Summary

EDEN - Effective Diabetes Education Now was created and developed as a multi-professional cross- boundary, primary and secondary care service to address needs in diabetes management and risk-reduction. Taking aim at the transformation of diabetes across the Leicester, Leicestershire and Rutland (LLR) healthcare spectrum, it specifically targeted the effective and appropriate treatment of patients, reductions in demands on secondary care, raising skill levels of diabetes healthcare professionals and measuring the impact of transformation.

Innovation

EDEN is a small team with an offering comprised of programmes in AI and technology, education and transformation, led by a team of clinicians and core staff passionate about improving diabetes care for patients. It was initially developed as part of a multisystem primary and secondary care pathway transformation, to improve care and outcomes for patients with diabetes throughout Leicester City. Recognising that courses alone do not impact in a sustainable way, EDEN development comprises baseline training needs analysis (TNA) (using cutting edge AI); evidence-based MDT and expert delivered, RCGP-accredited modules in all key areas; mentoring at practice level to support a step change skill and thus improved patient care; GP mentors and cross secondary care partner relationships and working; and data and analytics - including pre- and post-module Knowledge and Confidence (K&C) questionnaire and national benchmarking of diabetes data.

Results

In Leicester City CCG results from hypo admissions show a decreasing trend from 120 in 2014 to 70 in 2016. EDEN has been rated a record 96% (4.8 out of 5) by participants on its courses. For the fourth year running average score of speaker evaluation forms has been above 92% with 1,804 speaker evaluation forms completed to date.

Dissemination and Sustainability

A ‘train the trainer’ programme was developed in early 2016 and has been delivered to a number of commissioning areas, with more commissioned on an ongoing basis. The blend of LDC written and evidenced programmes, with ongoing Quality Assurance support, while developing a local network of skilled HCP educators, is the optimum way to deliver sustainability and spread. Provision of AI algorithms and data/TNA ensures the right programmes can be delivered to address local need and gaps. The TNA as a stand-alone is reproducible to define and signpost education need across any clinical area and has been acknowledged as having such potential by winning the Training and Development category at this year’s HSJ Awards.

Method

Commissioned in 2013, EDEN has evolved enormously over four years as a collaboration between Leicester Diabetes Centre (LDC), which sits across the University Hospitals of Leicester NHS Trust, University of Leicester and Leicester City CCG. From three core modules in diabetes care, to 13 current programmes, design and delivery is always based on feedback from patients and staff, ongoing data analysis, outcomes and performance plus the commitment to stay abreast of current and future directions and need in diabetes care. To identify baseline need a systematic K&C questionnaire was developed, linking 73 competency statements to all modules. The resultant self-reported survey produces recommendations via sophisticated algorithms in seconds - at individual, role, practice or CCG level for best practice and reduction in variation. This is completed annually plus pre- and post-course to identify improvements in knowledge and confidence, as well as competence. Modules are multidisciplinary in design and delivery, for example:

• Foundation & Advanced insulin and Glycaemic Therapies - Diabetes Specialist Nurses (DSNs), Secondary Care Specialist, Consultant Nurse and GP
• Footcare - across boundaries - primary, secondary and community care staff including podiatry, specialist nurse and footcare specialist consultant and team
• Obesity and Lifestyle Behaviour Change incorporates innovative physical activity research re: activity and decreased sedentary time, motivational interviewing and change-behaviour skills, delivered by a blend of clinical psychologist, dietician, physiotherapist and physical activity researcher
• Diabetes and the Older person - optimising treatment in acute primary care and care home settings is critical and often a source of unscheduled admissions. This module encompasses end of life care, optimisation of medication and ranges and is delivered by GP, Nurse Consultant and Physician, and incorporates feedback from what matters most in care homes. This is currently being tested and delivered in bite-sized chunks in care and residential homes
• Pharmacists are portrayed as one of solutions to the health service burdens. Our pharmacist programme modules were designed and delivered by a specialist delivery team comprising community pharmacy specialist, DSN and consultants/GP, and was delivered in partnership with the Local Pharmaceutical Committee and a commercial pharmaceutical company to pilot new ways of working.

Growth has been steady based on need, feedback data and results, with the aim always to improve outcomes for patients with diabetes in primary care and decreasing burden on secondary care.

In addition to module delivery, which is in varied and engaging models, of face-to-face and e-learning, a monthly clinical engagement meeting chaired by EDEN and the CCG GP lead has created a platform for primary and secondary care to combine and discuss current practice, new delivery, research audit and patient case studies.