Dr Rob Estelrich, Clinical Lead for Diabetes, explains how the virtual clinic model is radically improving patient care by offering specialist support to GP practices looking after the most complex patients.

New ways of working are helping doctors and practice staff to manage complex patients with Type 2 Diabetes.

Primary Care Networks (PCNs) in Gloucestershire are now able to build on their core services so they can provide more proactive and personalised care to their patient populations. As part of the enhanced Type 2 Diabetes service offer, practices are invited to tap into valuable expertise through virtual clinic support.

Data from a practice is collected, analysed and compared with data across other PCNs. After determining what the issues are for a particular practice, GP teams will be offered a virtual diabetes clinic at either practice or wider PCN level with either one or multiple clinicians where they will recommend ways in which the practice (or PCN) can improve the care it offers.

Rob said: “It’s good working with practices and understanding how their systems work. Different practices have different populations and the help we offer depends on what the needs are.

“By looking at the data we can get a feel for systems and we’re able to work out what the issues are and where efforts should be concentrated.”

A practice team is asked to identify five patients with Type 2 Diabetes with needs that require close management. Once the patients are selected, the information is anonymised and practice staff are able to directly benefit from clinical expertise about how to manage those patients.

As well as linking in with the clinician and getting virtual support, practices are offered a follow up clinic for six months after the initial meeting to review the patients and decide whether the recommendations put in place are having a positive impact. Signing up for the clinics means that remote guidance will be given on a regular basis.

When people who have Type 2 Diabetes are invited for their annual review, practice teams will look at nine areas to make an assessment about the patient. These nine areas of interest or ‘care processes’ include: blood glucose testing, blood pressure measurement, cholesterol screening, foot examination, eye screening and a smoking review.

Practices are given treatment targets they must meet based on the first three areas.

“We have had good feedback from practices saying it’s helpful to have a conversation, pick someone’s brains and get things in place to improve patient care,” said Rob.

“Some of the key areas for practices where they need help include encouraging patients to engage, medication and diagnostics.

“Expertise is really valuable when we use it to make sure the patient is at the centre of everything we do.

“Sharing learning in this way may seem like a very fundamental and obvious thing to do, but sometimes you need to put a structure in place to make things happen.

“It then becomes easier to adopt a different approach and try something new”.

Rob attributes the success of the clinics in part to the dynamism of the Diabetes Clinical Programme Group (CPG) which is the driving force behind such innovation.

He said: “Our CPG is dynamic. In Gloucestershire it’s small and bespoke including primary and secondary care as well as representatives from the Voluntary Community Social Enterprise (VCSE) sector working in a really integrated way.

“It’s a partnership where we are achieving a lot for patients and I think it’s fair to describe us as ‘ahead of the game’ in terms of diabetes care.”