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At the 4-Front: A forum for today’s diabetes nurse leaders and a springboard for the leaders of tomorrow

Celebrating 10 years of At the 4-Front and its initiatives to enhance the education and training of those UK diabetes nurses widely acknowledged to be leaders and visionaries in their fields.

At the 4-Front is an annual conference established in 2010 to enhance the education and training of those UK diabetes nurses widely acknowledged to be leaders and visionaries in their fields, whether clinical, education or management-oriented. Despite the existence of several nursing groups and conferences at the time (each one aimed at different segments of the diabetes nursing populous), there was no forum that focused exclusively on the training and developmental challenges faced by nurse leaders.

In order to attract an appropriate audience, a mission statement was distributed across the country and diabetes nurses were invited to apply if they felt they met the following criteria for a diabetes nurse leader:

“Experienced, well respected senior diabetes nurses who are innovative and an inspiration and motivation to others. They have a vision to transform the boundaries of diabetes care and have an impact on diabetes services. Through evaluation and clinical expertise they continually develop services. They can see what is happening and what needs to happen, and then, through inspiring others, make it happen.”

Once accepted, every successful candidate was subsequently asked to put forward colleagues who they felt might both add value to the forum and gain benefit through active participation. Since initiation, the At the 4-Front conference has proved highly successful, with an analysis in October 2018 concluding that 99.3% of sampled delegates would change their practice as a direct result of attending the event (Bannister et al, 2019a). This was a retrospective analysis of anonymised delegate feedback forms captured between 2010 and 2018.

The At the 4-Front steering group, responsible for all programme concepts and content, is comprised of founding members Mags Bannister, Nurse Consultant in Bradford; Helen Rogers, Consultant Nurse in London; Julie Brake, Nurse Consultant in Liverpool; Sian Bodman, Diabetes Lead Nurse in South Wales; and Nicola Milne, Community Diabetes Specialist Nurse in Manchester.

As well as their highly successful annual conference, in recent years the group has also pioneered the At the 4-Front Diabetes Nursing Academy, an innovative education course aimed at those nurses who aspire to be leaders but who, as yet, have not fulfilled all aspects of the leadership criteria outlined previously. Revolving around face-to-face meetings and also incorporating aspects of distance learning, the programme is organised by Mags Bannister and Julie Brake, and addresses a diverse range of skills and challenges: clinical, management, research, presentations and writing for publication.

As an example of its success so far, a small anonymised survey of 10 “graduates” of the Academy showed that every one of them had authored at least one paper since completing the course, with two of them authoring three or more (Bannister et al, 2019b).

Now celebrating 10 years since being established, At the 4-Front continues to go from strength to strength. If you are interested in joining the group or applying to join the Academy, please do get in touch by emailing, and we will provide more information.


The At the 4-Front: Leadership in Diabetes Nursing activities, including the main Cohort programme, Academy and Faculty meetings, have been sponsored by Napp Pharmaceuticals Limited.

Napp Pharmaceuticals Limited have had no input into the agenda or content of the 2019 programme.

Case study: My journey with
At the 4-Front
Nicola Milne, Community Diabetes Specialist Nurse, Manchester
I applied to join the At the 4-Front Academy in the autumn of 2014. At that time, my role was as a practice nurse with a special interest in diabetes, working very much “at the coalface”. I had many proven innovations to improve diabetes care and education for primary healthcare professionals, but I was struggling to find ways to share my learning.

The sessions relating to research/audit, writing for publications and developing presentation skills were particularly pertinent to me during my time in the Academy, giving me that desired ability to share my experience. I have since authored over 15 publications and delivered presentations at both national and international conferences.

The clinical knowledge sessions have always been topical, and to a very high standard. Time is always given for reflection on knowledge gained and for discussion on how practice can be enhanced; my journey home always sees me with a head full of ideas and renewed enthusiasm.

In terms of leadership skills developed, until two years ago these were more relevant to my roles locally in relation to healthcare professional education and within various national committees, including The Primary Care Diabetes Society, and in being the first practice nurse to be Chair of the Diabetes UK Professional Conference Organising Committee (for the 2019 conference, in Liverpool).

My main daytime role was often working in silo, so the sessions pertaining to writing business plans and looking at staff retention had not been the highest on my list of priorities. However, In April 2018, I found myself in a new role as a Community Diabetes Specialist Nurse with the remit of establishing a community team in Central Manchester. The project has been a two-year pilot with the need to demonstrate its value for continuation after only the first 14 months, so there was a clear necessity to be able to “hit the ground running”! Out came my notes from the relevant Academy sessions and out went numerous emails to my mentors and other colleagues I had met through the Academy who had set up similar services. Their response and support has been invaluable, most especially in sharing both positive and negative experiences so that pitfalls may be avoided, best practice delivered and the future of the community service secured.

Joining the At the 4-Front Academy has been a highly valuable learning experience, including within areas I had thought might be less relevant. For me, and anecdotally for others within my cohort, such excellent tuition, networking opportunities and ongoing support from inspirational diabetes nurse leaders has ensured that our leadership awareness, knowledge, competence and confidence has blossomed. I now look forward to my continuing role within At the 4-Front, as a faculty member, in being able to offer others the same opportunities I am so very grateful to have had.


Bannister M, Brake J, Bodman S et al (2019a) How effective is the “At the 4-Front” conference in educating nurse leaders? A retrospective survey review. Diabet Med 36(Suppl 1): 34–82 (Abstract P269)

Bannister M, Brake J, Bodman S et al (2019b) How effective is the “At the 4-Front Academy” in developing future nurse leaders? A survey-based analysis. Diabet Med 36(Suppl 1): 34–82 (Abstract P268)

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