Improving administration efficiency to increase uptake of DESMOND in Northamptonshire

Northamptonshire diabetes multidisciplinary team

The Northamptonshire diabetes multidisciplinary team educate and provide self-management of diabetes for those living with the condition to avoid acute and long-term complications of diabetes. They have been using the DESMOND programme since 2006. 

The team provides a locality-based educational service that is complex in nature, working collaboratively to support the delivery of excellent diabetes care with colleagues working in the community and primary care. 

In 2023, the Northamptonshire team won the DESMOND Award for Impact.  

Lynsey Burgess, Diabetes Specialist Nurse and Diabetes Pathways Lead explains: “We continually strive to innovate and are passionate about targeting improvement opportunities to benefit people with diabetes in our community. Several innovation and improvement initiatives were identified within the DESMOND pathway and work began in 2021 to collaborate with key stakeholders and staff to transform our DESMOND service.” 

The Northants team have implemented a number of changes which have had such a positive impact on participants that attended their groups, when they rated how confident they felt to manage their type 2 diabetes, the response increase from an average of 5 out of 10 before attending to 8.3 out of 10 after.  

“It is really inspirational to see the great impact that the Northamptonshire DESMOND team are having for people with type 2 diabetes across their patch. This award is an absolute credit to their hard work and sheer determination”, added Alison Northern, Implementation Lead for DESMOND from the Leicester Diabetes Centre (LDC). 

Innovation 1: DESMOND Referral Form 

By working with the Clinical Pathway Lead in Integrated Care Northamptonshire, the DESMOND Northants team were able to co-design a bespoke DESMOND e-referral form, which has since been implemented across all GP practices.  

The new referral template is accessible to GPs on both EMIS and SystmOne gateway and facilitates a quick and easy e-referral. This change has resulted in an increase in referrals, with over 200 per month. 

This new form merges personal characteristics and clinical details from a person’s record including:  

  • Ethnicity (automated capture, will influence service development going forward) 

  • Communication preferences 

  • DESMOND Referral guidance 

  • Outcome of DESMOND referral to support the National Diabetes Audit 

  • HbA1c, Lipid profile including HDL and LDL, Blood Pressure, Waist Measurement 

  • Patient’s preferred DESMOND format: face to face, virtual, or the MyDesmond online platform 

  • Downloadable promotional patient information leaflet about DESMOND course that highlights key course information. 

Two GP clinical systems are used in Northamptonshire, but the DESMOND Northants Educators only have access to one. This new referral process gives Educators access to the clinical details of attendees, which benefits DESMOND participants by allowing Educators to assist with completion of their health profile chart, enabling them to make informed decisions that influence their action plans. 

Innovation 2: DESMOND Education Template 

The Northants team has collaborated with their Trust’s clinical systems department to create a template in the teams’ clinical system that includes nationally agreed coding for capturing information on DESMOND referrals into the service as well as other data sets. 

This collaboration has improved e-data capture supporting accurate team Key Performance Indicators (KPIs) and administration efficiencies. A key part of the new system is that it facilitates a consistent approach across administrators regardless of staff absences.  

The development and implementation in the shared clinical record will improve data capture in Northamptonshire for the National Diabetes Audit, providing the mechanism for capturing data extracted from GP electronic records as well as specialist providers such as Northamptonshire Healthcare NHS Foundation Trust (NHFT). 

Innovation 3: Memorandum of Understanding with Integrated Care Northamptonshire 

In September 2022, one-off additional funding was secured to support the expansion of structured education programmes with the goal of increasing participation and decreasing non-attendance. This funding was part of the development of the robust and standardised administration processes that the Northampton team now use, which includes: 

  • Developed admin SOP and job plans 

  • Protected time to train administrators 

  • Script to use at every contact to promote courses and encourage attendance 

  • Monitoring and benchmarking attendance, uptake rates and non-attendances  

  • Telephone call upon receipt of DESMOND referral 

  • Reminder text to prompt engagement  

  • SMS text reminder prior to booked courses 

  • Education template guides capture of the stage in process on clinical record  

  • Robust discharge back to GP 

  • DNA / decline letters offer self-referral 

Innovation 4: Telephony System 

Introduced in mid-2021, a new telephony system enabled the team to set up a dedicated 03000 number to call for DESMOND courses. This service transcribes voicemails into text and sends along with an audio file to an education group email address. 

Patients can leave a message at their convenience and no messages are lost. Numbers are pulled through with the audio file and the message can be answered with no risk of the message being missed due to staff absence.  

What impact have these innovations had? 

Sarah Jane Harding, Diabetes Education Coordinator, Northants Community Diabetes team explains: “Responses from participants are consistently positive and show a high level of satisfaction with the course, increased confidence after taking the course and very good experiences with the Community Diabetes Team.” 

Here are examples feedback that the Northamptonshire DESMOND team has received about their service:  

“Small friendly group, excellent advice, lovely hosts. Very helpful welcome pack. Educators were able to produce my cholesterol and hba1c levels as hadn’t been given by GP.” 

“Information given in a SMART way, sharing with others in the group, questions answered, tutors knowledgeable, friendly.” 

“Meeting with other people who have type 2 and learning about measuring HbA1c and not trying to micromanage it. Very well run, relaxed environment, lots of information to take away.” 

“The amount of very relevant information but conveyed in a very informative way. Q + A format meant the time passed quickly. Charlotte and Rita were approachable, very knowledgeable and excellent in doing the course.” 

Alex Batchelor