The diabetes NSF delivery strategy: how to get ahead

It is now more than a month since the diabetes NSF delivery strategy was published and nurses working in diabetes care may well have had some preliminary thoughts about the implications for them. However, as with the standards document, there is a large amount of additional information which is not produced in the paper format but is only available electronically on the NSF website (www.doh.gov.uk/nsf/diabetes). As before, some of this background material makes interesting reading and will probably also be useful for deciding how diabetes nurses should, and can, be involved in developments in diabetes care over the next 10 years.

Local priorities
The results of the consultation exercises on service models and performance indicators are available, as well as illustrative targets for local priorities. These may well serve as a framework for primary care trusts (PCTs) and local implementation teams (LITs) to begin the work of determining their own priorities.

Underpinning programmes
In addition to these documents there are links from the diabetes NSF website to underpinning programmes, which include the diabetes information strategy and workforce issues (Department of Health, 2003). The information strategy considers what information is needed for the general public, people with diabetes themselves (to help them manage their condition), healthcare professionals and others working with people with diabetes; and that needed for quality improvement, performance, management, prevention and health improvement and planning. For example, within this document is more information about patient held records and the audit agenda.

Diabetes is incorporated into the Long Term Conditions Care Group Workforce Teams. These teams are exploring the workforce pressures inherent in delivering improved services in conjunction with different ways of working. You may have read about the project that explores the skills and competencies needed for working with people with diabetes, which is part of this initiative.

Research and development
By far the largest piece of work in the underpinning programmes section, is ‘Research and Development’ (Department of Health, 2002). As the name suggests, the document reviews both current and future research on diabetes, and identifies opportunities for future research. The scope of the research programme is vast, covering topics such as molecular biology, epidemiology and complications of diabetes.

Fortunately, this is a well-organised document and navigating around it is easy. The sections that are most likely to be of immediate interest are the sub-group reports on patient self-management and service organisation and delivery. In both of these reports, current knowledge is  examined and they conclude with recommendations for future work. For example, the issue of group versus individual education is discussed in the patient self-management report. It is acknowledged that group education is likely to be cheaper to deliver but there is a need for further research to determine whether the costs of group education to people with diabetes are greater.

Similarly, the service delivery document identifies the need for research in professional education as there is remarkably little currently published;  apparently there are only 11 hypothesis testing/empirical studies altogether! Other topics in this sub-report include models of care, care of the elderly with diabetes, carers and in-patient management of diabetes. 

One step ahead of the rest
Sue Cradock, in her viewpoint on the NSF delivery strategy (Cradock, 2003), pointed out that PCTs are going to need help to deal with the framework and that opportunities exist for diabetes nurses to contribute to that process. Having a good knowledge of the additional information found on the internet could provide an invaluable advantage for those engaging in such processes.

I anticipate that all of this readily available information should keep you in bedtime reading for some time to come!