Patients will be able to access NHS England’s flagship diabetes prevention programme remotely when it moves into the next phase.
NHS England said this comes as patients under 65 years of age have lower take-up when referred to the programme, which they linked to the inability to attend the 13 required face-to-face sessions due to work commitments.
The scheme, launched in 2016, targets patients at the non-diabetic hyperglycaemia (NDH) – or ‘pre-diabetes’ – stage, offering a lifestyle intervention to stop them developing type-2 diabetes.
Digital provision is one of a number of amendements to the scheme, as NHS England moves to re-launch it for a new three-year period from 2019/20.
Speaking at the Best Practice conference, NHS England’s GP advisor for the programme Dr Chirag Bakhai said that there have been 270,000 referrals to the scheme so far, and 115,000 initial assessments.
But because there is a time delay between referral and assessment, the programme is seeing an uptake rate of ‘around 60%’, with more than half of starters completing the programme.
He said: ‘The programme is doing better than expected.’
Dr Bakhai further said more programme participants are female than male, at a ratio of 45% to 55%, which ‘could be better’, as men are more prone to the condition. However he added this was better than what is typically seen for commercial weight loss programmes.
He also said: ‘People over 65 are more likely to attend… and that is probably because it is more difficult to attend if you are of working age… If you can’t take time off work then going to 13 face-to-face sessions could be difficult, so that is something we are working on.’
‘The current framework we are using expires in March next year. A new service spec has come out and imminently we are going to be doing the re-procurement.’
He said that the programme has ‘a few areas where we think we could be doing better’ and added that NHS England has ’looked at who can really benefit from a digital option’ and is ‘doing digital pilots right now to get more of the evidence base’.
‘We particularly think working-age people, for whom going to face-to-face sessions is difficult, might benefit from the digital provision. Also some of the demographics from the more deprived populations and our black/Asian minority ethnic groups who tend to have NDH younger, could benefit… We should be getting some evidence [from our pilots] early next year,’ he said.
Dr Bakhai added that the reason for digital being offered only after face-to-face is declined is ‘because we are still developing the evidence base’.
He said: ‘For now, the way digital will be placed in the DPP pathway is someone will be offered face to face first, and if they turn it down, or they can’t attend, then they will be offered digital, because there is nothing to lose there if they are not going to be attending face to face.’
Another key difference in the next phase will be targeted funding towards areas with the highest prevalence.
Dr Bakhai said capacity on the programme had initially been allocated based on ‘who had infrastructure’ to support it, ‘but actually now that we have nationwide coverage it makes a lot of sense to move to something more needs-based’.
He said: ‘So we are now going to be moving to allocations based on diabetes prevalence from QOF data and also demographic stuff, so on deprivation and proportion of the population who are from minority ethnic groups. So basically giving the allocation based on need.’
He said this would mean some areas would have fewer places on the programme than they have currently. But he added there was a chance capacity could be expanded, as the DPP has put in a request for more funding from the NHS’s long-term plan, which is currently being negotiated with the Government.
It comes as an evaluation of the programme, published in March, said patients who have attended have lost an average of 3.3kg in weight, which NHS England said was ‘equivalent to nearly 15 double cheese burgers’.
The scheme, launched in 2016, was designed to delay or stop the onset of diabetes by providing lifestyle interventions such as education on health, advice on weight loss and healthy eating, and physical exercise programmes.
This comes as NICE published eight new QOF indicators today, which it says will help GPs ‘personalise’ care for frail diabetes patients.
