NHD clinical - - diabetes in Hackney
allowing a seamless service for patients, is
one of the strengths of the Diabetes Service
in Hackney.
What does the Hackney diabetes team do?
a. Secondary Care clinics
In the Secondary Care setting, the DSN
and DSD teams see their own patients for
one-to-one consultations in the Hackney
Diabetes Centre (HDC) and in Consultant-
led clinics at both Homerton University Hos-
pital (HUH) and St Bartholomew’s Hospital.
They also support a joint Antenatal/Diabetes
clinic, a Specialist Diabetes Foot clinic, and
a Diabetes Problem clinic (where urgent GP-
referred patients are fast-tracked to see the
consultant-led multidisciplinary team). As far
as possible, patients with Type 1 diabetes
receive their care in the hospital-based clin-
ics, including a weekly evening consultant-
led clinic at St Bartholomew’s Hospital.
Alongside these Secondary Care clinics,
the Diabetes Service also runs the Retinal
Screening service, based in HUH, for City c. Patient education Bartholomew’s (Barts) Hospital.
and Hackney patients. In 2008-09, 100 per- The Hackney Diabetes Team offers a
X-PERT sessions are delivered both in
cent of the patients on the Diabetes Regis- variety of structured group education pro-
HDC and in the community running three or
ter were offered retinal screening (as part of grammes for diabetes patients, as follows:
four courses per month. X-PERT courses
their diabetes annual review) and around 90 • EDDI (EDucation for DIabetes) for pa-
are delivered in a variety of languages by the
percent attended, a target that the Diabetes tients newly diagnosed with Type 2 dia-
team's multilingual Diabetes Lay Educators.
Team is proud of. betes. This is two three-hour sessions
The philosophy behind each of the struc-
(one week apart), similar to DESMOND, tured education programmes that the Hack-
b. Primary Care clinics delivered by a DSN and a DSD.
ney Diabetes Team delivers is the same - to
The community DSN and DSD teams do • X-PERT for patients with established
increase patients’ knowledge and skills to en-
one-to-one clinics at each of the 45 GP sur- Type 2 diabetes (usually one year or
able them to manage their diabetes with con-
geries in City and Hackney. The DSDs offer more). This is a national programme,
fidence and to participate fully in the decisions
between eight and 15 clinics per year to each run as five or six-weekly two-and-a-half-
about their diabetes care, thereby achieving
GP practice, according to the Diabetes Reg- hour sessions, delivered by two Diabe-
better outcomes for their diabetes. In general,
ister size; the DSNs can offer more frequent tes Team members (DSD, DSN or Lay
the course groups are six to 14 patients and
clinics, up to four per month in the bigger prac- Educators).
the programmes are well received by those
tices. The focus in these clinics is on patients • BHICEP (Barts and Homerton Insu-
who attend. The difficulty is that not all pa-
with more complex needs: patients with the lin and Carbohydrate Education Pro-
tients who are invited do attend. These ‘hard
poorest diabetes control and those with Type gramme) for patients with Type 1 diabe-
to reach’ patients remain a challenge to the
2 diabetes who need to start insulin therapy, tes on basal bolus insulin regimes who
Hackney Diabetes Service (see below).
or who have secondary problems (such as wish to adjust their insulin to fit a more
hyperlipidaemia or renal impairment). Pa- varied diet. This is four-weekly six-hour
(d) Healthcare professional training
tients are offered 30-minute appointments sessions, modelled on the Bournemouth
The National Service Framework (NSF)
with the DSD, but those who need more fre- programme (similar to DAFNE) and de-
for Diabetes Standards (2001) (3) stated
quent follow-up may be offered additional ap- livered by a DSN and a DSD.
that, ‘People with diabetes should be con-
pointments at the HDC - an advantage of the • Carbohydrate Counting for Type 1 pa-
fident that the member of staff they see is
Diabetes Team operating across the Primary/ tients. New one-off (three to four- hour)
properly trained and up-to-date…’ To this
Secondary Care boundary. sessions, as an introduction to BHICEP,
end, the Diabetes Team provides training
A particular feature of the community clin- or to reinforce carbohydrate estimation
for Primary Care teams (GPs and Practice
ics is the meeting at the end with the GP or for patients who have attended BHICEP,
Nurses) in Hackney, as follows:
Practice Nurse or both, which is a require- run by the DSDs.
• Diabetes in Primary Care. A course of
ment of the Local Enhanced Service for EDDI is delivered at HDC twice per
five weekly half-day sessions, which is
diabetes that the GP teams sign up to. The month, but pressure of numbers (of newly
delivered twice per year.
discussion of the patients seen by the DSD/ diagnosed Type 2 diabetes patients) means
• Insulin Skills Study Day. A one-day
DSN allows for the informal training of the this will increase to three times per month
course to help GPs and PNs initiate in-
Primary Care team, raising diabetes care from December 2009.
sulin therapy and titrate doses for Type 2
standards by sharing best practice. The BHICEP also runs in the Secondary Care
diabetes patients in the community.
DSDs and DSNs act as a conduit of special- setting, with six to eight courses per year.
• Informal training for GPs and their teams,
ist advice, calling upon the diabetes consul- However, an increasing waiting list of Type 1
either as one-off training sessions at the
tants, if need be, for their expert guidance. patients wishing to attend a BHICEP course
surgery or through the post-clinic meet-
Again, this is an aspect of the joined-up care means this will increase next year to monthly
ings (discussed above).
that the Hackney Diabetes Team strives for. courses, alternating between HUH and St As well as providing training to colleagues
NHDmag.com Mar '10 - issue 52 19
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