Living Well with Diabetes
in Bradford
A partnership between Bradford Districts, Bradford City, Airedale, Wharfedale and
Craven Clinical Commissioning Groups (CCGs) and RNIB to help GP practices to
improve self management of diabetes.
Diabetes is the leading cause of preventable
sight loss amongst the working age
population. Effective self management of
diabetes is essential to reducing the risk
of sight loss, amputations, heart attacks,
stroke and kidney failure.
Our research highlighted that:
• diabetes is a complex condition for
people to understand and manage
• people struggle with all of the
information, all the health care
appointments, the targets and results
• people are often in denial about the
condition, they don’t understand
prevention and have a sense of fatalism
• people are often confused about the
need for both an eye examination
and screening.
Health professionals often feel:
• overwhelmed with diabetes: snowed
under, on a treadmill
• frustrated their patients don’t seem to
take responsibility for their condition
• helpless, especially with little time
to see patients and when there are
particular challenges like patients
not speaking English
• co-ordinating and sharing information
amongst professionals is challenging
and does not always happen.
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All patients living with diabetes
in participating practices were
offered a Living Well with Diabetes
self‑management folder. It can help
facilitate a coaching conversation,
enabling professionals to use
a motivational interviewing
approach with patients. It can
also help patients develop a
sense of ownership, help organise
appointments and information.
Patients are living with diabetes
8,760 hours a year with on average
only 4 hours of support from
health professionals.
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Feedback
from health
professionals
What worked well
“Talking through the ‘results’ page with
people, I realised that people don’t
understand the difference between ‘hypo’
and ‘hyper’ so then they take the wrong
action to try to put it right.” Practice Nurse
“Going through people’s medication with
them in order to enter it into the folder
showed me how little people know about
the medicines they take.” GP
“I have a 67-year-old male patient. He was
overweight, drinking too much, lots of
social activities. He is an intelligent man.
Going through the folder he realised that
he wasn’t doing as well as he thought.
He lost weight and is back in control
without more medication. The folder
motivated him; it helped him to focus
and remember.” Practice Nurse
“The folder helps the different carers to
see what is happening.” Practice Nurse
“A mum who has a son with learning
disabilities living independently finds it
useful to keep track of which appointments
he has been to.” Practice Nurse
The challenges
“The folders are initially received pretty well
by patients but they don’t tend to keep up
with them and the action planning is still
being driven by the health professional
rather than the patient.” Practice Nurse
“I am snowed under with work. This,
together with the time constraints of the
appointment, mean more often than not
I only have time to give the folder out and
do not have time to do the motivational
interviewing part to try and support and
encourage the patient to change their
behaviour.” Practice Nurse
“New patients only get a 15 minute
appointment which is not sufficient time to
introduce the folder and start goal setting.”
Practice Nurse
“Patients believe what is said in the
community and not what their healthcare
professional is saying.” Practice Nurse
Evaluation
In addition to conversations with staff,
RNIB evaluated the project by asking GPs
to provide data for patients given the folder
including: cholesterol, blood pressure,
HbA1c. The aim was 20 newly diagnosed
patients and 20 patients struggling to
manage their diabetes from each practice.
Twelve months later practices were asked to
provide post-intervention data. In addition
patients were asked to complete
a self management questionnaire.
Number of GP practices involved in the project:
35
22
10
3
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signed up for
the project:
fully
participated
partly
participated
did not start
the project
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Data was provided for 182 existing
patients at baseline and 145 newly
diagnosed patients. But post-intervention
data was provided for only 41 existing
patients and 37 newly diagnosed patients.
The picture from the results was mixed,
although some promising findings were
recorded demonstrating improvements
in blood pressure and cholesterol among
existing patients and improvements in
cholesterol and HbA1c among newly
diagnosed patients. However, the small
sample size means that results cannot
be generalised.
The Living Well with Diabetes folder was
developed as part of a Department of
Health funded project which trialled a
series of interventions to increase
uptake of eye care services amongst
people with diabetes. This project took
a whole systems approach and had very
positive results. Attendance at Diabetic
Retinopathy Screening increased between
10%-15% depending on the interventions
received. Knowledge about how to
manage diabetes improved. There was
a 15% increase in understanding of the
need to attend both eye examinations
and Diabetic Retinopathy Screening and a
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23% increase in understanding about the
need to check blood sugars and attend
appointments to reduce complications
from diabetes.
For more information:
www.rnib.org.uk/living-well-with-diabetes
Elaine Appelbee has led this work in
Bradford on behalf of RNIB:
“Although the original research was carried
out with the Pakistani heritage community
all the professionals involved recognised
there were strong similarities with the
understanding and behaviour of people
from other communities; that class and
education levels have more of impact than
ethnicity alone.”
Greg Fell, Consultant in Public Health has
been a champion of this work. He says:
“We’ve found a way of implementing self
care that actually makes sense to the
people who have the condition.”
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The way forward
The value of this work has been recognised
nationally having won the prestigious
Quality in Care Diabetes 2015 award for
best initiative supporting self-care.
Using motivational interviewing with the
folder can help patients take responsibility
for managing their diabetes. It can
help health professionals provide the
support patients want and need. It is a
mass intervention that involves using
existing resources differently to have
a greater impact.
What is needed to make it work?
• Time for health professionals to work with
patients – 15 minutes is not long enough
for someone who is newly diagnosed
with diabetes. Investing time to help
patients manage their diabetes will save
time and resources in the near future.
• Encouraging patients to stay motivated
to use their folder – send a text
reminding them to bring their folder, put
a display up about the folders in the
surgery.
• Consider tailoring the folder to the
needs of particular communities, for
family and
friends
health
professionals
example an insert around managing
diabetes during Ramadan.
A whole practice approach to use the
folder and motivational interviewing –
battling alone to introduce the folder is
demoralizing and unproductive. Use the
folder alongside other initiatives such as
the Diabetes Year of Care.
Training for staff on motivational
interviewing is essential. The online
e-learning module is a start and open
to all primary care staff in Bradford and
Airedale. If you haven’t received or are
struggling to access the Living Well with
Diabetes e-learning module contact
[email protected]
A whole community approach is needed.
Diabetic Retinopathy Screening staff,
podiatrists and optometrists can all make
use of the folder. The wider community,
family, friends, religious leaders can all
be encouraged to understand health
promotion and share consistent messages
about living well with diabetes.
If you would like copies of the folder
contact [email protected]
No one can tackle diabetes
alone. It needs individuals,
health professionals, friends,
family and the wider society
and community to work
together to tackle diabetes.
wider society
and community
© 2015 RNIB
Registered charity number 226227 (England and Wales) and SC039316 (Scotland)
Isle of Man – RNIB Charity registered charity number 1173
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