service redesign and improvement consultancy case study
TRANSCRIPT
April 2017
www.diabetesconsultancy.co.uk 02037577813 [email protected]
Service Redesign and Improvement Consultancy
Case Study
Impact on key treatment targets using the Diabetes Primary Care Profiling Tool (DPCPT) and Best
Practice Modelling (BPM)
The development and implementation of the DPCPT and associated support processes such as Best
Practice Modelling (BPM) enables the Consultancy team at Diabetes UK to support CCGs to achieve
clear improvements in the lives of people living with Diabetes.
The DPCPT allows CCGs to get a real time snap shot of their diabetes populations. This acts as a
benchmark to measure future improvements. The tool creates practice level profiles that can then
be aggregated to create a CCG level profile. The DPCPT, (among other searches), identifies patients
who have diabetes complications, and those who have not, those who have received the key care
processes and checks, and those who have not, and importantly, those who have met the 3 key
treatment targets, and not.
The insights allow practices and CCGs to think about targeted interventions for specific diabetes
population groups.
Example: A CCG based in the Midlands
The following table highlights the improvements across the CCG, solely using the profiling tool to
create local practice improvements.
This highlights that a focus on diabetes by the CCG provides the impetus for many practices to create
change. The CCG prioritised an increase in people receiving their key diabetes checks as well as
improvement in HbA1c achievement. The DPCPT was re-run after 12 months. Key Improvements
include:
1) Receiving at least 1 check has increased across the whole CCG by almost 800 people
2) HbA1c achievement – increased by 534 more people
3) Good Control (3 NICE targets) – increased by 330 people
Year 1 Year 2 Improvement
Receiving at least 1 key check
Across whole CCG 95.65% 15,490 95.90% 16,287 797 more people
Practice with greatest improvement 88.97% 242 93.45% 271
29 more people
HbA1C Achievement
Across whole CCG 39.40% 6380 40.71% 6914 534 more people
Practice with greatest improvement
37.94% 140 45.60% 176 36 more people
Good Control (all 3 NICE Targets met)
Across whole CCG 21.45% 3437 22.18% 3767 330 more people
Practice with greatest improvement
17.90% 63 25.20% 96 33 more people
April 2017
www.diabetesconsultancy.co.uk 02037577813 [email protected]
The CCG has a practice improvement officer who visits each practice annually. The DPCPT was used
to inform these discussions and will have influenced these outcomes.
Best Practice Modelling (BPM)
Once the DPCPT has been conducted it is simple to identify those practices that perform well across
a number of processes and diabetes treatment targets.
To recreate the success of the best performing practices, the Consultancy offers a localised
programme to unpick the secrets of success in these practices.
Using a specific methodology, Best Practice modelling involves undertaking short structured
interviews with key diabetes clinicians and practice managers to learn about the approaches and
methods used at those practices that leads to good results. Form these structured interviews, simple
pathways for each key diabetes target are created. These can then be replicated in other practices in
the CCG to support and deliver local improvements in treatment targets.
The advantage of this approach is that the solutions are locally owned and a short education
programme can be delivered to embed the learning across all practices in the CCG.
Example: The table below is a practice in East London. Both the DCPCT and BPM have been used
here. The baseline profile was produced in December 2015 shortly followed by the implementation
of the Best practice Modelling Programme.
This clearly shows that the tool and processes has enabled them to
1) Identify more people with Diabetes
2) Significantly increase the uptake of the key checks
3) Significantly increase the numbers of people achieving each of the three key targets
Baseline
DPCPT results after
year 1
Improvements
Diabetes Population 5.10% 788 5.04% 796 8 more people
BP checked in last 12 months 89% 698 97% 769 71 more people
Cholesterol Checked in last 12
months 84% 664 94% 748
84 more people
HbA1c Checked in last 12 months 86% 678 95% 756 78 more people
Missing all checks in last 12 months 6.34% 50 2.51% 20 30 less people
BP Target Achievement 72.59% 572 87.94% 700 128 more people
Cholesterol Target Achievement 68.78% 542 76.01% 605 63 more people
HbA1C Target Achievement 47.08% 371 53.89% 429 58 more people
All 3 target Achievement 32.61% 257 39.70% 316 59 more people
April 2017
www.diabetesconsultancy.co.uk 02037577813 [email protected]
When working with primary care we recommend that practices make 2 key changes based on the
insights from the Best Practice Modelling Programme. This enables the tasks to be very ‘doable’ and
achievable. This particular practice chose to make the following 2 changes:
Making a minor change in working hours to allow practice staff to run a monthly blood clinic
to increase HBa1c collection.
A very simple review of DNA follow up procedures. More contact from clinical staff lowered
the number of people missing their key diabetes checks.
The result has been a real improvement in treatment targets.