Clinical leadership team

Super Six model of care

Can diabetes care be improved by choosing carefully which patients need to be seen by specialists and delegating the rest to community based services with enhanced skills? The results are in for the Super Six scheme in Portsmouth, which was designed to do just this, and they are very encouraging, says Partha Kar, consultant at Portsmouth Hospital NHS Trust.

The scheme was launched in 2010, with six categories of care allocated to specialists—antenatal, foot, renal, insulin pumps, type 1 and adolescent diabetes, and inpatient diabetes. These were chosen because the need for specialist input was beyond dispute, because of the interdisciplinary nature of the condition, or because the low numbers of cases that would be seen in each practice would limit skills. Patients requiring other types of care were discharged from specialist to primary care.

Waiting for outcome measures was, says Kar, “like waiting for the exam results—but we were all pleasantly surprised.” Hospital admissions were down for diabetic ketoacidosis and hyperglycaemic conditions, heart attack and stroke rates were down by 22%, and major amputations by 39%. Patient satisfaction rates averaged 9.5 (out of a possible 10), and patients were unanimous in wanting to continue the service. Kar estimates that the service is saving the local health economy around £1.9m (€2.4m; $2.7m) a year.

“A number of places are now adopting our model,” says Kar. Examples he cites include Southampton, Leicester, Camden, Gateshead, and Liverpool. “NHS England has been very supportive. The model ticks all the boxes, politically speaking—keeping people out of hospital, saving money. That’s why it has drawn a lot of attention. But the real …