Integrated Diabetes Service for Castle Point and Rochford & Southend CCG

Tender description

NHS Castle Point and Rochford CCG & NHS Southend CCG are tendering for an Integrated Diabetes Service (Adult). The Service will provide clinical management of diabetes in adults across south east Essex in line with an agreed model of delivery. The service will be provided to patients with both Type 1 and Type 2 diabetes mellitus. The service will be available to adults, aged 19 years and over, and children diagnosed with Diabetes between the ages of 16-18 years as part of the agreed pathway. The service will also provide planning for the transfer to adult services from 14 years of age in accordance with the agreed Essex Transition Protocol. The Integrated Diabetes Service (Adult) will be provided by a comprehensive diabetes skilled multidisciplinary team. The consultant-led service will include diabetes specialist nurses, dietitians, and podiatrists who will provide individualised care plans to meet the needs of the local diabetic population. This should include diet and lifestyle reviews & advice, podiatric review, blood test results and advice accordingly (HbA1C, Kidney functions, Cholesterol), BP check/advice and medication review and change where appropriate including insulin initiation and follow ups (pumps where appropriate). GPs may refer their diabetic patients for any (or all) of the above elements. Integrated care by its definition requires all professionals involved in a person’s care to work in partnership, including generalists, specialists, other health professionals, social care and support staff, with the person living with diabetes and his/her family at the centre of their care. The provider shall deliver services in accordance with the agreed service model as included in the specifications and will work particularly closely with Primary Care clinicians.The contract term is for 5 years, with yearly KPI reviews for continuation of the contract to the next year up to 5 years.