Diabetes Integrated Pathway - Southern Derbyshire Clinical Commissioning Group

Tender description

The overarching aim of the integrated service is to coordinate, promote, embed and provide, via a single point of access, a holistic care pathway that has self-care, preventative care and medical care as the key components to improve the overall quality of life for patients and carers affected by diabetes. This approach shall encompass the whole pathway from prevention through to highly specialist care to streamline services. It shall empower individuals to make informed choices about their health by changing from a traditional medical model to one that is integrative and holistic that not only deals with symptom management but also addresses the root causes of the condition and associated problems. The service shall be delivered in the community setting across Southern Derbyshire CCG. Through the provision of the service, the lead provider shall ensure that an integrated approach to the management of diabetes is embedded across Southern Derbyshire with all health professionals working in partnership to ensure that patients are seen by the right person, at the right time according to their needs. Commissioners are looking for a partnership and collaborative approach to the service provided to cover diabetes related dietetics, podiatry and specialist nursing activity for Southern Derbyshire CCG, which includes Derby City. Additional core functions to the service will be medical and psychological care. The lead integrated service provider shall ensure that the following specific service elements are provided: - Integrated, multidisciplinary diabetes community support - Single point of access - Combined clinics in primary care - Health professional education - Case finding - Self-management - Patient education - Psychological Support - Dietetics - Podiatry - Pre-conception care - Culturally appropriate care - Peer and social support - Triage of outpatient referrals - Admission avoidancance - Self-management