Table 3

Overview of selected long-term condition services*

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ConditionDiabetesDementiaDiabetesStrokeDiabetesDementia
CommunityCalderdaleSomersetWirral
FocusDeveloping a strategic plan for diabetes services that enables a more modern, general practice-based model of careImproving dementia services to enable community-based health and social care, as part of a local strategic alliance between commissioners and providersBuilding a new model of diabetes care focused on shifting services away from acute provision towards a nurse-led and community-based serviceDeveloping an Early Supported Discharge Service for Stroke, involving relocating care from hospital or community hospital settings to people's own homesBuilding an effective recall and review service for diabetic podiatry, enabling routine foot screening to take place in general practiceDevelopment of a Memory Assessment Service focused on earlier intervention, extended voluntary support and enhanced capacity to meet predicted need
DriversExtended waiting lists combined with a desire to develop a new model of diabetes careLow levels of diagnosis, duplication of assessment by providers, and over-use of hospital beds by dementia patientsNeed to address rising diabetes prevalence and build capacity to address this; also to reduce inequalities in access to services and clinical outcomesNeed to decrease the length of stay in hospital, to meet targets for time spent on specialist wardsComplaints from clinicians and service users, combined with commissioners’ concerns about the existing model of careIncrease service capacity and accessibility in the light of predicted need, and address high levels of emergency admissions for people with dementia
Start date201020102009200920082007
Progress (during study period)Limited staff support at the PCT meant that there were no significant changes to the main provision of diabetic services in primary or secondary careTwo stakeholder planning workshops leading to three priorities, one of which emerged as a local pilot project (to develop integrated care for people with dementia)Service launched in April 2010 following 3 years of groundwork. Commissioners worked at strategic and operational levels to implement new models of careRegional directive provided impetus to establish service from March 2011, with commissioners providing management support and working closely with providers on design and implementationWork under way to put an electronic system in place within the community provider, and avoid the service falling through gaps between providersService launched in October 2010 by local mental health trust. Commissioners worked collaboratively, grounding work in detailed assessment, design and review
OutlookPromising signs emerged as clinical commissioners sought to prioritise the redesign of diabetes services in late 2011There was no change to contracts for dementia care, although further work in the area may prompt developments in the futureShift to nurse-led care achieved, but progress has not been as rapid as hoped for, with some clinical measures improving but others being addressedThe service has struggled to meet its target of 40% of stroke patients, despite the significant commissioning effort expendedLimited time and resources meant that commissioners found it hard to focus on planning for this serviceThree-year service specification in place, with regular review of capacity and finances, and plans to commission for specific outcomes in the future
  • *Detailed descriptions of each of the long-term condition services included within the study can be found in the final research report.13