Date

Welcome to the London Type 1

Diabetes

Network Event

Tuesday 21st November 2017

WiFi: Connect to the cloud

No password required

2

Welcome & Introductions Dr Stephen Thomas Clinical Director

Date

Type 1 Consultation Tool

Dr Pratik Choudhary

Senior Lecturer, Consultant in Diabetes,

King’s College London November 2017

Date

Type 1 Diabetes

Commissioning Pack

National Diabetes Audit

Participation

Gemma Snell

London Diabetes Lead

November 2017

5

Type 1 Diabetes Commissioning Pack

Three main parts: 1. Service specification

2. Clinical management:

optimal pathway

3. Implementation guide

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What is the NDA?

National Diabetes Core Audit (NDA): This annual audit of primary care

and specialist diabetes services covers care processes, treatment targets,

complications and mortality.

Collection Period: 12th June – 13th July 2017

National Diabetes Inpatient Audit (NaDIA): This is a snapshot audit of

every hospital covering inpatient care of people with diabetes.

Collection period: 25th – 29th September 2017

National Diabetes Footcare Audit (NDFA): This audit collects data about

specialist foot care services for people with diabetes.

Continuous data collection, services can commence participation at any

time

National Pregnancy in Diabetes (NPID) Audit: This audit examines

antenatal services for women with pre-gestational diabetes.

Continuous data collection however submission deadline to be included

in August 2016 annual report was 10th February 2017

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NDA in London: 2016/17

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2016/2017 Participation (%)

London participation = 96% England participation = 95%

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Why participate in the NDA 2016/17

Comparative data to support

planning and improvement

activity

CCG accountability and

assessment

High participation ensures

high quality data across all

diabetes audits

9

Why participate in the NDA

1. Monitor

2. Compare

3. Identify trends

4. Identify priorities

5. Link to long term outcomes

6. Find omissions

7. Learn from others

8. Demonstrate excellence in

care

9. Improve care

10.Save money

http://content.digital.nhs.uk/nda_collection

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Why participate in the NDA

1. Monitor

2. Compare

3. Identify trends

4. Identify priorities

5. Link to long term outcomes

6. Provides data for other

diabetes audits

7. Learn from others

8. Demonstrate excellence in

care

9. Improve care

10.Use money wisely

11

Useful websites

https://digital.nhs.uk/catalogue/PUB30142

http://www.londonscn.nhs.uk/publications/

Date

Commissioning Type 1 services in

South East London; Bromley –

Journey Towards Better Diabetes

Care

Jennifer Luong & David Hopkins

Senior Clinical Commissioning Manager, Bromley CCG

November 2017

13

Implementing the T1 tools in your

local area Table discussions with group feedback

Each table to discuss and answer the following questions in

relation to type 1 service provision:

1. What type 1 services are commissioned in your area?

2. What would be needed by both commissioners and providers

to implement the commissioning pack?

3. What three things will you take away with you to action after

the event to move forward implementation of the

commissioning pack?

25 minute table discussion

15 minutes for all group feedback

Please nominate someone on your table to scribe and give table

feedback

Date

Type 1 Diabetes

and the Treatment & Care

Transformation Funding

Dr Stephen Thomas

Clinical Director, London Diabetes Clinical Network

November 2017

15

Tea and coffee break

Resume at 15:15

16

Type 1 Network Workstreams: Outline

• Structured Education including T&C bid implementation Chaired by Dr Pratik Choudhary

Objectives: • Where are we: To identify how many courses are run across London and compare capacity to

requirement • Identify what plans are in place as part of the Transformation bids across London • How can we facilitate / influence change and engage people across London?

• Commissioning and resources required for type 1 diabetes services Chaired by Deborah Causer and Jennifer Luong

Objectives: • Implementation of the LCN type 1 commissioning pack • Support completion of the self-assessment by commissioners to identify gaps, priorities for

action and areas of good practice and innovation. To look at integrating responses to the survey into these assessments where data and information is not readily available.

• Type-1 patients not accessing specialist care Chaired by Dr Bobby Huda

Objectives:

• All STPs to have a dashboard to identify those at high risk and those not accessing care • All representatives from the 4 STPs to discuss what they are currently doing in their own services • To identify our at risk groups and to involve all the workstreams in this

• Access to and funding for technologies Chaired by Dr Nick Oliver

Objectives: • Defining where London is at the moment with technology accessibility across the region and

defining the variations

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Type 1 Network Workstreams:

Development Sit in your preferred workstream area.

Answer the following questions:

1. What should the workstream working groups be developing for a

pan-London approach to type 1 diabetes?

2. How will impact of any ‘products’ developed be measured?

3. What is happening locally that can feed into the workstream?

4. How will the workstream support the treatment and care bids?

If you would like to become more involved with the working groups

please complete the EOI form on the tables.

Please nominate someone on your table to scribe and give table

feedback

Timings: 20 minutes for table discussions, 20 minutes for group feedback

NHS London Procurement Partnership

Responsible Diabetes Prescribing Group

FreeStyle Libre®:

London Update and Discussion

Vicky Chaplin

Senior Pharmacist for Medicines Optimisation

21/11/2017

• NHS LPP’s Medicines Optimisation Primary Care Workstream supports CCG medicines optimisation teams.

• A key way to achieve this is by encouraging high quality of prescribing with the aim of maximising quality of care and reducing unwarranted variation.

• Our workplan has always been led by our stakeholder’s clinical priorities and to support this we now focus on a select number of clinical areas via our task & finish groups.

• The Responsible Diabetes Prescribing Group was asked to consider the prescribing of Libre® following the announcement of its inclusion in the national Drug Tariff on the 1st of November 2017. (London Chief Pharmacist and CCG Lead meeting 28th of September).

Background

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• The request to create London-wide supporting information for prescribing was forwarded to and agreed by the senior leads of the following regional networks:

London Diabetes Clinical Leadership Group

London Type 1 Diabetes Network

Children and Young People’s South East Coast & London Diabetes Network

Healthy London Partnership

• These groups have a variety of clinician and patient representatives and represent both adult and paediatric diabetic patients.

• Involvement of these groups resulted in numbers of suggestions for actions, and the development of potential programme of work (led by the LPP) to ensure the safe and effective introduction of FreeStyle Libre® across London.

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Engagement with London’s clinical networks

Interim statement

• On the 13th of October, NHS LPP released interim advice for Clinical Commissioning Groups in London.

• It noted that FreeStyle Libre® was due to be added to the national Drug Tariff on the 1st of November 2017, but that it was important to note that the Drug Tariff is not a list of recommended products and NHS organisations and prescribers are not obliged to supply every item listed within it.

• It recommended that “Prescribers in primary care should not prescribe Freestyle Libre® sensors on an NHS prescription until the Freestyle Libre® device has been evaluated and approved for use through local governance processes”.

• Most areas have prescribing formularies, which list locally evaluated items approved for local prescribing.

• The mechanism for evaluation of items for formularies is via local Area Prescribing Committees or equivalent.

• It was hoped that clinician led recommendations for the region would assist NHS organisations in the evaluation process and avoid variation in practice.

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• There are four NHSE Regional Medicines Optimisation Committees who review certain items for prescribing.

• Development of the LPP statement preceded the confirmation and subsequent publication of the national RMOC position statement.

• This was released on the 1st of November and provided recommendations on:

- Where to initiate

- Patient groups to consider

- Other considerations before initiating (e.g. training, adjunctive strips)

- When to review

- Data collection

- Comments on currently available data.

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RMOC statement

Actions following the RMOC statement release

• The London Type 1 Diabetes Network met on the 3rd of November and discussed the statement.

• They discussed the implications and potential implementation of the national statement.

• The statement is advice to area prescribing committees. APCs manage the entry of new medicines and prescribable medical devices into the NHS locally, develop prescribing guidelines and develop and maintain locally agreed formularies.

• CCGs are the statutory commissioner and only they can make a decision about whether or not and how to commission FreeStyle Libre® for their patients.

• It was agreed by the type 1 diabetes network that it was still worthwhile to take a regional approach to create the necessary implementation tools to be used in the evaluation process.

• Comments on this were fed back at the London RMOC meeting on the 9th of November.

15 December 2017 23

Draft plan for implementation – suggested initial work prior to APC consideration

• Regional treatment plans and referral pathways, including review considerations and any further details for distinct cohorts of patients (e.g. pregnancy). These will provide further information on recommended trial periods and “stop” criteria.

• Recommendations for appropriate transfer of prescribing into primary care, e.g. shared care documentation and details on necessary and available primary care training needs and methods for continuing data collection.

• Data collection tools and HCP training must be in place (and suitably peer-reviewed and user-tested) before this rolls out.

• Budget impact model required to review impact – formulary committees must review the level of funding available locally for Libre® against other items competing for local funding.

• Develop mechanism for ongoing review of data and information as more is available, e.g. NIHR cost-effectiveness review, data collected by healthcare organisations.

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