DIABETES is a growing national problem – but it poses particular challenges here in the North-East.

More people than ever are being treated for the debilitating condition that causes a person’s blood sugar levels to become too high.

That’s partly due to improvements in spotting the symptoms, but also because the far more common Type 2 diabetes – where the body doesn't produce enough insulin, or the body's cells don't react to insulin – is linked to poor diet and deprivation.

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And, according to Dr Srikanth Mada, consultant physician and clinical lead in diabetes for County Durham and Darlington NHS Foundation Trust, that means that the incidence of diabetes in a relatively poor region like the North-East is growing faster than the national average. In County Durham and Darlington alone, there are 40,000 known diabetics out of a population of 600,000, and that figure has risen by about five per cent in the past year.

But now, thanks to an award-winning initiative, County Durham and Darlington is leading the way in developing what Dr Mada and his colleagues describe as a “radical” new model for managing diabetes.

Indeed, Debbie Calland, the trust’s nurse manager and lead nurse in diabetes services, makes an even bolder declaration. “We believe it is the biggest transformation in the management of any long-term condition in the country, not just diabetes,” she says.

And that claim of national leadership is backed up by the fact that the North-East project has just been awarded the diabetes collaboration initiative of the year at the Quality in Care Diabetes Awards.

The model is based on the principle of shifting care closer to home, with consultants and diabetes specialist nurses working alongside GPs and practice nurses to upskill them in managing Type 2 diabetes within primary care rather than acute hospitals.

The initiative took root in 2007 with a 12-month pilot involving 12 GP practices in the management of diabetes in the Durham Dales. That led to a second year-long pilot, this time focused on Easington and Sedgefield. In turn, that inspired a review of the entire county-wide diabetes service.

Although the pilots had involved GPs, it was clear that the service was still being delivered by specialists from the trust, and the conclusion was reached that it could only be sustainable if GPs and practice nurses were given the necessary skills.

In 2014, North of England Commissioning Support was brought in on behalf of the area’s three Clinical Commissioning Groups (CCGs) – Durham Dales, Easington and Sedgefield; North Durham; and Darlington – to map out the current services.

That exposed glaring inconsistencies in diabetes care. “It was almost a postcode lottery,” says Dr Mada. “There were some places where the service was good and some where it wasn’t.”

An unprecedented working group was established. It comprised representatives of the Diabetes Clinical Team; specialists from three North-East foundation trusts (County Durham and Darlington, North Tees and Hartlepool, and City Hospitals Sunderland); GPs leading in diabetes for practices in the area’s three CCGs; and non-clinicians covering areas such as finance, data, project management and public health.

Diabetes systems manager Gemma Handley, who manages the initiative on behalf of all the partners, says: “The formation of that working group was an achievement in itself but what was even more remarkable was that they came up with a consensus on the way forward.

“There was agreement that we couldn’t continue the way we were. We needed something radical to deliver high quality services in the future.”

The model began being rolled out in 2016. Durham Dales, Easington and Sedgefield CCG went first, followed by North Durham from April 2017, and Darlington from October.

There are seven localities and each is allocated either a named consultant or a GP with special interest in diabetes, along with a specialist nurse. Those specialists work with practice nurses, delivering regular clinics and building their knowledge.

“This is the real USP – where the learning, upskilling and mentoring is taking place, resulting in improved patient care,” says Gemma.

Although the initiative is still in its early stages, the benefits are already clear:

Improved patient satisfaction, with greater convenience and reduced waiting times; Reduced variations in the quality of care; Fewer diabetes-related hospital admissions; Better control of blood glucose levels; Patient records kept at GP practices and, therefore, more accessible.

“Because patients are seen closer to home, we are picking up high-risk patients quicker,” says Debbie Calland. “It's so innovative, we’re seeing an increase in applications from diabetes specialist nurses, wanting to be part of it."

Gemma adds: “Patients who were reluctant to attend hospitals are more likely to come to their own GP practice so there's much more engagement. We are bringing the expertise to the patients."

Sedgefield GP Winny Jose agrees: “The key is that the new model has brought us all together to work collaboratively. The new integrated service ensures patients receive individualised care, there is better care planning with specialist input and our patients are at the centre of decision making.”

Dr Patrick Ojechi, a GP in North Durham, adds: “I'm very optimistic that this would be the future for other chronic disease management in the community.”

Diabetes may be growing in the North-East – but so is the region's reputation for dealing with it.