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Empowering PCNs to achieve 100% diabetes QOF targets and maximise revenue

First Contact Dietitians Empowering PCNs to achieve 100% diabetes QOF targets and maximise revenue 

Alistair Kumi – First Contact Dietitian in Diabetes 

Emmer Green Surgery, Primary Care Dietitians 

Fundamental insights and opportunities 

  • A diabetes dietitian with practitioner capabilities can bring vast value to service provision 

  • QOF fulfilment is a key area for dietetic utility 

  • Patient trust and enhanced experience are keys to patient retention and lasting health improvement  

The Role 

I work as a First Contact Dietitian (FCD) within diabetes in one practice. 

  • First contact Dietitian – “diagnostic clinician working in Primary Care at the top of their clinical scope of practice at Masters level to assess and manage undifferentiated and undiagnosed presentations” 

  • Since qualifying as an FCD, patients with diabetes are booking in to see me straight from reception and I’m able to support with day-to-day queries such as issuing of correct blood glucose meters, freestyle libre advice, GLP-1 discussions, weight management advice and the list goes on.  

  • Doing this has meant that I’ve been able to take the lead on these queries in practice and feedback to the GPs if I need medication changes authorised, or insulin initiated (as I’m not a prescriber) 

  • If I’m to become a prescriber it would allow the team even more freedom to work with other groups of patients as diabetes requires constant monitoring and review, as does weight management. 

Referral criteria 

- Unspecified / potential diabetes  

- Type 2 diabetes (Newly diagnosed, on oral tablets and insulin) 

- Type 1 diabetes in need of additional carb counting/ care process support 

- Prediabetes (HbA1c 42-47) 

- Hypercholesterolaemia + CVD (for dietary support – complementary to the pharmacist support) 

- Weight management (pre-bariatric surgery) 

- IBS/ undifferentiated gastro presentations with red flags excluded.  

 - Nutrition support (low BMI <20, acute weight loss and disease related malnutrition)  

  • Exclusion: home visits, gestational diabetes and antenatal diabetes (for secondary care) 

PCN priorities for 2024/25 

  1. Continue to work closely with our practice manager and clinical director to identify if there were locally commissioned services that could support what we were doing and prioritise them over ‘pay-to-play services’ 

  1. Established links with Secondary care for optimised endocrinology referrals and virtual MDT clinics 

  1. Streamlined the process of collecting care processes/annual reviews and prioritising those who needed optimising; vigilance with correct coding  

  1. Help the surgery flexibly manage diabetes medication shortages and support the pharmacists with D/C summary changes to diabetes medication. 

  1. Encouraging outbound referral to NDPP – to reduce workload 

  1. Offered a dedicated type 2 diabetes clinic and created a tool to encourage greater 9CP consciousness 

  1. Created a diabetes technology hub within the surgery to get eligible patients with T1DM and T2DM on BD insulin onto Libre quicker – upskilled the GPs and PNs to reduce reliance on secondary care and improve patients quickly 

  1. Insulin and GLP-1 initiation clinics 

Service Aims 

  • Support DSN to lead an innovative primary care diabetes service as a first contact diabetes practitioner 
    - to be the first port of call for all things diabetes (Type 1, Type 2, PreDm) 

  • To advise on medication shortages and advise on strategy for supporting patients  
    - Year of care annual reviews and physical checks 
    - audits and QOF fulfilment for 2024-25 

  • To collaborate with secondary/community care on mutual patients and liaise with consultant and community diabetes nurses for virtual clinics. 

  • To get involved with locally commissioned diabetes services offered in BOB ICB  

Provide ADHOC dietetic support:  

- IBS investigation and first line advice before onward referral 

- weight management support (3 appointments) 5% weight loss  

- nutrition support; queries and monitoring if not yet been referred to community dietitians   

Diabetes QOF Indicators 

 

A screenshot of a computer screen Description automatically generated 

(NHS England. https://www.england.nhs.uk/wp-content/uploads/2024/03/PRN01104-Quality-and-outcomes-framework-guidance-for-2024-25.pdf) 

Our Emmer Green Model – a diabetes team in action 

  • Deputy Practice Manager monitors our data quarterly and coordinates a traffic light system for annual reviews 
    - i.e. Hba1cs of 52 and below can access self-help education whereas 55s and above flagged to see the DSN and myself. Enhancing automation without harming rapport. 

  • Our Care-Coordinator organises our ever-growing caseload and manages our annual recalls and has automated feedback to patients doing well and patients in need of more support 

  • Our Diabetes health care assistant would conduct the ‘part 1’ assessment and interim bloods  

  • Our former diabetes specialist nurse and now our current diabetes specialist nurse would conduct the ‘part 2’ assessment and recommend changes to medication and offer ongoing review until all parameters to target 

  • Our lead diabetes GP would support on prescription changes in weekly MDTs between the DSN and myself and would facilitate outbound referrals and address medical concerns   

  • I review coding and conduct the part 2 review from a cardiorenal metabolic standpoint, recommend medication changes, offer dietary advice and education and lead on liaison with secondary and community care, the ICB and projects for optimising QOF fulfilment.  

Diabetes QOF Outcome 

NHS England provides a large pot of funding to specialist care services and primary care with the aim of incentivising and enhancing services all over the country. 

  • The value of a QOF point for 2024/25 was £220.62 per point achieved, paid to the practice if they’ve signed up! In 2023/24 this was £213.43! 

  • In diabetes QOF there were 17 points available if patients with type 2 diabetes (without moderate frailty) could achieve a Hba1c of 58 or less 

  • Achieving all QOF targets meant that the practice could access almost £15,000 from NHSE to improve services! Which was achieved in the 2022/23 financial year and again in 2023/24!  

Conclusion 

  • A diabetes dietitian with practitioner capabilities can bring vast value to service provision 

  • QOF fulfilment is a key area for dietetic utility 

  • Patient trust and enhanced experience are keys to patient retention and lasting health improvement