East Anglia Eye Screening Service update
We welcomed Nadine Rash, Deputy Programme Manager, East Anglia Diabetic Eye Screening Programme to give an update on their services.
The main eye screening service was suspended mid-march to mid-July, the only exceptions being high risk and pregnant patients. Since the service resumed they have seen patients with mild eye disease, and are now working on screening those with background retinopathy. Next will be patients who did not attend eye screening appointments and patients with no disease. They expect to catch up in 18-24 months. All GPs have been told they can refer patients, and patients can refer themselves by calling 01284 848418. You are recommended to do this if your blood glucose has risen, you have a change in your treatment regime, or if you have general eyesight concerns.
Each hub can now see 25 patients per day, still less than the 35-50 patients pre-covid. In addition, some of their venues are still closed. Local screening is back at Brownfields Community Centre in Chesterton.
They are searching for new screening centre sites. They are taking over some office space at Vision Park in Histon, so eye screening will be very local for us starting in the New Year! They also have a large lorry-based mobile screening centre that will offer screening at one of the Cambridge Park & Ride sites.
If you have eye problems, see your GP, optician or, in case of emergencies, A&E as usual.
A copy of Nadine’s presentation can be downloaded here:
RESIT research trial – volunteers needed
Next up was Marsha Brierley, Research Assistant, Sedentary Behaviour, Health and Disease Research Group, Brunel University London. The RESIT study focuses on the dangers of sitting too much and is aimed at those with diabetes. Excessive sitting time is associated with higher incidences of chronic disease and premature mortality. Even if you take the recommended exercise each day you could still be sitting over 13 hours/day. Brunel are trialing an intervention which will include 4 health coaching sessions, phone or computer apps, a wearable device and an on-line education programme.
It’s a 6 month programme starting in January 2021, and volunteers will be randomly assigned to the intervention or control groups. Both groups will have data collection calls at the start, at 3 and 6 months, which will include an online questionnaire, Zoom call, some basic tests and measurements and wearing an activity monitor for 8 days. Participants are still required so if you are interested please contact Marsha at Marsha.Brierley@brunel.ac.uk or via the web site at www.tinyurl.com/RESIT-information .
You can download a copy of Marsha’s presentation below:
Local diabetes initiatives
Mike then spoke about developments to improve diabetes care going on within the county. He attended a recent on-line Cambridge and Peterborough Clinical Commissioning Group’s (CCG) Diabetes Patients Forum. In addition he was invited to join a recent Diabetes & Obesity Clinical Community meeting. Both meetings were chaired by Dr Jessica Randall-Carrick who is driving forward much of what follows.
A database system ECLIPSE allows the CCG to monitor the performance of GP surgeries, clinics etc. and compare them to national averages. Rankings for the CCG are above the national average, but there is a clear north/south split, with control of diabetes poorer in the Fens.
There are 43,300+ patients with diabetes on the system, and 2,000 have an HbA1c greater than 100, which is very high. There are metrics for diabetes care given as 3 and 8 core tests. 28% of patients had the 8 core tests in the past 12 months, bearing in mind this was during the pandemic. 21% had the 3 core tests – blood glucose, blood pressure and cholesterol – within range, therefore showing good management.
In the county during the pandemic there have been around 5,000 excess heart attacks, which they believe is due to people being less activite and not presenting at GPs or A&E.
There are many CCG initiatives which I’ve attempted to summarise in the table above, that relate to general public health as well as specifically to diabetes.
For prevention of diabetes they are backing the NHS Healthier You campaign. GPs are asked to write to patients potentially at risk of diabetes referring them to the programme. You can also self-refer after checking your own risk using the Diabetes UK “Know your risk” tool at https://riskscore.diabetes.org.uk .
Details of the programme can be found here https://www.stopdiabetes.co.uk. The programme consists of 13 group education sessions (currently remote video during the pandemic) and also a digital programme (on-line) that you can use at any time, and designed for those who work variable shifts.
For getting T2 diabetes patients into remission, they are at the moment mainly working on an education programme for clinicians “Ambitions for Remissions” emphasising that remission is possible and advocating low carb diets – reduce starches, not just sugars in diets. Doctors are lucky to get 3 lectures on nutrition in 6 years at medical school. They are running low-carb seminars for staff and commissioning a video, possibly with Dr David Unwin. The county bid, but failed, to be part of the NHS England low calorie (soups & shakes) diet trial now taking place, so plan to start their own diet trial, but this is likely to be rolled out in the Fens first rather than around Cambridge.
Incidentally NHS England believe the remission code on your medical record that we have previously discussed should only be used for reference, and should not remove you from the need for continuing checks for blood glucose levels, retinopathy, etc.
For the recently diagnosed they are starting to trial a health training programme as a supplement to sending patients away with some pills, telling them to lose some weight and sending them on a DESMOND course. This consists of 6 x 30 minute behavioural change appointments, personalised support, goals etc.
For care it is now possible for GP staff to set up a Video Conference referral (VCR) so they can discuss complex cases with a specialist team. This removes the need for patients to endure a long wait for a hospital referral – they are treated at the surgery – and it improves the knowledge of the surgery staff too.
The CCG are also setting up care improvement trials at Ely. Type 1 patients with significant care gaps and who are unable to visit the surgery will be able to get video appointments with their GP surgery. For Type 2 to support prevention of diabetes and increase remission rates they are working with Diabetes UK to set up peer groups (like ours).
On the public health side, the CCG in connection with the NHS has set up “BMI can do it”, a web site – with content covering exercise, healthy eating and sleeping – aimed initially at those with T2 diabetes and a high BMI. They are hoping to capture BMI of patients via local practices and also setting up campaigns – for instance they distributed 10,000 of the Diabetes UK “15 health checks” leaflets via pharmacies who popped the leaflets in with prescriptions. The web site can be found at www.bmicandoit.co.uk .bb
Working with a consortium of Cambridge City and District councils, and contractor Everyone Health, an Integrated Lifestyle Service “Healthy You” has been rolled out. This is an improved continuation of services we are familiar with, covering prevention of obesity, healthy eating, exercise, adult weight management, stop smoking services, falls prevention and NHS health checks.