QOF

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Newly diagnosed in the preceding 1 April to 31 March aged 17 years and over

Referred for diabetes structured education programme codes (within 9 months of diagnosis)

8Hj0. Referral to diabetes structured education programme
8Hj3. Referral to DAFNE diabetes structured education programme
8Hj4. Referral to DESMOND diabetes structured education programme
8Hj5. Referral to XPERT diabetes structured education programme

Diabetes structured education programme exception codes (Added in the last 12 months)

9OLM. Diabetes structured education programme declined
8IE9. Referral to diabetes education and self management for ongoing and newly diagnosed structured programme declined
8IEa. Referral to DAFNE diabetes structured education programme declined

Diabetes exception reporting codes (Added in the last 12 months)

8I94. Diabetes structured education programme not available
 
9h4.. Exception reporting: diabetes quality indicators
9h41. Excepted from diabetes quality indicators: Patient unsuitable
9h42. Excepted from diabetes quality indicators: Informed dissent
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DM 014.1 Rationale

Diabetes is a progressive long-term medical condition that is predominantly managed by the person with the diabetes and/or their carer as part of their daily life. Accordingly, understanding of diabetes, informed choice of management options and the acquisition of relevant skills for successful self-management play an important role in achieving optimal outcomes. These needs are not always fulfilled by conventional clinical consultations. Structured educational (SE) programmes have been designed not only to improve people’s knowledge and skills, but also to help motivate and sustain people with both type 1 and type 2 diabetes in taking control of their condition and in delivering effective self-management. The indicator requires that SE is offered (preferably through a group education programme) to every person with diabetes and/or their carer from the time of diagnosis, with annual reinforcement and review. An alternative education programme of equal standard may be offered to people unable or unwilling to participate in group education sessions.

The NICE technology appraisal on patient education models and the NICE clinical guideline on type 2 diabetes considered SE models for diabetes to be both clinically and cost-effective. There are a number of SE programmes available for diabetes. Some programmes will be more suitable for type 1 diabetes and others for type 2 diabetes.

The NICE quality standard for diabetes in adults is based on NICE clinical guidelines for diabetes. The NICE quality statement on SE states that ‘People with diabetes and/or their carers receive a structured educational programme that fulfils the nationally agreed criteria from the time of diagnosis, with annual review and access to ongoing education’. The NICE quality standard states that a patient educational programme meets five key criteria laid down by the DH and the Diabetes UK Patient Education Working Group

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• Any programme should be evidence-based and suit the needs of the individual. The programme should have specific aims and learning objectives. It should support the learner plus his or her family and carers in developing attitudes, beliefs, knowledge and skills to self-manage diabetes.

• The programme should have a structured curriculum that is theory-driven, evidence-based and resource-effective, has supporting materials and is written down.

• The programme should be delivered by trained educators who have an understanding of educational theory appropriate to the age and needs of the learners and who are trained and competent to deliver the principles and content of the programme.

• The programme should be quality assured and be reviewed by trained, competent, independent assessors who measure it against criteria that ensure consistency.

• The outcomes from the programme should be regularly audited.

Some practices may be able to deliver SE programmes in-house. These programmes would need to meet the requirements outlined above.

A NICE commissioning guide on patient education programmes for people with type 2 diabetes gives further information on providing services.

This indicator suggests referral to a programme within nine months of entry onto the diabetes register to be appropriate for people with type 1 or type 2 diabetes. A timeframe of nine months for this indicator has been set to take into account the differing expectations for referral into SE programmes from diagnosis for people with type 1 and type 2 diabetes.

DM 014.2 Reporting and verification

See indicator wording for requirement criteria.

Where services are not available locally, practices would be expected to discuss this with the CCG and encourage the commissioning of the relevant services. This may take some time so practices may wish to consider whether it would be appropriate to offer the service in-house, or to services available in different CCGs or neighbouring practices etc.

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Prepared By Jean Keenan