World Diabetes Day on 14th November is the largest diabetes awareness campaign globally, reaching an audience of more than 1 billion people in over 160 countries (World Diabetes Day). Diabetes and well-being is the theme for World Diabetes Day for the next three years, and with 63% of people with diabetes saying that the fear of developing diabetes-related complications affects their well-being, raising awareness of timely access to diabetes care is paramount in supporting patients’ welfare.
Diabetes is a wide-ranging condition that can affect multiple organs in the body, which is why Diabetes & Endocrinology is one of Consultant Connect’s most popular elective care telephone specialties, with 17% more calls to these lines than the average specialty. Diabetes & Endocrinology is also one of the top elective care specialties by hospital avoidance for telephone advice, with 75% of calls made to these lines via Consultant Connect enabling the patient to avoid a hospital visit (Consultant Connect). Here are a few examples of how our Diabetes & Endocrinology advice lines are helping patients with diabetes-related symptoms/conditions get the care they need in the right place quickly.
Bypassing an inappropriate destination for a vascular emergency
Enhanced Advice & Guidance has been available in Coventry and Warwickshire ICB since 2017. The service rapidly connects NHS clinicians to specialists for comprehensive advice via telephone and photo messaging. Diabetes & Endocrinology is one of the available specialties, enabling healthcare professionals like Sylvanna Sandhu to send patient images for specialist input securely:
‘A patient attended the podiatry clinic in the community for a review but was found to have deteriorated significantly. The podiatrist securely uploaded clinical photographs with the patient’s consent and added a brief history.
‘The images were reviewed, and the patient was transferred urgently to the Vascular Team at University Hospitals of Coventry and Warwickshire NHS Trust (UHCW). This was all done via Consultant Connect. Without this service, the patient would have likely been sent to South Warwickshire University NHS Foundation Trust for an assessment and then transferred to UHCW. Still, by sending the images for analysis, we bypassed that completely.
‘The fact that the patient was seen so quickly and efficiently is particularly important as they had an ischaemic foot, which is a vascular emergency.
‘This is such a beneficial service as the patient knows their condition has been acted on immediately. I can say, “I have taken some pictures, and now everybody who needs to can see what is going on to make a quicker decision”.
‘Some of the patients I see have a foot wound, and usually, I would have to describe the wound. But a photo tells the story so much quicker. If I had a patient with no foot pulses whom I thought needed urgent intervention, an expert could look at the picture, say, “It looks ischaemic,” and advise on the next steps.’
– Sylvanna Sandhu, Diabetes Foot Nurse Specialist.
Starting same-day management for diabetes
Before the introduction of Telephone Advice & Guidance, Dr Gregory would phone or email consultants he knew if they worked in the appropriate specialty. Otherwise, he would use advice & guidance via ‘Choose and Book’:
‘Previously, if I had a suspected urgent case, I would have been forced to try and admit the patient or phone a secretary to get a message to a consultant (which was often unsuccessful). Using Telephone Advice & Guidance provided by Consultant Connect is immediate. It is always better to be able to deal with the problem, resolve it and tick it off. Sometimes, this is clinically crucial, too. I have found it very useful and recommend anyone with access to use it.
‘After seeing a patient who potentially had type 1 diabetes, I was unsure if they should be started on insulin or oral hypoglycaemics. Usually, I would manage type 2 presentations but admit children or teenagers presenting with type 1 to paediatrics.
The patient was anxious to act on the situation and wanted answers straight away. I contacted the Diabetes and Endocrinology Team via Consultant Connect, and they understood the difficulty in defining this type of diabetes. After the conversation, they started the patient’s management the same day through the diabetes nurse in the hospital clinic. Admission was not indicated, but a referral to outpatients would have taken some weeks at least. It felt reassuring to have the management started within a few hours of the diagnosis. This was a great result.’
– Dr Gregory, GP in Warwickshire.
Providing comprehensive care allowing patients to safely remain in the community
For NHS areas with capacity issues or no local provision, out-of-area NHS consultants on our National Consultant Network (NCN) can provide Diabetes & Endocrinology Advice & Guidance. Dr Steve Jackson, Consultant and Chief Medical Information Officer at the University Hospitals of Leicester NHS Trust, answers calls from local and out-of-area clinical colleagues via Consultant Connect and shares how this impacts patient care:
‘Patient-wise, I get lots of people with newly diagnosed type 1 diabetes, where the GP might see this very infrequently, and they just want some management advice. This saves an admission to hospital. In particular, the Friday afternoon calls are important because these sorts of patients will come in maybe for a whole weekend and be treated unnecessarily. In reality, we can discuss this in a few minutes, manage the patient in the community, and have them go home safely with the appropriate red flag symptoms passed onto them.
‘I was speaking with a colleague who previously didn’t want to be on the rota, and he told me how much he enjoys taking the calls; it gives him a nice warm feeling at the end of the day that he’s supporting GPs and patients.’
– Dr Steve Jackson.
Reduce waiting list backlogs so patients receive care quicker
Our clinically-led Referral Triage and Validation service, delivered by consultants on the NCN, provides virtual management plans for long waiters or new referrals and has proven to reduce waiting lists by 33% on average, even more in some specialties. The service supports Trusts with clinical staffing challenges by bringing in temporary NHS consultant capacity in the form of ‘virtual locums’, they work remotely and follow local pathways and protocols under the leadership of the Trust’s clinical lead.
One Trust opted to triage a backlog of diabetes referrals, resulting in:
- 36% of patients being safely returned to primary care with detailed management plans.
- 62% of patients receiving a routine appointment without diagnostics.
- 2% of patients receiving an urgent appointment without diagnostics.
If you would like to discuss how we can support patients in your NHS area with diabetes, please email hello@consultantconnect.org.uk or call 01865 261467.
