Our objectives:
- An Integrated Diabetes Team bringing together the roles of: the specialist diabetes team, the primary care team and diabetes education
- Clear, patient-centred pathways that are easily navigable and developed in partnership with patients and their families
- Providing suitable support taking into account individual’s circumstances
- Education, advice and support readily available to people with diabetes and those supporting them so that they can get into the right habits early and then maintain them
- Collaborative care planning, with patients and clinicians working as partners to agree goals, identify support needs and implement action plans
As a result of the engagement with people with diabetes and clinicians across primary and secondary care, eight areas of need to focus on were agreed:
Primary Care access to Specialist Diabetes Team
Improving access and timely referral to community podiatry services
Improving access to the multi-disciplinary footcare team
Improving access to healthy lifestyle support
Every contact count towards lifestyle change
Ensuring same standard of diabetes care at home
Creating place-based offers of support
Improved and consistent patient access to targeted education resources