The NHS spends at least £10 billion a year on diabetes. Almost 80% of the money is spent on treating complications. In some hospitals, over a quarter of the beds are used by people with diabetes.
It’s no wonder that measures to tackle Type 2 Diabetes and other metabolic conditions have become virtually a national guideline for primary care.
Diabetes UK estimates more than five million people in the UK are living with diabetes, an all-time high.
The role of primary care cannot be underestimated in tackling this problem, but with growing numbers of patients requiring monitoring and treatment in an environment of an increasing patient-to-GP ratio, there is a real risk that important opportunities could be missed.
The Diabetes Dashboard is a free-to-use tool designed by SmartLife Health designed to help practices and PCNs meet their Primary Care Diabetes Enhanced Service. Clinician-led, it helps practices optimise patients’ three treatment targets (3TTs) and reduce the patient’s risk of cardiovascular disease, based on the Steno-2 trial which has been shown to increase longevity by up to 7.9 years.
As well as the 3TTs, the dashboard also helps clinical teams and administrative support monitor the 9 key care processes and non-diabetic hyperglycaemia.
The dashboard was used in a pilot scheme in Long Lane PCN, in North West London; an area with a diverse population including demographics who suffer proportionately more from metabolic conditions, including Type 2 diabetes.
The seven practice PCN, with c40,000 patients, have several thousand patients with diabetes across all practices. Increased population growth and one of the ICBs with the greatest shortage of GPs in England where targets have previously been missed, Long Lane PCN is an example of the kind of PCN where good quality software and efficient processes can improve patient outcomes and allow the PCN to earn funding.
The Results
At the beginning of October, the PCN was:
8.5% below the minimum level needed to achieve the target for the 3TTs.
23% below the minimum level needed to achieve the target for the 9KC processes.
9% below the minimum level needed to achieve the target for NDH.
At the end of March, the PCN had:
Achieved the upper target for 3TTs, with 34% of patients meeting the recommended clinical indicators.
Achieved 9% above the upper target for the 9KC processes.
Achieved 14% above the upper target for NDH assessments.
Our three lead KPIs were all comprehensively met. At the beginning of the project, we hoped to achieve the minimum targets. By March, we had achieved the higher targets across the PCN.
By using the diabetes dashboard and ARRS staff the PCN met the higher target set by NHSE and NWL for Type II diabetes.
By using a clear system of monitoring patient results and the most up-to-date list of patients with Type II diabetes, we were able to increase the percentage of patients meeting the 3TT from 19% in October 2023 to 34% in March from a diabetic population of ~3300, helping to deliver improved patient outcomes and prolonged life expectancy.
Dr Jay Verma, GP Partner said:
“We developed this dashboard because the evidence shows that meeting these key targets increases life expectancy and significantly reduces co-morbidities. Therefore, the more practices that can help patients achieve their three treatment targets, the better it is for everyone.
“For us, this dashboard is our way of trying to help our colleagues in primary care, allowing them to focus on the patients rather than wading through admin. We hope it helps others the way it helped in our PCN.”
If you are interested in finding out about the Diabetes Dashboard, please contact: rebecca@smartlifehealth.co.uk
You can download the full case study:
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