Minutes of Educator Network 3 Meeting 25 April 2013 Cripps Post Graduate Centre, General Hospital, Area J, NN1 5BD Delegates: Sarah Phillips (Chair) Leicester Angela Thomas Birmingham Community Beverly Cunningham Birmingham Community Pash Dhindsa Derby Community Stella Ruston Derby Community Eileen Richardson Kathy Kerlogue Judith Eisenberg Royal Derby Lesley Peters University Hospital, Birmingham Rosanne Dunkley Worcestershire In attendance: Gillian Thompson Apologies: Central DAFNE Sandwell Nottingham The meeting opened, the grouped thanked Eileen for organising the venue and refreshments. The group also welcomed Gill Thompson from central DAFNE who introduced herself; introductions were then made around the table. Centre update: Birmingham Community Trained HCPS: 4 DSN, 3 Dietitians and 3 Doctor. DAFNE records show 5 Dietitians with 1 on sabbatical till September 2013 Courses: 11 booked DAFNE database shows 12 Funding: No Changes Waiting list: 0 Recruitment issues: Low numbers Follow-up arrangements: arranging refreshers sessions Local threats: Heartlands Bertie and Sandwell Derbyshire Community Trained HCPS: 1 DSN, 1 Dietitians and 1 Doctor. Courses: 1 Funding: Under review Waiting list: 0 Recruitment issues: steady Follow-up arrangements: 6/52 6 months/1 year and refreshers Local threats: Aspire North Derbyshire and All Changes DAFNE Educator Network Meetings sponsored by: Gold Novo Nordisk UK, Silver Lilly Diabetes 1
Leicester Trained HCPS: 6 DSN, 4 Dietitians, 4 DAPs and 11 Doctor. DAFNE records show 7 DSNs and 13 Doctors Courses: 14 course 10 DAFNE 2 Pump and 2 5x1 Funding: N:F up? Super 6 Waiting list: 3-4 months Recruitment issues: People less interested in taking time off work Follow-up arrangements: Refresher session, user group Local threats:? Super 6/7 No information provided Royal Derby Trained HCPS: 2 DSN, 2 Dietitians and 1 Doctor. Courses: 9 DAFNE database shows 6 Funding: South Derby s CCG Waiting list: 3 months Recruitment issues: None but Patients are not able to be flexible Follow-up arrangements: 6/52 Post Course meeting, DAFNE refresher Local threats: Cost stating charges Uni Hospital Birmingham Trained HCPS: 5 DSN, 2 Dietitians 5 DAPs and 2 Doctor. DAFNE records show 6 DSN, 1 Dietitian and 5 Doctors Courses: 16 DAFNE database shows 12 with one still missing stats Funding: No Changers PCT/GP Waiting list: 0 Recruitment issues: Steady Follow-up arrangements: Refreshers Local threats: No Changes/Threats yet Worcestershire Trained HCPS: 2 DSN, 1 Dietitians and 3 Doctor. DAFNE records show 6 DSN, 1 Dietitian and 5 Doctors Courses: 7, 2 or 3 5x1 courses DAFNE database shows 6 and 3 5x1 Funding: CCG no changes yet Waiting list: 6 months Recruitment issues: No Geography of county with locations Follow-up arrangements: 6-8 per year, annual refresher Local threats:? CCGs The general theme is one of limbo as centres wait to find out how the newly formed CCG s will fund diabetes services, and how budget cuts will affect specialist roles as teams face reviews with potential for posts to be downgraded to a lower band. DAFNE Educator Network Meetings sponsored by: Gold Novo Nordisk UK, Silver Lilly Diabetes 2
Derby Community Waiting for the 4 CCG s to decide how they will provide and fund diabetes services. They have developed a programme called Diabetes and Me a structured education programme that has been successful in reducing medication and progression to insulin in people with type 2 diabetes. Derby South Derbyshire South Derbyshire CCG support city and county DAFNE courses, funding seems reasonably secure. There is some concern within the DAFNE team that CCG s may start to question the cost of DAFNE. DSN posts are under review and maybe downgraded to a lower band. The team have set up weekly DAFNE clinics which has improved data collection. Worcestershire Another DSD has been employed and structured education has been commissioned for the next financial year. 5x1 courses are very popular. University hospital Birmingham DAFNE is going well. Numbers are slowing down as people struggle to get time off to attend. Referrals are coming in from other services such as transition, antenatal and pump. Birmingham community hospitals Jill Hill has left the team. The rest of the team will be moving to shared accommodation in June. Ongoing issues regarding the communication between the secondary care team and the county/kettering team. Dr Fox and Dr Kilvert have left and their replacements have settled in well and work very well together. The director of medicine has been querying the cost of services including DAFNE. Leicester Leicester is transforming diabetes service using the super six model developed in Portsmouth. In terms of DAFNE this is unlikely to be a threat, as structured type 1 education is likely to remain within the remit of secondary care. However there is a huge drive to have more patients cared for by primary care which is likely to result in more type 1 patients being discharged from secondary care. The current plan for the provision of an enhanced diabetes service within primary care has not so far included DSD. DAFNE Educator Network Meetings sponsored by: Gold Novo Nordisk UK, Silver Lilly Diabetes 3
QA Audit The group discussed recent experience of audit. The new electronic paperwork saves time on the day of the audit visit but JE explained that it takes quite a bit of time to prepare and complete the electronic paperwork before the audit visit. There was general discussion around how audit reports good or bad can be used to the centres advantage. Audit form D has been sent out and is also available on DAFNE online in the HCP area Action; next time bring and discuss further experience of audit. Timetables and Audit form F Leading on from audit the group discussed audit form F and how it should be completed. This should be done for all the main timetables used at a centre. There are additional pages on the spreadsheet for various versions of the timetable. Centres do not need to complete a form for every slight change to the timetable just the main ones that are used. SP stressed that the importance of this form is to protect the time required to deliver a DAFNE course. KPI s and outcome targets GT explained that central DAFNE would like to provide more information on outcomes at the DAFNE collaborative each year. This will be done as an anonymous league table. However before this can happen there needs to be a higher ascertainment of 1-year post course data. The group discussed ways that they have improved data collection by running dedicated DAFNE clinics and structured follow-up. 5x1 and pump curriculum SP clarified the process of conversion training and the group discussed some of the key opportunities and feedback from 5x1. Some centres would like to train but due to the new financial year they have not been able to book 5x1 courses and until the courses are booked they can t attend training, this results in a bit of a vicious cycle. They cannot promote the courses to the commissioners until they re trained but can t train until the courses are booked. SP and GT to feedback to central DAFNE Educator group elections and chair post SP announced the results of the elections which are also on the website, and explained the process for the recruitment of a new chair. GT also explained some of the duties of the chair. DEP trainees Competencies The template will be circulated with these minutes DAFNE Educator Network Meetings sponsored by: Gold Novo Nordisk UK, Silver Lilly Diabetes 4
Action: educator to please populate the template with their experiences particularly focussing on what aided their success. New session learning outcome forms All centres to check that the new forms are in use and the old ones have been removed from master files. Curriculum session 6 Network 3 are all following the original DAFNE timetable with regard to this session. All centres do a full session in the morning and review acetates and goals in the afternoon session. The group agreed that the afternoon session is very important for setting goals and making decisions on dose adjustment. Dr s input to the course It was felt that any input to a DAFNE course should be by a DAFNE Dr however most centres at some point struggle to get a Dr to attend for Q&A particularly if they are delivering a course in a primary care setting. Centres have used teleconference or email for Dr s Q&A. Support for graduates port course Centres continue to run refresher sessions. Some centres run DAFNE clinics. Other centres encourage graduates to form their own social support groups but were careful not to get involved in exchanging contact details between individuals or groups. Insulin At diagnosis NPH bd Pre-mix Basal Bolus Derby Worcester Worcester (od analogue BI) Leicester Leicester B ham city (od Analogue BI) B ham community The group noted that it was interesting that centres would still start from diagnosis on od analogue as a BI but would go to bd BI either before or during a DAFNE course. Pre course Most centres reduce BI at pre-assessment clinic if the dose seems high or if there is a problem with hypos. Worcester review glargine once per day and if it appears to be running out would change them to bd Levemir. DAFNE Educator Network Meetings sponsored by: Gold Novo Nordisk UK, Silver Lilly Diabetes 5
Most centres currently would not change to bd BI prior to the course as a matter of routine but would assess on clinical judgement. Next Meeting Date Wednesday, 16 th October 2013 at 10 am start will take place at: Loughborough Training Room Bradgate Ward Loughborough Hospital Hospital Way Loughborough Leicestershire LE11 5JY DAFNE Educator Network Meetings sponsored by: Gold Novo Nordisk UK, Silver Lilly Diabetes 6