DIABETES MELLITUS PATHWAY PLEASE REFER TO HTPCT GUIDELINES AND PATHWAYS FOR DIABETES:

http://www.haringey.nhs.uk/services/care_pathways_and_guidelines/index.shtm

SECONDARY CARE
Secondary Care
Insulin initiation Type 1 or complex Type 2 Management of complex care Pt education Check patient registered with GP- if not give appropriate information Pts meeting criteria, referred back to Intermediate/ primary care

INTERMEDIATE CARE

PRIMARY CARE

Asymptomatic caresymptomatic patient or identified by routine test

Type 1 diabetes mellitus confirmed: Refer to secondary care Refer to guidelines for specialist referral: and where appropriate refer to secondary care

Type 2 diabetes mellitus confirmed Care remains within primary care

Intermediate Care Patient seen by multi professional Team Check patient for retinal screening. Check patient referred to appropriate structured education programme Advised re Foot health/ nutrition & dietetics Care plan agreed Review CVD risk Client held record and literature issued/ updated Insulin initiation (non complex Type 2)

Primary Care Patient seen in practice by GP/ Nurse with specialist qualification in diabetes Advice given re diet/ foothealth etc Review CVD risk Referred for retinal screening. Referred to relevant structured education programme Care plan agreed and individualised targets agreed client held record and literature issued Placed on call/ recall system as appropriate to need Type 2 patient requiring insulin initiation (Non complex) - refer to intermediate care Patient Review Advised re Foot health/ nutrition & dietetics review CVD risk Check pt referred for retinal screening. Care plan reviewed and individualised targets agreed Type 2 patient requiring insulin initiation (Non complex) - refer to intermediate care

Following assessment/ care planning in Intermediate Care: Reviewed at a maximum of 3 months by multi professional team

Care plan not being met, or primary care unable to manage patient care:
Care remains in intermediate care

Care plan being met & primary care provider able to manage patient:
Patient referred back to practice for monitoring. Patient can access Intermediate care direct for advice/ support

If patient becomes complex and meets guideline:'Criteria for specialist referral, and where appropriate:
Refer to secondary care

Patient's needs not being met: review date set according to patient's level of need (In primary care) OR Refer to Intermediate/ Secondary care (see Guidelines for referral)

Patient's condition satisfactory (according to guidelines and pathways): placed on 3-6 monthly review (As appropriate to needs)

KEY PRINCIPLES UNDERPINNING SERVICE MODEL: Patients should be seen by the right professional, at the right time according to their assessed needs At all stages, practitioners will take account of the psychological and emotional impact of being diagnosed and living with Diabetes on patients Practitioners will be appropriately qualified to provide care for people with Diabetes; and agreed model of Diabetes training and education will be in place Protocols will be developed that will ensure that these principles are in place, regardless of where a patient receives their Diabetes care

SERVICE MODEL DEVELOPED BY MEMBERS OF HARINGEY TEACHING PRIMARY CARE TRUST DIABETES STEERING GROUP

Name Wendy Alleway Karen Anthony Maria Barnard Catherine Brown Lou Clatworthy Mags Farley Caylie Fields Poh-Ling Fields Clare Felton Catherine Jenkins Juliet Jensen Shantell Naidu Katriona McCann Alex McTeare Liz Rahim Jonathon Ridell Jill Shattock Thomas Strommer Jatin Pandya Rita Wallace Judith Whitehead Fiona Yung

Designation Interim Manager Consultant Diabetologist Consultant Diabetologist Performance Manager Practice Nurse, Bounds Green Group Practice Operations Manager (Diabetes service manager) Adults and Older People's Service Manager Diabetes Specialist Nurse Head of Commissioning Diabetes Specialist Nurse Public Health Consultant Diabetes Specialist Nurse Manager Head of Strategic Commissioning Adults and Older People Interim Director GP, Highgate Group Practice, West Collaborative GP, Highgate Group Practice, West Collaborative GP, GP Clinical Director SE GP Collaborative Head of Foothealth Care Pathways Manager Adults and Older People's Service Manager- Professional Lead Dietetics

Organisation HTPCT Whittington Hospital Whittington Hospital HTPCT HTPCT North Middx Hospital HTPCT North Middx Hospital HTPCT Whittington Hospital HTPCT HTPCT Whittington Hospital HTPCT HTPCT HTPCT HTPCT HTPCT HTPCT HTPCT HTPCT HTPCT