Primary care - resources
Here are links to evidence-based resources which support this area of practice. You may also want to refer to information about the national service frameworks and strategies across the UK.
Some of the resources listed below are in PDF format - see how to access PDF files.
Guidelines and guidance
Department of Health: Long term conditions
This area of the Department of Health is for generic policy and resources as opposed to disease specific. The introduction to the section explains that there is no definitive list of long term conditions and states that there are around 15 million people in England with at least one long term condition with numbers expected to increase, in particular those with two or more conditions.
Department of Health: Personal health budgets
Personal health budgets are intended to enable people to have more choice and control over the health services and care they receive and allow for greater flexibility. "At the heart of a personal health budget is a care plan, the agreement between the primary care trust and the individual that sets out the person’s health needs, the amount of money available to meet those needs and how this money will be spent". This section of the DH website brings together news and information about personal health budgets such as the pilot programme.
Department of Health (2010) Patient leaflet on personalised care planning
A leaflet which explains to patients with long term conditions what they should expect from personalised care planning and their care plan.
Department of Health (2009) Your health, your way - a guide to long term conditions and self care
The core aims of Your health, your way are to empower and support people with long term conditions to understand their own needs and be able to make an informed choice about the self care support they wish to access from the resources available.
Department of Health (2006) Care planning in diabetes: report from the joint Department of Health and Diabetes UK Care Planning Working Group
A report containing guidance on the care planning process for diabetes services, building on standard three of the Diabetes National Service Framework (NSF). It explains the principles and processes of care planning, reviews the evidence base, and offers guidance on putting it into practice.
Department of Health (2006) Caring for people with long term conditions: an education framework for community matrons and case managers - education framework
A framework for commissioners and providers of education and training for community matrons and case managers. It is designed to help ensure education and training for practitioners enables them to provide more effective care for people with complex long term conditions.
Department of Health (2006) Supporting people with long term conditions to self care: a guide to developing local strategies and good practice
A comprehensive self care guide which sets out to help local organisations develop local strategies to deliver self care support for people with long term conditions.
Department of Health (2006) Supporting self care - a practical option: Diagnostic, monitoring and assistive tools, devices, technologies and equipment to support self care
This report and summary report provides a review of research on tools, devices and technologies to support self care.
Department of Health (2005) Supporting people with long term conditions: an NHS and Social Care Model to support local innovation and integration
The NHS and social care model is a blueprint to support local NHS and social care organisations in improving local services for people with long term conditions. Existing successes and innovations from the NHS and social care and international experience are drawn upon to help local health communities to develop a more integrated and systematic approach.
Diabetes UK (2003) care recommendation: patient-held records
Diabetes UK believes all records, and particularly those which are held by patients, should be adapted for different areas to take account of local needs and priorities. Diabetes UK has produced this guidance and a template for a patient held record.
NHS Diabetes: Commissioning
This commissioning resource describes eight practical steps to help with carrying out the key commissioning tasks. It is intended to be used along side the relevant care area – see NHS Diabetes commissioning guides.
NHS Diabetes: Year of Care
The Year of Care programme set out to learn how routine care can be redesigned and commissioned to provide a personalised approach for people with long term conditions. This section of the NHS Diabetes website describes the Year of Care programme and its background, and presents the findings from the programme. This includes guidance on care planning and the training necessary to make this work effectively. The importance of commitment to care planning throughout an organisation is emphasised.
Royal College of Nursing (2006) Telephone advice lines for people with long term conditions: guidance for nursing practitioners (PDF 293.1KB)
Produced by the RCN Rheumatology Forum, this guidance supports practitioners who provide telephone advice. It outlines important steps in developing high quality, sustainable and cost-effective telephone services, working with the local community and patient organisations.
Systematic reviews and evidence summaries
Cochrane Review: Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings
Different systems have been proposed to manage diabetes care. This review investigates the effects of different interventions, targeted at health professionals or the structure in which they deliver care, on the management of patients with diabetes in primary care, outpatient and community settings.
Cochrane Review: Systems for routine surveillance for people with diabetes mellitus
There is wide variation in the extent of general practice involvement in diabetes care. To assess the effects of involving primary care professionals in the routine review and surveillance for complications of people with established diabetes mellitus compared with secondary care specialist follow up.
PRODIGY
PRODIGY, which was formerly Clinical Knowledge Summaries (CKS), aims to be a reliable source of evidence-based information and practical 'know how' about the common conditions managed in primary and first-contact care. It is aimed at general practice and nurses working in primary care. There are sections on type 1 diabetes and type 2 diabetes.
University of Birmingham: Quality and innovation in service provision (2006) Improving care for people with long term conditions: a review of UK and international frameworks
This report was produced for the NHS Institute for Innovation and Improvement. It describes some of the key frameworks used to conceptualise chronic care and summarises evidence about the effects of these frameworks.
Other resources
Chronic conditions management demonstrators: Diabetes intermediate care project
The purpose of the diabetes based work of the national demonstrator at Cardiff is to develop a proposal to move a proportion of secondary care based diabetes out patient clinics into the community. The work is also looking into the realignment of services into the community and ensure appropriate access for the population, a reduced reliance on secondary care services, and deliver a model for community based diabetes management for different communities.
Department of Health (2005) Self care support: a compendium of practical examples across the whole system of health and social care
This document sets out to draw together evidence from service models in the UK and elsewhere, together with published articles and reports, to consider how self care support models might be more widely transferred and used.
Diabetes UK (2008) Minding the gap: the provision of psychological care and support
This reports the findings of the first detailed survey of the availability of psychological care for people with diabetes in the UK. The survey found that 85 per cent of people with diabetes do not have access to specialist psychological services. The report makes recommendations round the development and commissioning of services, skills and training required and the development of appropriate screening tools and guidelines.
Healthcare for London: Long-term conditions
The Healthcare for London programme was established by the capital's 31 primary care trusts (PCTs) to transform healthcare services. Diabetes was selected as the focus of the first long-term conditions project because of the major impact this illness has on individuals and local communities. The project aims to dramatically improve access to high quality diabetes care for all Londoners and to reduce health inequalities in the capital using a new model of care developed for all London's PCTs and providers.
NHS Diabetes: Factsheets
Factsheets published by NHS Diabetes bring together the most important facts and information on a selected subject. They can also take the form of a summary of key points from a report, helping to condense the most relevant information.
Primary Care Diabetes Society
The Primary Care Diabetes Society supports primary care professionals in the delivery of high quality clinically effective care, in order to improve the lives of people living with diabetes.
RCN: eHealth: Telehealth and telecare
Telecare is increasingly being used in diabetes care. This section of the RCN eHealth resource provides general information about telehealth and telecare and their potential benefits and impact. There is also a learning area within the RCN learning Zone for practitioners who are looking at the potential for and implementation of telehealth - see Telehealth explained [you will need to access this with your RCN membership number].
Yorkshire and Humber Public Health Observatory: Diabetes
The Yorkshire and Humber Public Health Observatory is the lead Public Health Observatory in diabetes. The website includes a simple guide to the PBS Diabetes Population Prevalence Model. This model allows strategic health authorities and primary care trusts to develop robust systems for identifying people with diabetes in their area, and promote more effective diabetes care.
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