Summary
Mid and South Essex Integrated Care Board (ICB) was a pilot site for implementation of a Type 2 Diabetes Path to Remission Programme from February 2022 to March 2024. This initiative was funded by NHS England (NHSE) based on Diabetes UK research, which demonstrated remission (where blood sugars return to normal range) for patients who have Type 2 diabetes and are obese or overweight via a low-calorie diet programme. This case study demonstrates the successful turnaround of initially poor uptake of this pilot programme in Mid and South Essex ICB with clinical leadership using available technology in a resource-constrained environment.
Innovation/Novel approach to an existing problem
A total of 500 spaces were made available by NHSE for this two-year T2 Diabetes Path to Remission pilot in Mid and South Essex. There are 72,000 residents with diabetes in the Mid and South Essex region. Over 65,000 residents have Type 2 diabetes and around 60% of adults are either overweight or obese. Between February 2022 and October 2022 the number of referrals received into this programme was approximately 124 and, of these, 66 were accepted into the programme. Given that the spaces available for this programme were 500 over a two-year period, the ICB was significantly behind schedule for filling the spaces. The SystmOne primary care IT system clinical lead for diabetes started their role in November/December 2022. At this point, the ICB was undergoing a restructure so limited support was available for this project. The clinical lead began with an analysis of the SystmOne data, examining referrals into the programme and the barriers to referral. The objective was to fill the 500 spaces through 1,000 referrals, as the conversion rate from referral to takeup of this programme was assumed to be 50%. A multi-pronged approach was initiated and included the following. A weekly lunchtime professional education session about the programme was established, working with the provider. SystmOne searches of eligible patients were made available to practices. Alerts and prompts were set up within SystmOne, gently nudging clinicians to refer into the programme, with prompts linking to referral forms and autopopulating a lot of the information to make clinicians’ lives easier. Clinicians were made aware of the small financial incentive (weight management Local Enhanced service of £11.50) for referral into this programme. Sample text messages and resources were created to send out to patients. Primary care network clinical directors with the lowest referral rates were contacted, with a view to seeking to understand barriers and offer support. Feedback was taken into account and strategic support offered. Patient awareness of the programme was raised through ICB communication channels, the Essex United Facebook page, direct engagement with residents through community events and working with Diabetes UK. Regular monthly monitoring of the data examined referrals into the programme alongside analysis of health inequalities data, patient safety incidents, challenges and patient experience. There was also collaboration with neighbouring ICB clinical leads to learn and share good practice.
Equality, Diversity and Variation
During the pilot phase, the initial focus was on increasing referrals into the programme to make it a success. There were regular discussions with the providers and monitoring of the data on equality, diversity and variation. In fact, the highest number of referrals came from one of the biggest practices serving the most deprived population in the area as a result of engagement with the team.
Impact to Patient Care
Impact on patient care includes the following. Patient access was improved because they were able to access the evidence-based Type 2 Remission programme. Patient experience was improved as participants were able to come off medications and reduce the medication burden. Patient outcomes were improved as weight loss and remission led to improved quality of life, a reduction in hospital admissions and a reduction in complications.
Results
Project outcomes as at March 2025 are as follows. Referrals by the end of pilot period (March 2024) totalled 875, compared to a total of 40 referrals in year one. The number of patient referrals accepted were 600 (68%). Of these, 432 have completed their initial assessment, 381 have started Total Diet Replacement (TDR) and 326 have completed TDR, averaging 10.1kg weight loss. A total of 313 have completed the food reintroduction phase. A total of 282 have completed six months on the programme, averaging 11.7kg weight loss. A total of 202 have completed 12 months of the programme, with an average 10.5kg weight loss. This project was funded by NHSE, but no implementation money or project lead was made available for the project locally. This initiative was successfully implemented through the methods described above, with resulting improvements in patient outcomes. Patients referred to this remission programme are advised to stop almost all diabetes medications and some blood pressure medications. This means that the burden of medications, side effects and risks with the medications are reduced for patients. Those in remission experience fewer complications, as well as reduced numbers of primary care and hospital visits. This also reduces the pressure on the ICB’s finances, including hospital admission costs and drug costs. The successful turnaround of the programme provided value for taxpayers by saving money, as each space in the programme costs the NHS under £1,500.
User Feedback
The family and friends test score average is 3. Service user feedback includes: ‘So happy with progress’; ‘Opened up so many opportunities’; ‘Have been able to go back into society with the weight loss that has been achieved and maintained’; ‘Found a part-time job which she is very active in’; ‘Have come off all medication and achieved 10 kg weight loss and managed to climb Everest base camp’.
