PROCEED Preconception Care for Diabetes in Derby Derbyshire
PROCEED Preconception Care for Diabetes in Derby/ Derbyshire: Paru King, Consultant Physician On behalf of the PROCEED team
The national picture • Women with diabetes are: – 2 -4 times as likely to have a baby with a congenital abnormality. – Five times as likely to experience a stillbirth • The risks can be reduced by preconception care • Only 34% access preconception care • 8 000 pregnancies affected in 2011 in the UK • Preconception is a NICE Quality standard 2011
The local scenario: Derby and Southern Derbyshire %
Gave us the opportunity to pilot PROCEED, the first integrated preconception service for diabetes.
Raising preconception awareness Practice Nurses Pharmacy Medicines Review GPs Health Visitors/Surestart Family planning clinics Refer Primary and secondary care diabetes teams Users (via clinician) Educators Non-diabetes specialist clinicians
CONTINUITY CHANGE CONSULTANT ROLE CROSS BOUNDARIES (INTEGRATE) PROCEED: OUR VISION 6 Cs COMPETENT CONSISTENT CHOICE
Hospital clinic (South Derby) Flexibility depending on clinical need and user choice Community clinics (Central Derby) Community clinic (North Derby)
PROCEED : Efficiency and productivity
Impact of PCC P<0. 01 P<0. 05
PROCEED : outcomes PROCEED
PROCEED : light and dark green dollar savings
PROCEED: Finance • Total annual savings from changes= £ 61, 000 • Recurrent cost of service =£ 17, 000 • Overall savings Year 1 =£ 44, 000 / year • Could save £ 14 Million if rolled out nationally
PROCEED: Summary • Preconception Care reduces abnormalities and improves outcomes in pregnancies complicated by diabetes. • We demonstrated a case for change and piloted PROCEED. • PROCEED a user centred integrated preconception service for diabetes, which is integrated not only vertically across specialities but for the first time horizontally across traditional primary and secondary care boundaries. • It improves productivity, efficiency, PCC rates, pregnancy outcomes as well as responding to user needs. • This model has a recurrent cost of £ 17, 000, but in the first year has resulted in savings of over £ 60, 000 locally, as is now commissioned.
PROCEED: Learning • PROCEED’S success was as much about building relationships to work across boundaries as it was the service redesign. • Listening to users is important in providing a service that meets their needs. • The importance of a solid financial evaluation should not be underestimated. • The support from the Health Foundation and Springfield was fantastic!
Thank You
- Slides: 15