Health care professional roles
Estimates vary but the prevalence of diabetes is likely to increase dramatically. Services are already under considerable strain, making the need to explore options for coping with future demands and sustaining the quality of services an urgent one.
What is not in doubt is the role of primary care to provide more routine care for people with diabetes so hospitals can concentrate on specialist care. In England the NHS Next Stage Review (Department of Health 2008b) continued the emphasis on bringing care closer to home.
The review also proposed the introduction of personal budgets for patients with long-term conditions adding to the challenges of developing the appropriate skill mix and competences to support self care. Personal health budgets have also been promoted in the White Paper ‘Equity and excellence: Liberating the NHS’ as part of a policy to give greater choice and control to patients (Department of Health 2010). A programme testing use of these budgets is now underway and further information is available in a section of the Department of Health’s website dedicated to personal health budgets. The imperative is to allow people with diabetes to receive continuity of care closer to home as they take on self management tasks.
Diabetes networks formed by all of the stakeholders within a diabetes community can provide a structure for service planning and delivery and promote seamless care. In Scotland, managed clinical networks (MCNs) which are linked groups of health professionals and organisations from primary, secondary and tertiary care are well established, providing better integrated and more patient-focussed care as well as challenges and opportunities in new ways of working.
Specific to diabetes care the Diabetes Workforce Executive Group (2007) produced a workforce strategy for services in England. The key policy driver is the NSF for diabetes. The aim is to recruit and retain high quality staff supported by quality assured training and education in order to deliver integrated services which are based both on robust local needs assessments and the input of people with diabetes.
The Diabetes Specialist Nurse (DSN) has a particularly important role to play. The RCN has provided guidance on roles, qualifications and ways of working in the provision of specialist nursing services for children and young people with diabetes (Royal College of Nursing 2006). Specialist nurses are valued by patients and the care and support they offer can do much to prevent episodes of hospitalisation (Royal College of Nursing 2010a). Data provided by the health care intelligence company CHKS for the Nursing Times indicate increasing recognition of and confidence in the contribution of specialist nurses. This is summarised in the commentary from Nursing Times ‘Powerful evidence’ of growing role of specialist nurses revealed. Yet an audit of Diabetes Specialist Nurses undertaken by Diabetes UK in 2010 has revealed over 200 DSN positions are unfilled and this is double the figure reported in the 2009 audit. Further details of the audit published in May 2011 are on the Diabetes UK website at ‘False economy’ as 200 frontline diabetes specialist nurses go in NHS cost-cutting.
The emphasis is on competence based workforce planning and Skills for Health has developed a suite of competences linked to the NHS Knowledge and Skills Framework (KSF), which include assessment and diagnosis of diabetes, initial and ongoing management and care planning for children, young people and adults (Skills for Health 2006). A competency framework developed by Trend – UK (Training, Research and Education for Nurses in Diabetes) is now in its third edition. Updated to reflect additional skills and areas of practice the framework also highlights the increasing variety of nursing roles involved in the delivery of diabetes care – see An integrated career and competency framework for diabetes nursing 3rd edition.
References
Full details of the bracketed citations in the text above and, in many cases, links to the actual documents are available in the reference list within this resource. Go to the reference list.
Resources
The resources section describes and links to key evidence which may be in the form of guidelines and guidance or systematic reviews and summaries of evidence. Go to resources.