance service refers patient to Clinical Educator via Single Point of Access

Clinical Educator notifies GP/Hospital team of patient’s hypo (prior to the pathway the GP/ Hospital Team may have been unaware their patient had a hypo)

Clinical educator will see primary care patients, either at their surgery or at home, and deliver hypo avoidance education

An outcome letter of the education session is sent to the both the GP and the patient

DIABETES EDUCATION

By Mandy Hunt, Lead Diabetes Specialist Nurse & Kirsty Thompson, Community Diabetes Team Administrator, West Suffolk NHS Foundation Trust

Education for Healthcare Professionals:  initiation  Insulin management DINE (Diabetes Interest Nurse Education) is a  Insulin intensification series of education sessions designed to provide information, discussion and practical Modules are directly linked to the key advice for nurses working in general elements of the Skills for Health Diabetes practice. Each DINE event includes lunch/ Competency Framework. dinner and a presentation on a particular subject/s in relation to diabetes. The format The MERIT programme is currently being of DINE facilitates learning in a relaxed rolled out throughout the area. informal environment and gives practice nurses opportunity for self-development. For more information on education for Topics covered so far include: Carbohydrate healthcare professionals please contact Awareness, Carbohydrates at Christmas, [email protected] Focus of Feet, RCN Revalidation and MODY (Mature Onset Diabetes of the Young). Education for Patients:

The MERIT programme (Meeting The West Suffolk Community Diabetes Educational Requirements, Improving Service currently provides DESMOND Treatment) is an RCN accredited programme (Diabetes Education Self-Management for FEEDBACK of modules for healthcare professionals to On-going and Newly Diagnosed) for those improve their skills. newly diagnosed with diabetes and Did you know Jigsaw is also available The delivery of MERIT consists of two carbohydrate awareness sessions for those as a hardcopy newsletter? elements, classroom based education with established diabetes. provided by a DINE Nurse Facilitator (funded Please click here to request a hardcopy by Novo Nordisk, although non-promotional) For more information on DESMOND or to be sent to you. and mentorship for the attendee from a carbohydrate awareness sessions please Community Diabetes Nurse, offering support contact Judy Tarbun on 01284 713241. Do you have an idea or would you like and guidance as the attendee works through to write an article for a future edition? the competency framework. In addition, from July, WSFT plans to introduce DAFNE (Dose Adjustment For If so, please click here to email your MERIT consists of the following modules: Normal Eating) for Type 1 patients. suggestion.  Pre-insulin treatment options  GLP-1 initiation To view previous editions of Jigsaw, please click here.