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NHS chiefs urged to rethink flagship diabetes prevention scheme to boost uptake

Health chiefs are being urged to rethink the flagship national diabetes prevention programme to increase numbers taking part in the scheme, amid concerns about uptake.

Pulse has learned that NHS England is looking at alternative ways to boost uptake of the programme - such as offering digital apps or online programmes - as official figures reveal that only a fifth of people that GPs have referred to the programme to date have even agreed to take part.

Meanwhile one area due to roll the out scheme next month still has no lifestyle programmes in place for GPs to refer to.

It comes after GP academics involved in the national scheme said more needed to be done to engage at-risk groups to help them to stick to the diet and exercise classes, based on results from their trailblazing prevention scheme.

Their study showed the programme run in Leicester failed to prevent at-risk people from going on to develop diabetes - and concluded this was largely down to not enough at-risk people sticking to the programme.

The Leicester study looked at a prevention programme that, like the national scheme, involved GPs identifying patients with raised glucose levels but not overt diabetes, and referring them to a programme of locally run diet and exercise classes.

An evaluation of the scheme recently published in a National Institutes of Health Research journal showed that after three years, there was no difference in the incidence of diabetes between patients who were referred and those who did not participate in the programme.

But the researchers found that among the third of people who stuck out the initial programme and also attended the complete course including follow-up refresher sessions there was a highly significant 88% reduction in the incidence of diabetes.

Co-investigator Professor Kamlesh Khunti, professor of primary care at the University of Leicester and a member of the steering committee of the national diabetes prevention programme, told Pulse that the ‘lesson here for the national programme is, we haven’t thought through how we keep people who attend the programme retained'.

Professor Khunti added: 'There isn’t much happening in terms of engagement and getting people through, and this is an area of intense research – how can we keep people going on the programme? A lot of this is keeping them engaged through regular feedback, regular texting that sort of thing.’

He said said this research included trying out the digital programmes to make the programme more accessible for people.

NHS England is currently testing out the approach – under the tag ‘digital DPP’ – in eleven areas. This includes in four areas covering central and West London where the online approach will be re-offered to people who previously declined to attend an initial consultation, along with four areas where digital education will be offered as an alternative to the in-person programme and three where this approach is being tried out on its own.

Dr Khunti explained: ‘We may need to tailor our programmes – for example, not everyone wants to come to face-to-face sessions, but once they have been to one face-to-face, maybe they can get online programmes.’

It comes as official figures reveal that only a fifth of people that GPs have referred to the programme at the Wave 1 sites rolling out the scheme this year have even agreed to take part.

Latest national figures from NHS England to the end of December indicated that out of a total of 18,737 referrals on to the national programme this year, just 4,413 - 23% - took up the offer. And figures seen by Pulse from one of the first seven 'demonstrator' regions for the national scheme revealed that by the end of January this year only 12% of people initially contacted by GPs ended up on of the programmes.

NHS England responded that the national programme has seen a rise in uptake in the past month since the official December figures were released, and that the scheme had already reached the numbers expected in terms of referrals for this year.

The national scheme is in the process of rolling out to a further 20 sites across England but it emerged that one - Gloucestershire - has yet to find a provider for the lifestyle programme. NHS England said in a bulletin that 'the contract for Gloucestershire will be retendered once the outcome for other Year 2 sites is known - allowing the possibility of the establishment of economies of scale by providers - following the receipt of no bids for this site'.

Professor Jonathan Valabhji, national clinical director for diabetes and obesity at NHS England, said: 'The Healthier You NHS Diabetes Prevention Programme is based on the best evidence from RCTs and pragmatic trials carried out in real world settings, and our intervention is significantly more intense than that delivered in the Leicester trial.

'What the Leicester trial did show is the importance of duration of patient participation, which is precisely why providers of our new Healthier You Programme are paid on that basis.'

National diabetes prevention scheme falters 

Under the national programme run by NHS England and Public Health England (PHE), GPs are being encouraged to target people with ‘non-diabetic dysglycaemia’ who are at high risk for diabetes and refer them to intensive lifestyle change programmes, involving group activities like cookery and Zumba classes.

The scheme launched last year at seven pilot - or ‘demonstrator’ - sites and rolled out to a further 20 sites this year, with a view to reaching 20,000 at-risk people in 2016/17 with further expansion planned to reach 100,000 per year by 2020.

The programme has come under criticism from some GP experts for potentially over-exaggerating the potential benefits of intensive lifestyle intervention in ‘real world’ patients, who may be less able or motivated to take up exercise and change their diet than trial participants.

Evidence to date has suggested the impact has been limited with uptake disappointing in demonstrator sites for the programme - although some have pointed to the role of GPs, with uptake of up to 60% in places where GPs were highly proactive in chasing people.  

But latest figures from the first wave of 20 sites rolling out the programme this year show that only around one in five people that GPs had identified (4,413 out of 18,737 referred) taken up the offer of the lifestyle intervention classes.

 

Readers' comments (8)

  • It's too difficult to refer. We had a list of 200 motivated mobile patients good to go in April 2016. First no referral form, then no local service, and now we are told we need to go back to each one and get their written permission to refer them! Too many obstructions. A £5 fee per referral would have helped

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  • My mum enrolled for the scheme but along with nearly everyone else she spoke to on the course is giving up as it was so poor

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  • I think the system should stop messing around with the edges and take more decisive action. Any new T2DM with a BMI 30 should be offered immediate bariatric surgery (they obviously do not have to accept it).

    It is both effective and likely to be cost effective (considering the price of care for DM).

    The only issues preventing it are:
    - The upfront investment required
    - The political cost as government has spent years making obese people the bad guy.

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  • Any new T2DM with a BMI of 30 should be told to go away and lose 3 stones. We simply cannot afford Nanny state measures any more.The public has to accept the consequences of its lifestyle choices.Why on Earth should the taxpayer fund expensive and possibly risky surgery for patients who refuse to acknowledge the folly of their dietary excess?

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  • It is very annoying for Professors when they find out that people don't behave in ways they are supposed to. Most people who are overweight are either genetically programmed to be that way or are fat and happy. This idea that the state should be poking its nose into peoples affairs in this way ( justified by very dubious health economics) is part of the newly discovered authoritarian liberalism and is thankfully being rolled by by the likes of Donald Trump.

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  • What a surprise! I wonder how many GPs and patients were involved in the design of this program? There are simpler, cheaper and easier ways to achieve better results.

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  • Is this what has been sold to the Saudis,they will want a refund!

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  • this perfectly backs up every GPs realisation that about one in five newly suspected type 2 diabetics will do the dramatic weight loss and exercise and cure themselves. the rest for whatever reason aren't able to do this; and efforts to galvanise them won't have much effect. Is there not a risk of 'moral hazard' whereby they know they don't have to do anything because there are lots of keen diabetes experts keen to ameliorate every symptom they get offering everything from cialis daily to bariatric surgery. Just look at the rising proportion of the NHS budget devoted to type 2 diabetes....

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