Lowers HbA1c
by one per cent
Comprehensive
Evidence base
For the NHS
by the NHS

Over the coming months, we are going to be sharing the great work of DESMOND providers across the UK and Ireland. This month’s ‘A focus on’ imparts the story of the DESMOND Nottinghamshire team. There is a huge amount to share with you all, so this story will be covered over two articles – please read on for part one, and part two will follow next month!

Background

In 2015, Nottinghamshire Healthcare NHS Foundation Trust were asked to start delivering structured Type 2 diabetes patient education. A decision was made to move to offering DESMOND, with delivery initially commencing across mid-Nottinghamshire. The service then expanded across south-Nottinghamshire in 2016 to cover the entirety of the county, and the team haven’t looked back since!

This well established DESMOND team forms part of the wider Nutrition & Dietetic department. The core team consists of diabetes educators & lay educators alongside clerical assistants. However, dietitians across the department also deliver the DESMOND courses within their role. Diabetes educators & co-ordinators, Sarah Kostewicz & Hannah Walters have been instrumental in both promoting and developing the service but the dedication, passion and enthusiasm from the entire team is truly key to their success. The team provide services across Nottinghamshire County; Mansfield & Ashfield, Newark & Sherwood, Rushcliffe, Broxtowe & Gedling.

Data presented by Hannah and Sarah at the Diabetes UK 2019 Conference, demonstrated significant improvements in HbA1c outcomes for those individuals living with Type 2 diabetes who attended a DESMOND course across Nottinghamshire County. This will be covered in more detail within next month’s release.

We caught up with Hannah recently and asked her to share the story of the Nottinghamshire Healthcare DESMOND team. She imparted how their DESMOND service have established themselves over the years and their strategy for embedding and delivering diabetes patient education during the Covid-19 pandemic.

Building the DESMOND Nottinghamshire brand

Hannah explained the importance of establishing their DESMOND service right from the offset as well as building key relationships. Ensuring the service remains at the centre of diabetes care across Nottinghamshire County has been paramount. The team have held a presence at protected learning time events, diabetes awareness events, diabetes forums, patient participant groups, diabetes support groups and many more.  Furthermore, communication with GP surgeries is key and relevant service information has been communicated via bulletins, newsletters and the team’s social media pages.

Anna Clark, Head of Service, commented on the process of integrating the new offer of education:

“We faced significant challenges when we had to come in and replace existing services that were familiar and valued by primary care. The change in service provision took time to embed as the DESMOND programme was very different to the previous offer of education delivered by specialist care. Therefore, it took a lot of networking, promotion, plus patient and colleague positive feedback for DESMOND to be accepted as an alternative offer.”

The Nottinghamshire team invest significant time into service development. Self-referral has been made available across the county, which has increased referrals into the service and has allowed the team to focus promotional efforts directly at individuals living with Type 2 diabetes. Furthermore, SystmOne e-referral has been launched, allowing healthcare professionals to refer with the click of a button and streamlining the process.

A significant number of displays have been established at GP Surgeries, Pharmacies, retinal screening locations, supermarkets & health and social care centres etc. Educators (Sarah, Hannah & Wendy)  have attended diabetes support groups, carers groups and local patient events to promote the service and ensure inclusivity. Resources have been developed and include a self-referral leaflet, service promotion poster, further support poster, staff shadowing poster and infographic.

The Nottinghamshire DESMOND team’s Facebook & Twitter pages are crucial in promoting the service further, both to individuals living with Type 2 diabetes and healthcare professionals. Social media posts and activities have been linked with national and international diabetes events, such as World Diabetes Day in November and Diabetes Week in June. All the above ideas and more can be found listed at the end of this article.

Alison Northern, Implementation Manager for DESMOND National Office commented:

“Hannah, Sarah, Wendy and the wider team in Nottinghamshire have demonstrated that consistent messaging is essential for strengthening the successful embedding of DESMOND. Many from within the DESMOND community can learn a lot from the team.”

Prior to the Covid-19 pandemic, the team delivered on average 200 face-to-face DESMOND courses annually.

Impact of Covid-19

The coronavirus pandemic and lockdown restrictions have led to individuals living with diabetes having to change the way they access information, with a significant move to online and virtual means of communication. Hannah commented:

“Straight away we knew we wanted to support individuals living with Type 2 diabetes across Nottinghamshire County as much as we possibly could.”

The DESMOND Nottinghamshire team continued to utilise a programme called ‘Recap Health’ throughout the pandemic. This trust-specific resource allows the team to prescribe digital information for health, wellbeing and recovery. Content was uploaded to ‘Recap Health’ to create a ‘Type 2 diabetes information pack’, which was more tailored to the current environment. The information pack was prescribed, upon request, to individuals contacted from their waiting lists but also to any new referrals received. The pack has been prescribed 264 times to all patients, 176 of whom have registered for an account, and the content has been read 367 times in total. The links lead the individuals to the direct download of the document or the website. Fantastic feedback was received from individuals on the resources included.

The content of the pack is outlined below: –

  • DESMOND Self-referral leaflet
  • Food fact sheet: Diabetes – Type 2
  • Your guide to Type 2 diabetes
  • Staying at home and managing diabetes
  • Coronavirus (COVIS-19) advice for people with diabetes and healthcare professionals
  • Diabetes UK website
  • Enjoy food guide: English
  • Enjoy food guide: African & African Caribbean
  • Enjoy food guide: South Asian
  • Food fact sheet: Glycaemic Index (GI)
  • FaceBook: Type 2 diabetes support with DESMOND Nottinghamshire
  • Twitter: DESMOND Notts

The team have offered MyDESMOND in addition to face-to-face education for some time now, but this became a vital resource throughout the pandemic. MyDESMOND was made available to all individuals on their waiting list and also to any new referrals received. DESMOND Nottinghamshire currently have 190 individuals active via MyDESMOND and 268 who have completed the programme. Recap Health registrations, as mentioned above, could be completed in addition to MyDESMOND to ensure individuals had access to evidence-based information to support their Type 2 diabetes management.

It was felt strongly by the team that individuals unable to access online programmes should still receive support with their Type 2 diabetes management. Therefore, the clerical team sent information packs via post to individuals who requested support in this way. The postal information pack was based on the content included in the ‘Type 2 diabetes information pack’ uploaded to Recap Health.

The team then decided to take on the world of virtual delivery! Hannah explains their thoughts:

“We have had MyDESMOND as part of our service offer for a while now but when the news of the DESMOND virtual groups was disseminated from head office, we were all excited to get thinking about providing virtual groups as a current replacement to our face-to-face education. We have been focused on providing the best possible support we can to our Type 2 diabetes population.”

Adjustments to provide a service during Covid-19

The DESMOND Nottinghamshire team commenced delivery of virtual groups at the start of September. There are regular groups planned between now and the end of November, with further courses being added to meet demand. The team have relished getting back to doing what they love!

“The interest for the virtual groups has exceeded our expectations and when we resume face-to-face groups, we are expecting there still to be a place for virtual delivery. We appreciate it is not quite the same, but we have loved being able to support individuals with Type 2 diabetes once again, just in a new environment!” – Hannah commented

Building the DESMOND Nottinghamshire brand – Marketing activities:

Diabetes UK Conference – poster presentation and abstract

Quality Improvement Project – poster presentation

Development of resources e.g.

  • DESMOND Self-Referral leaflet
  • DESMOND Promotional Poster
  • DESMOND Course Outline Poster (produced as an A1 laminated poster for display during the DESMOND groups)
  • DESMOND Staff Shadowing Poster
  • DESMOND Further Support Poster (produced as an A1 poster for display during the DESMOND groups)
  • MyDESMOND Pilot

DESMOND promotion at:

  • Protected Learning Time Events
  • Diabetes Support Groups
  • Health Awareness Events
  • Annual Public Meetings
  • Patient Participation Groups/Patient Forums
  • Carers Groups
  • GP Surgeries

Attendance at:

  • East Midlands Diabetes Conference
  • Diabetes UK Conference
  • DESMOND Awards
  • SystmOne e-referral & self-referral

Displays in:

  • Pharmacies
  • GP Surgeries
  • Supermarkets
  • Retinal Screening Clinics etc.

Information circulated via GP bulletin & TeamNet.

If you are interested in finding out more about embedding activities and how DESMOND head office can support you in these please contact Alison.northern@uhl-tr.nhs.uk

Coming soon: new DESMOND website with a wealth of support materials to help DESMOND providers in successful embedding

 

Come back for Part Two next month to learn more about the service evaluation work undertaken by the DESMOND Nottinghamshire team and the challenges they have overcome as a service.