Summary
Lakeside diabetes team, based in one of Bexley’s most deprived communities, has been providing high-quality, innovative, patient-centred services from the practice with impressive results.
More than 15,000 patients are registered at Lakeside, making it the largest patient list in Bexley: 737 patients have diabetes, 692 have Type 2 and 45 Type 1.
Results
In 2010/11 the team made significant progress, meeting all three objectives – only 10 patients from a list of 737 continue to receive essential care in an acute setting, ensuring patient care is closer to home and more cost effective.
One hundred and thirty-six patients have reduced their HbA1c levels from 8.6 per cent to 7.8 per cent thanks to structured education programmes being offered from the practice. As a result, Bexley was the best performing borough in London.
Type 2 diabetes patients on insulin regimes have reduced their HbA1c on average from 9.5 per cent to 8.2 per cent after receiving their injectable therapies from the practice.
Patient satisfaction is at an all-time high thanks to continued engagement with patient groups, networks and patients using the diabetes service. As a result the team have been able to create much improved patient-centred services.
Lakeside’s team-approach has positioned them at the forefront of innovative diabetes care in Bexley.
Challenge
The team had three key objectives were to:
- Improve essential care
- Provide structured patient education and cohesive follow-up programmes
- Engage with Bexley’s diabetes practice development team and patient groups.
Solution
GP lead Dr Maryam Tahmassebi set out to create a unified and comprehensive taskforce of professionals who could care for, treat and empower Type 2 diabetes patients to improve their health and wellbeing.

