Commissioning Guide for Diabetes and Eye Services… · diabetes and eye care † A high level...
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Commissioning for Diabetes and Eye Services Supporting, Improving, Caring July 2011
Transcript of Commissioning Guide for Diabetes and Eye Services… · diabetes and eye care † A high level...
Commissioningfor Diabetes and
Eye Services
Supporting, Improving, Caring
July 2011
NHS Diabetes Information Reader Box
Review date 2013
Commissioning Diabetes and Eyes Services
NHS Diabetes would like to thank the following for their advice and contribution to the development ofthis commissioning guide:
Peter Scanlon Consultant Ophthalmologist/Programme Director, English National ScreeningProgramme for Diabetic Retinopathy
Fionna O’Leary National Programme and Quality Assurance Manager, English National ScreeningProgramme for Diabetic Retinopathy
Esther Provins National Informatics Lead, English National Screening Programme for DiabeticRetinopathy
Clare Bailey Consultant Ophthalmologist/ Chair of the Quality Assurance Group , EnglishNational Screening Programme for Diabetic Retinopathy
John Sparrow Consultant Ophthalmologist, Connecting for Health, National Clinical Lead forOphthalmology
Sue Cohen National Quality Assurance Director, English National Screening Programme forDiabetic Retinopathy
Thomas Wilson Director of Contracting and Performance, NHS Thameside and Glossop
Bridget Turner Diabetes UK
And to Thoreya Swage who wrote this publication
3
Page
Commissioning for Diabetes and Eyes Services 5
Features of Diabetes and Eyes Services 6
Diabetes and Eyes Intervention Map 8
Contracting Framework for Diabetes and Eyes Services 10
Template Service Specification for Diabetes and Eyes Services 23
Contents
5
Commissioning for Diabetesand Eye Services The NHS Diabetes commissioning approach helps to deliver high quality integrated care through a three-stepprocess that ensures key elements needed to build an excellent diabetes service are in place. The approach issupported by a wide range of proven tools, resources and examples of shared learning.
Step 1 – involves understanding the local diabetespopulation health needs by developing a local HealthNeeds Assessment and setting up a steering groupwith key stakeholder involvement including a leadclinician, lead commissioner, lead diabetes nurse andlead service user
Step 2 – involves the development of a servicespecification to describe the model of care to becommissioned. This becomes the document on whichtenders may be issued.
Step 3 – involves monitoring the delivery of theservice specification by the provider and evaluating theperformance of the service. Input from the steeringgroup with service user representation will be animportant mechanism for monitoring the service aswell as patient surveys.
This commissioning guide has been developed by NHSDiabetes with key stakeholders including clinical andsocial services professionals, the English NationalScreening Programme
for Diabetic Retinopathy and patient groupsrepresented by Diabetes UK.
It is not designed to replace the Standard NHSContracts as many of the legal and contractualrequirements have already been identified in this setof documents. Rather, it is intended to form the basisof a discussion or development of diabetes and eyeservices between commissioners and providers fromwhich a contract for services can then be agreed.
This commissioning guide consists of:
• A description of the key features of high qualitydiabetes and eye care
• A high level intervention map. This intervention mapdescribes the key high level actions or interventions(both clinical and administrative) diabetes and eyeservices should undertake in order to provide themost efficient and effective care, from admission todischarge (or death) from the service.
It is not intended to be a care pathway or clinicalprotocol, rather it describes how a true ‘diabeteswithout walls’1 service should operate going acrossthe current sectors of health care.
The intervention map may describe current servicemodels or it may describe what should ideally beprovided by diabetes and eye services.
• A diabetes and eye services contracting frameworkthat brings together all the key standards of qualityand policy relating to diabetes and eye care
• A template service specification for diabetes andeye services that forms part of schedule 2 part 1 ,orsection 1 (module B) of the Standard NHS Contractcovering the key headings required of aspecification. It is recommended that thecommissioner checks which mandatory headingsare required for each type of care as specified bythe Standard NHS Contracts.
Commissioners are referred to the English NationalScreening Programme for Diabetic Retinopathy fordetails on how to commission diabetic retinopathyscreening services – seewww.retinalscreening.nhs.uk/commissioning
For further detail on how to approach thecommissioning of diabetes services please seehttp://www.diabetes.nhs.uk/commissioning_resource
Step 2
Step 3
• Understanding your diabetes population health needs
• Implementing improved services and evaluation
• Understanding what you need to commission for an integrated service
Step 1
1 Commissioning Diabetes Without Walls , 2011, http://www.diabetes.nhs.uk/commissioning_resource/
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High quality diabetes and eye services shouldhave:
• systems to manage the call and recall of peoplewith diabetes who require regular retinopathyscreening
• a process to screen for diabetic eye disease,e.g. retinopathy, maculopathy and cataracts
• a process to screen for diabetic eye disease forpregnant women with diabetes, includingthose with gestational diabetes
• a specialist service to treat diabetic eye disease
• regular monitoring of people with diabeteswho have had retinopathy identified.
In addition, the services should:
• be developed in a co-ordinated way, taking fullaccount of the responsibilities of otheragencies in providing comprehensive care andplacing users at the centre of decisions abouttheir care and support - "no decision about mewithout me" (Equity and Excellence: Liberatingthe NHSi).
• be commissioned jointly by health and socialcare based on a joint health needs assessmentwhich meets the specific needs of the localpopulation, using a holistic approach asdescribed by the generic model for themanagement of long term conditionsii
• provide effective and safe care to people withdiabetes in a range of settings including the
patient’s home, in accordance with the NICEQuality Standards for Diabetesiii
• deliver the outcomes for diabetes asdetermined by the NHS Outcomes Frameworkiv
• take into account the emotional, psychologicaland mental wellbeing of the patientv
• take into account race and inequalities withrespect to access to care
• ensure that services are responsive andaccessible to people with Learning Disabilitiesvi
• have effective clinical networks with clearclinical leadership across the boundaries of carewhich clearly identify the role andresponsibilities of each member of the diabeteshealthcare team
• ensure that there are a wide range of optionsavailable to people with diabetes to supportself management and individual preferences
• take into account services provided by socialcare and the voluntary sector
• provide patient/carer/family education ondiabetes not only at diagnosis but also duringcontinuing management at every stage of care
• provide education on diabetes management toother staff and organisations that supportpeople with diabetes
• have a workforce that has the appropriatetraining, updating, skills and competencies inthe management of people with diabetes
Features of Diabetes and Eye Services
i Available on the DH website athttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353
ii Available on the DH website at http://www.dh.gov.uk/en/Healthcare/Longtermconditions/DH_120915
iii Quality Standards: Diabetes in adults, http://www.nice.org.uk/guidance/qualitystandards/qualitystandards.jsp
iv Available on the DH website athttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122944
v Emotional and Psychological Support and Care in Diabetes, Joint Diabetes UK and NHS Diabetes Emotional and Psychological SupportWorking Group, February 2010, http://www.diabetes.nhs.uk/our_work_areas/emotional_and_psychological/
vi http://www.diabetes.nhs.uk/commissioning_resource/
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• provide multidisciplinary care that manages thetransition between children and adult servicesand adult and older peoples’ services
• have integrated information systems thatrecord individual needs including emotional,social, educational, economic and biomedicalinformation which permit multidisciplinary careacross service boundaries and support careplanningvii
• produce information on the outcomes ofdiabetes care including contributing to nationaldata collections and audits
• have adequate governance arrangements, e.g.local mortality and morbidity meetings ondiabetes care to learn from errors and improvepatient safety
• take account of patient experience, includingPatient Reported Outcomes Measures, in thedevelopment and monitoring of servicedeliveryviii
• actively monitor the uptake of services,responding to non
vii http://www.diabetes.nhs.uk/year_of_care/it/
viii http://www.ic.nhs.uk/proms
8
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Diabetes and eyes intervention map
9
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10
IntroductionThis contracting framework sets out what is requiredof clinically safe and effective services that areproviding eye care for people with diabetes. Theframework is designed to be read in conjunction withthe high level patient intervention map, whichdescribes the interventions and actions required alongthe patient pathway as well as entry and exit pointsand the standard service specification template fordiabetes and eyes services.
Commissioners are also referred to guidance on‘Commissioning Systematic Diabetic RetinopathyScreening’ published by the English NationalScreening Programme for Diabetic Retinopathyfor further details on commissioning retinopathyscreening services1.
The framework brings together the key quality areasand standards that have been identified by NHSDiabetes, Diabetes UK, the English National ScreeningProgramme for Diabetic Retinopathy, the RoyalColleges and other related organisations.
The principles that establish a safepathway for patient care Establishing the principles that underpin the systemsand processes of pathways for patient care leads tomore efficient patient throughput and can reduce risk
of fragmentation of care and serious untowardincidents. The principles operate at four layers withina patient pathway:
• commissioning
• clinical Case Direction or the overall Care Plan (i.e. the management of an individual patient)
• provision of the clinical service or process
• organisational platform on which the clinical serviceor process sits (the provider organisation)
A straightforward or simple pathway is one in whichthe overall management, including both clinical casedirection and the delivery of the clinical processes,conventionally sits within one organisation. However, with a more complex pathway, there is adanger that fracturing the overall managementpathway into components carried out by differentclinical teams and organisations will requireduplication of effort leading to inefficiency andincreased risk at handover points.This can bemanaged by establishing clear governancearrangements for all the layers in the pathway.
In addition, Commissioning Bodies must balance thebenefits of fracturing the pathway against increasedcomplexity and ensure that the increased risks are mitigated.
The governance arrangements required for all threelayers and the commissioner responsibilities areshown below:
Contracting Framework for Diabetesand Eye Services
11
In essence, at each level, there are governancearrangements to ensure sound and safe systems ofdelivery of patient care with clear lines ofaccountability between each level.
The diabetes and eye services. The key principle of good diabetes and eye care isto provide a high quality service that is reliable interms of delivery and timely access for patientsrequiring that care.
Diabetes eye care is provided by a number ofdifferent teams in the primary, community andacute settings. It is essential that there is co-ordination of care of the patients through the careplanning process and a consultant ophthalmologistretains the clinical accountability and responsibilityfor the services. Responsibility for overall patientcare across the whole pathway rests with thepatient’s GP who also retains overall responsibilityto ensure the management of side effects andcomplications.
The initial management and continuing care ofindividuals with diabetes should include anassessment of their emotional and psychologicalwell-being, together with timely access toappropriate psychological and biological/psychiatricinterventions. Mental health disorders can posesignificant barriers to diabetes care and thereforemental health stability is vital for good self care2.
The services themselves will also have clinicaloversight and accountability for governancepurposes.
This contracting framework focuses on peoplewith diabetes, including children, young people,adults and older people, who require screeningand treatment for diabetic eye conditions. Thiscontracting framework should also be read inconjunction with Commissioning SystematicDiabetic Retinopathy Screening1 published by the
English National Screening Programme for DiabeticRetinopathy and the diabetes commissioningguides for children and young people, diagnosisand continuing care, for older people and followthe principles for the effective commissioning ofservices for people with Learning Disabilities 3.
Ensuring qualityCommissioning Bodies should ensure that thediabetes eye services commissioned are of thehighest quality. There may, in addition, be someorganisations that wish to offer their services, but do not have a history of providing such care.
i) For provider organisations already involved inthe delivery of diabetes eye services, thereshould be retrospective evidence of systemsbeing in place, implemented and working.
ii) For organisations new to the arena, thecommissioner should reassure itself that theprovider has the organisational attributes,governance arrangements, systems andprocesses set up to provide the platform for safeand effective delivery of diabetes eye services.
This framework describes what theCommissioning Body needs to ensure ispresent or addressed in its discussions withthe provider organisation.
Under the ‘elements’ column there are crossreferences to the Standard NHS Contract for AcuteServices – bilateral (main clauses and schedules)4.(The cross references also apply to the clauses andschedules in the Standard NHS Contract forCommunity Services). This is to assistcommissioners and providers in having anoverview of how the elements link to the StandardNHS Contract. Some of the areas are open tointerpretation and consequently the references arenot exhaustive.
12
TOPI
CEL
EMEN
TSC
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TIC
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n cl
ause
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rgan
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spu
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itco
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igh
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ervi
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ultu
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open
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eth
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orga
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all i
ts a
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.
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10
An
orga
nisa
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is g
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the
prin
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:
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part
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rule
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tran
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ll fu
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incl
udes
inte
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ansit
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rvic
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Qua
lity
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in th
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A g
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all a
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raisi
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rgan
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miss
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ovid
er a
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Litig
atio
n A
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t rev
iew
the
Clin
ical
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ligen
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r Tru
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ngem
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ther
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rofe
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ndem
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ld h
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ing
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r lin
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f acc
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ty a
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spon
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ty.
The
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ice
is re
quire
d to
com
ply
with
gui
delin
es, p
ublic
hea
lthgu
idan
ce a
nd a
ppra
isals
publ
ished
by
the
Nat
iona
l Ins
titut
e fo
rH
ealth
and
Clin
ical
Exc
elle
nce
that
are
rele
vant
to th
e ca
repr
ovid
ed b
y th
e se
rvic
e 6
13
TOPI
CEL
EMEN
TSC
HA
RA
CTE
RIS
TIC
S, S
KIL
LSA
ND
BEH
AV
IOU
RS
OU
TPU
TSD
IAB
ETES
SER
VIC
ES S
PEC
IFIC
OU
TPU
TS/C
OM
MEN
TS
Gov
erna
nce
Clin
ical
Gov
erna
nce
•co
mpl
aint
s M
anag
emen
t•
patie
nt a
nd P
ublic
Invo
lvem
ent
•pa
tient
dig
nity
and
resp
ect
•eq
ualit
y an
d di
vers
ity•
intr
oduc
ing
new
tech
nolo
gies
and
trea
tmen
ts•
an e
xter
nally
acc
redi
ted
Qua
lity
Ass
uran
cesy
stem
and
inte
rnal
err
or re
port
ing
invo
lvin
g al
l sta
ff g
roup
s.
CG
sys
tem
s sh
ould
hav
e cl
ear a
ndde
mon
stra
ble
links
to o
ther
NH
S sy
stem
sw
ith c
olla
bora
tive
CG
act
iviti
es a
nd s
harin
gof
exp
erie
nce
and
lear
ning
.
Prov
ider
sho
uld
prod
uce
annu
al C
linic
alG
over
nanc
e re
port
s as
par
t of N
HS
CG
repo
rtin
g sy
stem
.
Prov
ider
s ar
e re
quire
d to
agr
eeC
omm
issio
ning
for Q
ualit
y an
d In
nova
tion
sche
mes
(CQ
UIN
) for
dia
bete
s ca
re, e
.g.
mod
el C
QU
IN s
chem
e pr
opos
ed b
y th
e N
HS
Inst
itute
for I
nnov
atio
n an
d Im
prov
emen
t 12
.
In a
dditi
on, t
he s
ervi
ce is
requ
ired
to c
ompl
y w
ith th
e fo
llow
ing:
i. G
uida
nce
publ
ished
by
NIC
E
•M
edic
ines
adh
eren
ce: i
nvol
ving
pat
ient
s in
dec
ision
s ab
out
pres
crib
ed m
edic
ines
and
sup
port
ing
adhe
renc
e 7
•G
lauc
oma:
dia
gnos
is an
d m
anag
emen
t of c
hron
ic o
pen
angl
egl
auco
ma
and
ocul
ar h
yper
tens
ion
8
The
serv
ice
is al
so re
quire
d to
com
ply
with
clin
ical
gui
delin
es fo
rTy
pe 2
Dia
bete
s M
ellit
us p
rodu
ced
by th
e Eu
rope
an D
iabe
tes
Wor
king
Par
ty fo
r Old
er P
eopl
e 9
For r
etin
opat
hy s
cree
ning
: the
ser
vice
s m
ust c
ompl
y w
ith:
•th
e se
rvic
e ob
ject
ives
and
qua
lity
assu
ranc
e st
anda
rds:
Nat
iona
lSc
reen
ing
Prog
ram
me
for D
iabe
tic R
etin
opat
hy 10
•G
uida
nce
on fa
ilsaf
e in
the
diab
etic
retin
opat
hy s
cree
ning
prog
ram
me
11
Clin
ical
qua
lity
Qua
lity
assu
ranc
e
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:4,
4A,1
2,16
,17,
18,
19,2
0,21
, 31,
32,
33, 5
4
Sche
dule
s:
2,3
(par
ts 4
, 4A
,4B,
4C,5
,6)
7,10
,12,
18,
20
Und
erst
andi
ng th
e co
ncep
t of
clin
ical
qua
lity.
Has
con
cern
for q
ualit
y w
hile
wor
king
eff
icie
ntly.
An
unde
rsta
ndin
g of
the
use
ofau
dit,
patie
nt a
nd s
taff
feed
back
to im
prov
e qu
ality
.
An
orga
nisa
tion
that
pro
vide
scl
arity
of o
bjec
tives
and
pro
mot
esre
flect
ive
prac
tice
to im
prov
equ
ality
of p
atie
nt c
are.
Qua
lity
assu
ranc
e sy
stem
s m
ust b
e in
pla
cean
d ap
prov
ed b
y co
mm
issio
ning
bod
y w
ithre
gula
r rep
ortin
g of
out
com
es.
Prov
ider
s ar
e re
quire
d to
pub
lish
qual
ityac
coun
ts fo
r the
pub
lic re
port
ing
of q
ualit
yin
clud
ing,
saf
ety,
exp
erie
nce
and
outc
omes
.
Prov
ider
s sh
ould
par
ticip
ate
in n
atio
nal a
udit
prog
ram
mes
.
Dia
bete
s an
d ey
es s
ervi
ces
mus
t co
mpl
y w
ith t
he p
erfo
rman
cem
easu
res
requ
ired
of N
HS
serv
ices
, i.e
mee
ting:
13
•Re
ferr
al t
o Tr
eatm
ent
wai
ts (9
5th
perc
entil
e m
easu
res)
The
serv
ice
is r
equi
red
to p
artic
ipat
e in
the
fol
low
ing
activ
ities
/pro
gram
mes
:
•N
atio
nal D
iabe
tes
Aud
it 14
•N
atio
nal D
iabe
tes
Inpa
tient
Aud
it of
Acu
te T
rust
s 15
•Pa
tient
Exp
erie
nce
Surv
eys
16
•D
iabe
tes
E 17
•Pa
tient
Rep
orte
d O
utco
mes
Mea
sure
s 18
•A
nnua
l Rep
ort
for
the
Engl
ish
Nat
iona
l Scr
eeni
ngPr
ogra
mm
e fo
r D
iabe
tic R
etin
opat
hy
14
TOPI
CEL
EMEN
TSC
HA
RA
CTE
RIS
TIC
S, S
KIL
LSA
ND
BEH
AV
IOU
RS
OU
TPU
TSD
IAB
ETES
SER
VIC
ES S
PEC
IFIC
OU
TPU
TS/C
OM
MEN
TS
Clin
ical
qua
lity
Wor
kfor
ce/ s
taff
Clin
ical
sta
ff a
ttrib
utes
criti
cal t
o sa
fety
and
qual
ity o
f int
erve
ntio
ns
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
t for
Acu
te S
ervi
ces
Mai
n cl
ause
s:11
,16,
26,3
3, 4
8 ,5
6
The
prov
ider
org
anisa
tion
has
syst
ems
and
proc
edur
es in
pla
ce to
assu
re th
e co
mm
issio
ner t
hat t
heir
clin
ical
team
has
the
nece
ssar
yqu
alifi
catio
ns, s
kills
, kno
wle
dge
and
expe
rienc
e to
del
iver
the
serv
ice.
Staf
f ar
e co
mpe
tent
and
fit
for
purp
ose.
Prov
ider
to
satis
fy c
omm
issi
oner
tha
t al
lst
aff
have
cur
rent
app
rais
al, c
lear
ance
s an
dre
gist
ratio
n ch
ecks
and
hav
e de
mon
stra
ted
com
pete
nce
in a
ll pr
oced
ures
rel
evan
t to
path
way
.
Prov
ider
to
satis
fy c
omm
issi
oner
tha
t th
ey c
an r
ecru
it (o
rpr
ocur
e) a
nd r
etai
n a
com
pete
nt c
linic
al t
eam
to
deliv
er t
hese
rvic
e
Spec
ific
qual
ifica
tions
req
uire
d of
hea
lth p
rofe
ssio
nals
prov
idin
g th
e se
rvic
e ar
e:
•Fo
r op
htha
lmol
ogy
med
ical
pra
ctiti
oner
s: r
egis
trat
ion
with
the
GM
C a
nd e
vide
nce
of f
urth
er q
ualif
icat
ion
inop
htha
lmol
ogy
and
man
agem
ent
of d
iabe
tic e
ye d
isea
se•
Nur
ses:
reg
istr
atio
n w
ith t
he N
MC
and
fur
ther
evi
denc
e of
qual
ifica
tion
in d
iabe
tes
eye
care
or
expe
rienc
e w
ithin
diab
etes
clin
ic 19
•Sc
reen
er/G
rade
rs f
or d
iabe
tic r
etin
opat
hy s
cree
ning
prog
ram
me:
com
ply
with
qua
lific
atio
ns a
s re
quire
d by
the
Engl
ish
Nat
iona
l Scr
eeni
ng P
rogr
amm
e fo
r D
iabe
ticRe
tinop
athy
•O
ptom
etris
ts:
spec
ific
trai
ning
in t
he e
xam
inat
ion
of t
he e
yeus
ing
slit
lam
ps (a
ppro
ved
by t
he Q
ualit
y A
ssur
ance
Com
mitt
ee o
f th
e En
glis
h Sc
reen
ing
Prog
ram
me
for
Dia
betic
Retin
opat
hy)20
Team
s, in
clud
ing
cons
ulta
nt a
nd o
ther
hea
lth c
are
prof
essi
onal
s, t
reat
ing
patie
nts
with
dia
betic
ret
inop
athy
shou
ld d
emon
stra
te e
xper
ienc
e in
the
fie
ld b
y ha
ving
wor
ked
in a
ded
icat
ed m
edic
al r
etin
a or
lase
r cl
inic
for
at
leas
t on
eye
ar. T
hey
shou
ld a
lso
atte
nd r
egul
ar c
ase
dis
cuss
ions
and
clin
ical
aud
it m
eetin
gs. T
his
shou
ld in
clud
e an
ann
ual r
evie
wof
out
com
es a
nd a
dver
se e
vent
s in
the
ann
ual r
epor
t 21
Hea
lthca
re p
rofe
ssio
nals
invo
lved
in d
eliv
erin
g di
abet
es c
are
are
requ
ired
to h
ave
the
rele
vant
com
pete
ncie
s (s
ee S
kills
for
Hea
lth-
Dia
bete
s C
ompe
tenc
ies
for
diab
etic
ret
inop
athy
) 22
15
TOPI
CEL
EMEN
TSC
HA
RA
CTE
RIS
TIC
S, S
KIL
LSA
ND
BEH
AV
IOU
RS
OU
TPU
TSD
IAB
ETES
SER
VIC
ES S
PEC
IFIC
OU
TPU
TS/C
OM
MEN
TS
Clin
ical
qua
lity
Wor
kfor
ce /
staf
f
Dev
elop
men
t
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:11
,16,
19,3
048
The
prov
ider
org
anisa
tion
has
syst
ems
in p
lace
to a
ssur
e th
eco
mm
issio
ner t
hat t
heir
clin
ical
team
is fo
rmal
ly in
duct
ed a
ndre
ceiv
es o
ngoi
ng a
ssist
ance
tode
velo
p th
eir s
kills
, kno
wle
dge
and
expe
rienc
e to
ens
ure
that
they
are
alw
ays
fully
upd
ated
.
Prov
ider
to
satis
fy c
omm
issi
oner
of
thei
rco
mm
itmen
t to
indu
ctio
n an
d C
PD r
elev
ant
to r
oles
.
Prov
ider
to
satis
fy t
he c
omm
issi
oner
of
thei
rco
mm
itmen
t to
tra
in s
taff
to
mee
t fu
ture
serv
ice
need
s.
All
heal
thca
re p
rofe
ssio
nals
shou
ld h
ave
suff
icie
nt s
tudy
leav
eal
loca
tion
(tim
e an
d fin
ance
) to
enab
le th
em to
dev
elop
ski
llsap
prop
riate
ly.
Clin
ical
qua
lity
Regi
stra
tion
and
licen
sing
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:4,
4A,5
,9,1
0,11
,12,
14,1
5,16
17,1
8,19
,21,
26,
27,2
9,33
,34,
35,
3643
,48,
49,5
253
,54,
56,6
0
Sche
dule
s:
2,3,
4,5,
6,8,
10,
12,1
3,15
,17,
19
, 20
The
Prov
ider
is re
quire
d to
be
regi
ster
ed w
ith th
e C
are
Qua
lity
Com
miss
ion
to d
emon
stra
te th
at is
mee
ts th
e es
sent
ial s
tand
ards
of
qual
ity a
nd s
afet
y fo
r the
regu
late
dac
tiviti
es d
eliv
ered
.
The
Prov
ider
is re
quire
d to
be
licen
sed
with
the
NH
S Ec
onom
icRe
gula
tor (
Mon
itor)
in o
rder
topr
ovid
e N
HS
care
.
Com
plia
nce
with
the
Car
e Q
ualit
yC
omm
issi
on a
nd M
onito
r re
quire
men
tsC
ompl
ianc
e w
ith th
e fo
llow
ing
Nat
iona
l Ser
vice
Fra
mew
orks
,w
here
app
licab
le:
•O
lder
Peo
ple’
s N
SF 23
•N
SF fo
r Chi
ldre
n, Y
oung
Peo
ple
and
Mat
erni
ty S
ervi
ces24
Com
plia
nce
with
Car
e Q
ualit
y C
omm
issio
n Re
view
s
Clin
ical
qua
lity
Wor
kfor
ce/ s
taff
Clin
ical
sta
ffco
mpe
tenc
ies
in u
se o
feq
uipm
ent
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:11
, 16,
17,
21,
26,
33
The
prov
ider
org
anisa
tion
has
syst
ems
in p
lace
to a
ssur
e th
eco
mm
issio
ner t
hat t
heir
clin
ical
team
are
com
pete
nt to
use
all
equi
pmen
t nee
ded
to d
eliv
er th
ese
rvic
e.
Prov
ider
to
satis
fy t
he c
omm
issi
oner
tha
t al
lst
aff
have
had
doc
umen
ted
com
pete
nce
asse
ssm
ent
rela
tive
to a
ll eq
uipm
ent
used
inco
ntra
ct.
All
heal
thca
re p
rofe
ssio
nals
invo
lved
in d
eliv
erin
g th
e di
abet
es e
yese
rvic
e ca
re a
re re
quire
d to
hav
e th
e re
leva
nt c
ompe
tenc
ies
inus
ing
appr
opria
te e
quip
men
t, e.
g. u
se o
f slit
lam
ps a
nd la
ser
safe
ty a
sses
smen
t.
16
ELEM
ENTS
CH
AR
AC
TER
ISTI
CS,
SK
ILLS
AN
D B
EHA
VIO
UR
SO
UTP
UTS
DIA
BET
ES S
ERV
ICES
SPE
CIF
IC O
UTP
UTS
/CO
MM
ENTS
Clin
ical
qua
lity
Patie
nt p
athw
ay
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:4,
4A,9
,10,
12,1
4,15
,16,
17, 1
8,19
,20,
21,2
7,29
,32
,33,
34,
35,3
6, 5
4 Sc
hedu
les:
3
(par
ts 1
and
2)
Resp
onsiv
enes
s an
d pa
rtic
ipat
ive
appr
oach
to in
clud
ing
patie
nts’
view
s ab
out t
heir
care
in th
ede
sign
of c
are
path
way
s.
Col
labo
ratio
n w
ith o
ther
orga
nisa
tions
invo
lved
in th
epa
tient
pat
hway
to p
rovi
de a
seam
less
pat
hway
of c
are.
An
esse
ntia
l com
pone
nt o
f the
man
agem
ent o
f a p
erso
n w
ithdi
abet
es is
the
care
of t
he e
yes,
this
invo
lves
:
1. A
sses
smen
t2.
Scr
eeni
ng
3. T
reat
men
t4.
Con
tinui
ng c
are/
follo
w u
p
1. A
sses
smen
t:Ev
eryo
ne w
ith d
iabe
tes
shou
ld h
ave,
as
part
of t
he m
anag
emen
tof
thei
r con
ditio
n, a
n as
sess
men
t of p
ossib
le e
ye d
iseas
e, e
.g.
retin
opat
hy, c
atar
acts
, gla
ucom
a et
c. T
his
shou
ld b
e do
cum
ente
din
the
patie
nt’s
care
pla
n.
2. S
cree
ning
: Th
e sc
reen
ing
path
way
for d
iabe
tic re
tinop
athy
sho
uld
follo
w th
ero
ute
as s
et o
ut in
‘Ser
vice
impl
emen
tatio
n –
Do
once
and
sha
re’:
Dia
betic
Eye
Dise
ase’
27.
All
patie
nts
with
dia
bete
s, fr
om a
ge 1
2 up
war
ds, s
houl
d be
refe
rred
to a
ccre
dite
d re
tinop
athy
scr
eeni
ng p
rogr
amm
es th
atha
ve b
een
set u
p ac
cord
ing
to th
e co
mm
issio
ning
gui
danc
epr
oduc
ed b
y th
e En
glish
Nat
iona
l Scr
eeni
ng P
rogr
amm
e fo
rD
iabe
tic R
etin
opat
hy 1
and
Esse
ntia
l Ele
men
ts in
Dev
elop
ing
aD
iabe
tic R
etin
opat
hy S
cree
ning
Pro
gram
me
28
3. T
reat
men
t 21:
•pa
tient
s re
quiri
ng tr
eatm
ent f
or s
ight
-thr
eate
ning
dia
betic
retin
opat
hy s
houl
d be
trea
ted
by s
ervi
ces
that
hav
e sp
ecifi
cm
edic
al re
tina
/ las
er c
linic
s w
ith a
ppro
pria
tely
trai
ned
staf
f
All
poss
ible
ent
ry a
nd e
xit p
oint
s m
ust b
ede
fined
with
com
preh
ensiv
e pa
tient
pat
hway
sth
at fa
cilit
ate
smoo
th p
assa
ge a
nd e
ffec
tive,
effic
ient
car
e fo
r pat
ient
s.
All
inte
rfac
es in
the
path
way
mus
t be
defin
edso
that
con
tinui
ty o
f clin
ical
car
e is
ensu
red
with
no
frac
turin
g of
the
path
way
.
Ther
e m
ust b
e sp
ecifi
catio
n of
cle
ar ti
mel
ines
and
aler
t mec
hani
sms
for p
oten
tial b
reac
hes.
Ther
e sh
ould
be
audi
t of p
athw
ay to
ens
ure
that
sta
ndar
ds a
re m
et.
Ther
e m
ust b
e ex
plic
it sp
ecifi
catio
n of
pro
vide
ran
d co
mm
issio
ner r
espo
nsib
ilitie
s fo
r the
who
le p
atie
nt e
piso
de fr
om re
gist
ratio
n to
final
disc
harg
e.
Acc
ount
abili
ties
shou
ld b
e ag
reed
and
docu
men
ted
by a
ll st
akeh
olde
rs.
Ther
e ar
e a
num
ber o
f ser
vice
s su
ppor
ting
patie
nts
with
dia
bete
s an
d th
ere
mus
t be
clea
rsu
b-co
ntra
cts
stat
ing
the
refe
rral
crit
eria
and
acce
ss to
thes
e su
ppor
ting
serv
ices
.
At e
ntry
to p
athw
ay:
The
com
miss
ione
r sho
uld
assu
re th
emse
lves
that
the
prov
ider
has
sys
tem
s an
d pr
oces
ses
inpl
ace
to
TOPI
C
Clin
ical
qua
lity
Out
com
es
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:4,
4A,1
0,14
,15,
16,2
1
Sche
dule
:3
(par
t 5),
5 (p
arts
1,2
,3),
12
Com
preh
ensiv
e un
ders
tand
ing
and
com
mitm
ent t
o de
liver
ing
and
impr
ovin
g ou
tcom
es o
f car
e
Com
plia
nce
with
the
NH
S O
utco
mes
Fram
ewor
k25C
ompl
ianc
e w
ith th
e Q
ualit
y St
anda
rds
for D
iabe
tes,
spe
cific
ally
26
17
TOPI
CEL
EMEN
TSC
HA
RA
CTE
RIS
TIC
S, S
KIL
LSA
ND
BEH
AV
IOU
RS
OU
TPU
TSD
IAB
ETES
SER
VIC
ES S
PEC
IFIC
OU
TPU
TS/C
OM
MEN
TS
Clin
ical
qua
lity
Patie
nt p
athw
ayi)
regi
ster
pat
ient
sii)
col
lect
rele
vant
clin
ical
and
adm
inist
rativ
eda
taiii
) man
age
the
appo
intm
ent p
roce
ss,
(reap
poin
tmen
t and
DN
A p
roce
ss, i
fap
prop
riate
)iv
) pro
vide
info
rmat
ion
to p
atie
nts
v) u
nder
take
initi
al a
sses
smen
t in
the
appr
opria
te lo
catio
n
At p
oint
of i
nter
vent
ion:
The
com
miss
ione
r sho
uld
assu
re th
emse
lves
that
the
prov
ider
has
sys
tem
s an
d pr
oces
ses
in p
lace
to e
nsur
e th
at:
i) th
e in
terv
entio
n is
cond
ucte
d sa
fely
and
in a
ccor
danc
e w
ith a
ccep
ted
qual
ityst
anda
rds
and
good
clin
ical
pra
ctic
e.ii)
the
patie
nt re
ceiv
es a
ppro
pria
te c
are
durin
g th
e in
terv
entio
n(s)
, inc
ludi
ng o
ntr
eatm
ent r
evie
w a
nd s
uppo
rt, i
nac
cord
ance
with
bes
t clin
ical
pra
ctic
eiii
) whe
re c
linic
al e
mer
genc
ies
orco
mpl
icat
ions
do
occu
r the
y ar
em
anag
ed in
acc
orda
nce
with
bes
tcl
inic
al p
ract
ice
iv) t
he in
terv
entio
n is
carr
ied
out i
n a
faci
lity
whi
ch p
rovi
des
a sa
fe e
nviro
nmen
t of
care
and
min
imise
s ris
k to
pat
ient
s, s
taff
and
visit
ors
v) th
e in
terv
entio
n is
unde
rtak
en b
y st
aff
with
the
nece
ssar
y qu
alifi
catio
ns, s
kills
,ex
perie
nce
and
com
pete
nce
vi) t
here
are
arr
ange
men
ts fo
r the
man
agem
ent o
f out
of h
ours
car
eac
cord
ing
to b
est c
linic
al p
ract
ice
At e
xit f
rom
pat
hway
: Th
e co
mm
issio
ner s
houl
d as
sure
them
selv
esth
at p
rovi
der h
as s
yste
ms
and
proc
esse
s,w
hich
are
agr
eed
with
all
part
ies
and
netw
orks
, in
plac
e to
:
•it
is de
sirab
le to
per
form
lase
r tre
atm
ent,
if in
dica
ted,
on
the
sam
e da
y of
dia
gnos
is of
the
prob
lem
requ
iring
trea
tmen
t.•
exit
digi
tal p
hoto
grap
hs s
houl
d be
take
n on
disc
harg
e fo
rfu
ture
refe
renc
e.
Thes
e op
htha
lmol
ogy
serv
ices
mus
t hav
e ac
cess
to 21
•flu
ores
cein
ang
iogr
aphy
•op
tical
coh
eren
ce to
mog
raph
y•
low
visi
on a
id s
ervi
ces
•co
unse
lling
(for
sig
ht lo
ss)
4. C
ontin
uing
car
e/fo
llow
up
•th
ere
shou
ld b
e sy
stem
s in
pla
ce to
ens
ure
the
follo
w u
p of
patie
nts
who
hav
e ha
d ey
e tr
eatm
ent a
nd c
ontin
ued
mon
itorin
g of
cha
nges
in th
e ey
es•
disc
harg
e in
form
atio
n sh
ould
be
sent
to:
o th
e re
leva
nt d
iabe
tes
mul
tidisc
iplin
ary
team
for
upda
ting
of th
e pa
tient
’s di
abet
es c
are
plan
o th
e ca
ll/re
call
cent
re o
f the
retin
opat
hy s
cree
ning
prog
ram
me
for u
pdat
ing
of th
e re
tinop
athy
scre
enin
g lis
t
The
retin
opat
hy s
cree
ning
ser
vice
mus
t ens
ure
that
arr
ange
men
tsar
e m
ade
for t
he fo
llow
ing
spec
ial g
roup
s to
hav
e ac
cess
to th
ese
rvic
e 28
:
•pe
ople
in p
rison
s•
the
hous
ebou
nd•
peop
le in
car
e ho
mes
•pe
ople
with
lear
ning
disa
bilit
ies
In a
dditi
on, p
regn
ant w
omen
with
dia
bete
s (in
clud
ing
gest
atio
nal
diab
etes
) sho
uld
have
:29
1. S
cree
ning
for d
iabe
tic re
tinop
athy
in th
e pr
econ
cept
ion
perio
d
2. W
omen
with
type
1 a
nd ty
pe 2
dia
bete
s sh
ould
be
offe
red
two-
field
myd
riatic
dig
ital p
hoto
grap
hy to
Nat
iona
l Sta
ndar
dsat
(or s
oon
afte
r) th
eir f
irst a
nten
atal
clin
ic v
isit a
nd a
gain
at 2
8w
eeks
’ ges
tatio
n.
3. If
bac
kgro
und
diab
etic
retin
opat
hy is
foun
d to
be
pres
ent,
anad
ditio
nal s
cree
n sh
ould
be
perf
orm
ed a
t 16-
20 w
eeks
.
4. If
refe
rabl
e di
abet
ic re
tinop
athy
is fo
und
to b
e pr
esen
t in
early
18
TOPI
CEL
EMEN
TSC
HA
RA
CTE
RIS
TIC
S, S
KIL
LSA
ND
BEH
AV
IOU
RS
OU
TPU
TSD
IAB
ETES
SER
VIC
ES S
PEC
IFIC
OU
TPU
TS/C
OM
MEN
TS
Clin
ical
qua
lity
Patie
nt p
athw
ayi)
unde
rtak
e te
leph
one
tria
geii)
mak
e ur
gent
onw
ard
refe
rral
s w
here
life
-th
reat
enin
g co
nditi
ons
or s
erio
usun
expe
cted
pat
holo
gies
are
disc
over
eddu
ring
an in
terv
entio
n/as
sess
men
tiii
) ens
ure
that
pat
ient
s re
ceiv
e di
scha
rge
info
rmat
ion
rele
vant
to th
eir i
nter
vent
ion
incl
udin
g ar
rang
emen
ts fo
r con
tact
ing
the
prov
ider
and
follo
w u
p if
requ
ired
iv) p
rovi
de ti
mel
y fe
edba
ck to
the
refe
rrer
re in
terv
entio
n, c
ompl
icat
ions
and
prop
osed
follo
w u
pv)
ens
ure
that
the
patie
nt re
ceiv
es re
quire
ddr
ugs/
dres
sings
/aid
svi
) ens
ure
that
sup
port
is in
pla
ce w
ithot
her c
are
agen
cies
as
appr
opria
te
preg
nanc
y, c
aref
ul o
phth
alm
olog
ical
sup
ervi
sion
is re
quire
dde
pend
ing
on th
e le
vel o
f ret
inop
athy
bot
h du
ring
preg
nanc
yan
d fo
r at l
east
6 m
onth
s po
st-p
artu
m.
5. B
ecau
se, l
ike
man
y dr
ugs
that
are
use
d in
pre
gnan
cy,
Trop
icam
ide
is on
ly li
cens
ed fo
r use
in p
regn
ancy
und
er th
edi
rect
ion
of a
regi
ster
ed m
edic
al p
ract
ition
er, c
are
path
way
ssh
ould
be
set u
p in
suc
h a
way
as
to e
nabl
e th
is to
be
unde
rtak
en. W
ritte
n po
licie
s an
d pr
otoc
ols
signe
d of
f by
the
clin
ical
lead
spe
cific
ally
dea
ling
with
the
adm
inist
ratio
n of
eye
drop
s to
pre
gnan
t wom
en s
houl
d al
way
s be
in p
lace
.
The
man
agem
ent o
f a
pers
on w
ith d
iabe
tes
who
is a
dmitt
ed fo
rey
e ca
re s
houl
d fo
llow
the
prin
cipl
es s
et o
ut in
the
emer
genc
y an
din
patie
nt c
omm
issio
ning
gui
de, i
.e.3 .
1. h
ave
acce
ss to
the
mul
tidisc
iplin
ary
diab
etes
team
2. h
ave
adm
issio
n an
d di
scha
rge
care
pla
ns3.
hav
e cl
ose
liaiso
n w
ith th
eir c
are
co-o
rdin
ator
4. T
here
sho
uld
be p
roto
cols
in p
lace
to a
llow
pat
ient
s, w
ho a
reab
le to
do
so, t
o se
lf m
anag
e th
eir d
iabe
tes
med
icat
ion.
Info
rmat
ion
shou
ld b
e pr
ovid
ed to
peo
ple
with
dia
bete
s ab
out
retin
opat
hy s
cree
ning
, not
driv
ing
as w
ell a
s ed
ucat
ion
and
advi
ceab
out d
iabe
tes
man
agem
ent.
Peop
le w
ith d
iabe
tes
shou
ld re
ceiv
e co
pies
of r
esul
ts o
f scr
eeni
ng.
Prov
ider
s sh
ould
ens
ure
acce
ss to
tran
spor
t fac
ilitie
s to
ena
ble
atte
ndan
ce fo
r spe
cial
ist tr
eatm
ent,
as re
quire
d.
Prov
ider
s ar
e re
quire
d to
take
not
e of
the
resu
lts o
f the
Nat
iona
lSu
rvey
of P
eopl
e w
ith D
iabe
tes
30.
Clin
ical
qua
lity
Clin
ical
em
erge
ncy
situa
tions
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:6,
11,1
2,14
,15,
16,1
8,32
,33
,42,
54
Sche
dule
s:
2,12
,20
Abi
lity
to n
egot
iate
and
agr
eear
rang
emen
ts w
ith a
ppro
pria
tepe
rson
nel a
nd o
rgan
isatio
ns to
prov
ide
effe
ctiv
ely
for e
mer
genc
ysit
uatio
ns.
The
com
miss
ione
rs s
houl
d sa
tisfy
them
selv
esth
at p
rovi
der h
as s
yste
ms,
pro
cess
es a
ndco
mpe
tent
per
sonn
el a
re in
pla
ce a
ndim
plem
ente
d to
ens
ure
that
all
clin
ical
emer
genc
ies
and
com
plic
atio
ns a
re h
andl
edin
acc
orda
nce
with
bes
t pra
ctic
e.
Ther
e sh
ould
be
prot
ocol
s in
pla
ce to
ens
ure
the
avai
labi
lity
ofad
vice
and
/or s
uppo
rt o
f spe
cial
ist d
iabe
tes
clin
ical
sta
ff to
man
age
diab
etes
clin
ical
em
erge
ncy
situa
tions
, e.g
. dur
ing
asu
rgic
al p
roce
dure
.
19
TOPI
CEL
EMEN
TSC
HA
RA
CTE
RIS
TIC
S, S
KIL
LSA
ND
BEH
AV
IOU
RS
OU
TPU
TSD
IAB
ETES
SER
VIC
ES S
PEC
IFIC
OU
TPU
TS/C
OM
MEN
TS
Clin
ical
qua
lity
Esta
tes
and
equi
pmen
t
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:5,
29, 3
3, 5
6
Sche
dule
s: 3
,10,
19
Und
erst
andi
ng o
f bui
ldin
gre
gula
tions
.
Acc
ess
to a
dvic
e on
“fit
-for
-pu
rpos
e” e
quip
men
t and
faci
litie
s.
Com
mis
sion
ers
mus
t as
sure
the
mse
lves
tha
tpa
tient
car
e is
del
iver
ed in
app
ropr
iate
lybu
ilt a
nd e
quip
ped
faci
litie
s w
hich
mee
tre
leva
nt H
TMs
and
Build
ing
Not
es, a
nd,
whe
re a
ppro
pria
te, a
re r
egis
tere
d an
d ar
esa
fe a
nd c
lean
.
Equi
pmen
t m
ust
be f
it fo
r pu
rpos
e.
Com
mitm
ent
to e
ffic
ient
use
and
satis
fact
ory
mai
nten
ance
of
equi
pmen
t.
Serv
ices
pro
vidi
ng re
tinop
athy
scr
eeni
ng s
houl
d pr
ocur
e di
gita
lfu
ndus
cam
eras
as
set o
ut in
‘ Es
sent
ial E
lem
ents
in D
evel
opin
g a
Dia
betic
Ret
inop
athy
Scr
eeni
ng P
rogr
amm
e’ 28
.
The
equi
pmen
t to
perf
orm
eye
sur
gery
sho
uld
be p
rocu
red
acco
rdin
g to
the
reco
mm
enda
tions
set
by
the
Roya
l Col
lege
of
Oph
thal
mol
ogist
s 21
.
Clin
ical
qua
lity
Kno
wle
dge
and
unde
rsta
ndin
g of
hea
lthan
d sa
fety
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:5,
11, 1
9, 5
4, 5
6, 6
0
Und
erst
andi
ng o
f clin
ical
acco
unta
bilit
ies
of h
ealth
and
safe
ty p
olic
ies.
Hea
lth &
Saf
ety
stra
tegy
and
pol
icie
s in
plac
e an
d im
plem
ente
d w
ith a
war
enes
sth
roug
hout
the
org
anis
atio
n..
Acc
essi
bilit
y to
exe
cutiv
e re
spon
sibl
e fo
rH
ealth
& S
afet
y fo
r qu
icke
r, fir
st c
onta
ctse
rvic
es.
Hea
lth a
nd s
afet
y po
licie
s as
per
pro
vide
r agr
eem
ent w
ithco
mm
issio
ners
.
Dat
a an
din
form
atio
nm
anag
emen
t
Stra
tegy
and
pol
icie
s
Cro
ss re
fere
nces
to th
eSt
anda
rd N
HS
Con
trac
tfo
r Acu
te S
ervi
ces
Mai
n cl
ause
s:8,
9,17
,19,
21,2
3,24
,27,
29,3
2,33
,54
Sche
dule
s:
5,7,
15,1
6,18
Stra
tegy
and
pol
icy
deve
lopm
ent
skill
s.
The
abili
ty to
ana
lyse
dat
a an
dha
ve a
cces
s to
info
rmat
ion
that
can
pred
ict t
rend
s an
d th
at c
ould
iden
tify
prob
lem
s.
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abili
ty to
cap
ture
evi
denc
e-ba
sed
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tice
from
Ren
ial &
Dia
bete
s N
atio
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ervi
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amew
orks
, NIC
E gu
idan
ce.
The
abili
ty to
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dat
a an
din
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atio
n ap
prop
riate
ly to
impr
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patie
nt c
are.
Tran
spar
ency
and
obj
ectiv
ity.
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prov
ider
sho
uld
have
an
expl
icit
data
and
info
rmat
ion
stra
tegy
in p
lace
tha
tco
vers
.
•ty
pes
of d
ata
•qu
ality
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ta p
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entia
lity
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ty•
tran
spar
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alys
is o
f da
ta a
nd in
form
atio
n•
use
of d
ata
and
info
rmat
ion
•di
ssem
inat
ion
of d
ata
and
info
rmat
ion
•ris
ks•
shar
ing
of d
ata
and
com
patib
ility
of
ITac
ross
diff
eren
t pr
ovid
ers
with
res
pect
to
care
of
patie
nts
acro
ss a
pat
hway
This
info
rmat
ion
shou
ld b
e in
clud
ed in
the
Dat
a Q
ualit
y Im
prov
emen
t Pl
an.
The
prov
ider
is re
quire
d to
hav
e in
form
atio
n sy
stem
s th
at re
cord
indi
vidu
al n
eeds
incl
udin
g em
otio
nal,
soci
al, e
duca
tiona
l,ec
onom
ic a
nd b
iom
edic
al in
form
atio
n w
hich
per
mit
mul
tidisc
iplin
ary
care
acr
oss
serv
ice
boun
darie
s an
d su
ppor
t car
epl
anni
ng 31
.
The
prov
ider
is re
quire
d to
col
lect
spe
cific
dat
a as
set
out
in‘c
omm
issio
ning
sys
tem
atic
dia
betic
retin
opat
hy s
cree
ning
1 .
The
Prov
ider
is re
quire
d to
use
the
follo
win
g fo
r the
col
lect
ion
and
prod
uctio
n of
dat
a, w
here
app
ropr
iate
:
•N
HS
Out
com
es F
ram
ewor
k25
•N
atio
nal D
iabe
tes
Info
rmat
ion
Serv
ice
32
•N
atio
nal D
iabe
tes
Aud
it 14
•D
iabe
tes
E 17
•H
ospi
tal E
piso
de S
tatis
tics33
•Pa
tient
Exp
erie
nce
16,3
0
•Pa
tient
Sat
isfac
tion
30
20
TOPI
CEL
EMEN
TSC
HA
RA
CTE
RIS
TIC
S, S
KIL
LSA
ND
BEH
AV
IOU
RS
OU
TPU
TSD
IAB
ETES
SER
VIC
ES S
PEC
IFIC
OU
TPU
TS/C
OM
MEN
TS
Dat
a an
din
form
atio
nm
anag
emen
t
Stra
tegy
and
pol
icie
sTh
ere
shou
ld b
e po
licie
s in
pla
ce t
hat
incl
ude:
•co
nfid
entia
lity
Cod
e of
Pra
ctic
e•
data
Pro
tect
ion
•fr
eedo
m o
f In
form
atio
n•
heal
th R
ecor
ds•
info
rmat
ion
Gov
erna
nce
Man
agem
ent
•in
form
atio
n Q
ualit
y A
ssur
ance
•in
form
atio
n Se
curit
y
Ther
e m
ust
be a
nam
ed in
divi
dual
who
isth
e C
aldi
cott
Gua
rdia
n.
•Pa
tient
Rep
orte
d O
utco
mes
Mea
sure
s18
•N
atio
nal D
iabe
tes
Con
tinui
ng C
are
Dat
aset
34
•D
iabe
tic R
etin
opat
hy S
cree
ning
Dat
aset
35
21
Source documentsCommissioners and providers should takeresponsibility for making references to the latestversion of the various documents and guidance.
1. English National Screening Programme for DiabeticRetinopathy, Commissioning Systematic DiabeticRetinopathy Screening, October 2007,http://www.retinalscreening.nhs.uk/commissioning
2. NHS Diabetes and Diabetes UK, Emotional andPsychological Support and Care in Diabetes, JointDiabetes UK and NHS Diabetes Emotional andPsychological Support, 2010http://www.diabetes.nhs.uk
3. The NHS Diabetes Commissioning Guides areavailable on the NHS Diabetes website athttp://www.diabetes.nhs.uk/commissioning_resource/
4. Department of Health, Standard NHS Contractshttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_124324
5. National Quality Board, Quality Governance in theNHS, 2011http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_125239.pdf
6. NICE Diabetes guidance,http://guidance.nice.org.uk/Topic/EndocrineNutritionalMetabolic/Diabetes
7. NICE, Medicines adherence: involving patients indecisions about prescribed medicines andsupporting adherence, Jan 2009,http://guidance.nice.org.uk/CG76
8. NICE, Glaucoma: diagnosis and management ofchronic open angle glaucoma and ocularhypertension , http://guidance.nice.org.uk/CG85,2009
9. European Diabetes Working Party for Older People.Clinical Guidelines for Type 2 Diabetes Mellitus,www.instituteofdiabetes.org
10. Service Objectives and Quality AssuranceStandards: National Screening Programme forDiabetic Retinopathy, June 2009http://www.retinalscreening.nhs.uk/standards
11. Guidance on failsafe in the diabetic retinopathyscreening programme, 2008,http://www.retinalscreening.nhs.uk/failsafe
12. NHS Institute for Innovation and Improvement,model CQUIN scheme: inpatient care for peoplewith diabetes, 2009
13. Department of Health, The Operating Frameworkfor the NHS in England 2011/12, 2010,http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122738
14. National Diabetes Audit.www.ic.nhs.uk/services/national-clinical-audit-support-programme-ncasp/diabetes
15. National Diabetes Inpatient Audit,http://www.diabetes.nhs.uk/our_work_areas/inpatient_care/inpatient_audit_2010/
16. The King’s Fund, The point of care. Measures ofpatients’ experience in hospital: purpose, methodsand uses. July 2009
17. DiabetesE - https://www.diabetese.net/
18. Patient Reported Outcomes Measures,http://www.ic.nhs.uk/proms
19. Training, Research and Education for Nurses inDiabetes – UK, An Integrated Career &Competency Framework for Diabetes Nursing(Second Edition), 2010
20. National Screening Programme for DiabeticRetinopathy, Training and Accreditation Standardsfor Slit Lamp Examiners Version 5 - Agreed by theQuality Assurance Committee of the EnglishScreening Programme, February 2008,http://www.retinalscreening.nhs.uk/userFiles/File/Englishslitlampbiovers%20-%20Version%205%202008-10-08%20_2_.pdf
21. The Royal College of Ophthalmologists,Ophthalmic Services Guidance The Delivery ofDiabetic Eye Care Jan 2009http://www.retinalscreening.nhs.ukuserFiles/File/Royal%20College%202009%20-TheDeliveryOfDiabeticEyeCareFeb2009.pdf
22. Skills for Health, Diabetes CompetencyFramework, https://tools.skillsforhealth.org.uk/
23. Department of Health, National Service Frameworkfor Older People, May 2001,http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4003066
22
24. National Service Framework for Children, YoungPeople and Maternity Services, 2004http://www.dh.gov.uk/en/Healthcare/Children/DH_4089111
25. Department of Health, The NHS OutcomesFramework 2011/12, December 2010http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122944
26. NICE, Quality Standards: Diabetes in adults, March2011, http://www.nice.org.uk/guidance/qualitystandards/qualitystandards.jsp
27. English National Screening Programme for DiabeticRetinopathy, ‘Service implementation – Do onceand share’: Diabetic Eye Disease’, June 2006,http://www.doas-ded.org/documents/doas-ded-appendixv1.0.pdf
28. UK National Screening Committee , EssentialElements in Developing a Diabetic RetinopathyScreening Programme, National ScreeningProgramme for Diabetic Retinopathy Workbook4.3, June 2009,http://www.retinalscreening.nhs.uk/workbook
29. Position statement on screening for DiabeticRetinopathy in pregnancy, National ScreeningProgramme for Diabetic Retinopathy, October2008, http://www.retinalscreening.nhs.uk/userFiles/File/FinalrevisedPosition%20statement%20on%20screening%20in%20pregnancy.pdf
30. Healthcare Commission, National Survey of Peoplewith Diabetes, 2006,www.cqc.org.uk/usingcareservices/healthcare/patientsurveys/servicesforpeoplewithdiabetes.cfm
31. York and Humber integrated IT systemhttp://www.diabetes.nhs.uk/
32. National Diabetes Information Service,www.diabetes-ndis.org
33. Hospital Episode Statistics,www.ic.nhs.uk/statistics-and-data-collections/hospital-care/hospital-activity-hospital-episode-statistics--hes
34. National Diabetes Continuing Care Dataset,www.ic.nhs.uk/webfiles/Services/Datasets/Diabetes/dccrdataset.pdf
35. English National Screening Programme for DiabeticRetinopathy, Diabetic Retinopathy ScreeningDataset, 2009,www.retinalscreening.nhs.uk/dataset
23
This specification forms Schedule 2, Part 1, orsection 1 (module B), ‘The Services - ServiceSpecifications’ of the Standard NHS Contractfor Acute Servicesa.
Service specifications are developed in partnershipbetween commissioners and provider agencies andare based on agreed evidence-based care andtreatment models. Specifications should be opento scrutiny and available to all service users/carersas a statement of standards that the user/carer canexpect to receive.
The following documentation, developed bythe Diabetes Commissioning Advisory Groupand the English National ScreeningProgramme for Diabetic Retinopathy providesfurther detail/guidance to support thedevelopment of this specification:
• the diabetes and eye services intervention map
• the contracting framework for diabetes and eyeservices
This specification template assumes that theservices are compliant with the contractingframework for diabetes and eye services.
This template also provides examples of whatcommissioners may wish to consider whendeveloping their own service specifications.
Description of diabetes and eye care:Diabetes eye care includes the assessment,screening, treatment and follow up of people withdiabetes to manage diabetic eye disease. Thisincludes screening for diabetic retionopathy.
The final specification should take intoaccount:
• national, network and local guidance andstandards for diabetes and eye servicesincluding retinopathy screening.
• local needs.
• cross references to the standard servicespecification for retinopathy screeningpublished by the English National ScreeningProgramme for Diabetic Retinopathy atwww.retinalscreening.nhs.uk
This specification is supported by other relatedwork in diabetes commissioning such as:
• the web-based Diabetes Community HealthProfiles (Yorkshire and Humber Public HealthObservatory)
• the web-based Health Needs Assessment Tool(National Diabetes Information Service).
These provide comprehensive information forneeds assessment, planning and monitoring ofdiabetes services.
Introduction• a general overview of the services identifying
why the services are needed, includingbackground to the services and why they arebeing developed or in place.
• a statement on how the services relate to eachother within the whole system should beincluded describing the keystakeholders/relationships which influence theservices, e.g. multi-disciplinary team etc
• any relevant diabetes clinical networks andscreening programmes applicable to theservices, e.g. retinopathy screening
• details of all interdependencies or sub-contractors for any part of the service and anoutline of the purpose of the contract should bestated, including arrangements for clinicalaccountability and responsibility, as appropriate
Standard Service SpecificationTemplate for Diabetes Eye Services
a Standard NHS Contracts http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_124324
24
Purpose, Role and Clientele1. A clear statement on the primary purpose of the
services and details of what will be provided andfor whom:
• who the services are for (e.g. people withdiabetes from age 12 upwards)
• what the services aim to achieve within agiven timeframe
• the objectives of the services
• the desired outcomes and how these aremonitored and measured
Scope of the Services2. What does the service do? This section will
focus on the types of high level therapeuticinterventions that are required for the types ofneed the services will respond to.
• how the services responds to age, culture,disability, and gender sensitive issues
• assessment – details of what it is and co-morbidity assessment and referrals to allrelevant specialties
• service planning – high level view of what theservices are and how they are used; howpatients enter the pathway/journey; what arethe stages undertaken, e.g. retinopathyscreening, diagnosis and continuingmanagement. The aims of service planningare to:
o develop, manage and reviewinterventions along the patient journey
o ensure access to other specialities / care,as appropriate
o ensure that care planning is undertakenby the diabetes multi-disciplinary team(as defined locally) with a clear care co-ordination function
• holistic review of patients in the managementof their diabetes using the principles of anintegrated care model for people with longterm conditions that is patient-centred,including self care and self management,clinical treatment, facilitating independence,psychological support and other social careissues
• risk assessment procedures
• detail of evidence-base of the service – i.e. thecontracting framework for diabetes and eyeservices, guidance produced by the RoyalCollege of Ophthalmologists, English NationalScreening Programme for DiabeticRetinopathy, Diabetes UK, etc
Service Delivery3. Patient Journey/intervention map
Flow diagram of the patient pathway showingaccess and exit/transfer points – see the diabetesand eye services intervention map as a startingpoint. See also the guidance published by theEnglish National Screening Programme forDiabetic Retinopathy(www.retinalscreening.nhs.uk)
4. Treatment protocols/interventionsInclude all individual treatment protocols inplace within the services or planned to be used
5. This will include a breakdown of how thepatient will receive the services and from whom.It should be a clear statement of staffqualifications/experience and/or training (ifappropriate) and clinical or managerialsupervision arrangements. It should specify, asappropriate:
• geographical coverage/boundaries – i.e. theservices should be available for people fromage of 12 upwards who live in the clinicalcommissioning group area
• hours of operation including, week-end, bankholiday and on-call arrangements
• minimum level of experience andqualifications of staff (i.e. doctors –ophthalmologists and GPs, Nursing staff –diabetes nurse specialists, ophthalmologynurses etc, other allied health professionals,e.g. optometrists and other support andadministrative staff)
• confirmation of the arrangements to identifythe care co-ordinator for each patient withdiabetes (i.e. who holds the responsibility androle).
• staff induction and developmental training
25
6. Equipment• upgrade and maintenance of relevant
equipment and facilities (e.g. digital cameras,eye laser equipment etc)
• technical specifications, e.g. digital funduscameras as set out in ‘Essential Elements inDeveloping a Diabetic Retinopathy ScreeningProgramme’b
Identification, Referral andAcceptance criteria7. This should make clear how patients will be
identified, assessed and accepted to theservices. Acceptance should be based on typesof need and/or patient.
8. How should patients be referred?
• who is acceptable for referral and from where
• details of evaluation process - Are there clearexclusion criteria or set alternatives to theservice? How might a patient be transferred?
• response time detail and how are patientsprioritised
Discharge/Service Complete/PatientTransfer/Transition criteria9. The intention of this section is to make clear
when a patient should be transferred from oneaspect of the diabetes service to another andwhen this point would be reached.
• how is a treatment pathway reviewed?
• how does the service decide that a patient isready for discharge
• how are goals and outcomes assessed andreviewed?
• what procedure is followed on discharge,including arrangements for follow-up
Quality Standards10. The service is required to deliver care according
to the standards for clinical practice set by theNational Institute for Health and ClinicalExcellencec
11. As a minimum, the Provider is required toagree a local Commissioning for Quality andInnovation scheme for services for people withdiabetes. (Insert details of the CQUIN Schemeagreed)
12. The service is required to deliver the outcomesfor diabetes as determined by the NHSOutcomes Frameworkd
Activity and PerformanceManagement13. This must include performance indicators,
thresholds, methods of measurement andconsequences of breach of contract. These willbe set and agreed prior to the signing of theoverall agreement.
For KPIs relating to retinopathy screeningplease seehttp://www.retinalscreening.nhs.uk/KPIs
14. Activity plans – Where appropriate, identify theanticipated level of activity the service maydeliver; provide details of any activity measuresand their description /method of collection,targets, thresholds and consequences ofvariances above or below target.
Continual Service Improvement15. As part of the monitoring and evaluation
procedures, the service will identify a methodof agreeing measurements for continuousimprovement of the service being offered andwork to ensure unmet need is both identifiedand brought to the attention of thecommissioner.
b UK National Screening Committee , Essential Elements in Developing a Diabetic Retinopathy Screening Programme, National ScreeningProgramme for Diabetic Retinopathy Workbook 4.3, June 2009, http://www.retinalscreening.nhs.uk/workbook
c http://www.nice.org.uk/guidance/qualitystandards/qualitystandards.jsp
d http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122944
26
16. Review:
• this section should set out a review date anda mechanism for review.
• the review should include both thespecifications for continuing fitness forpurpose and the providers’ delivery againstthe specification.
• this should set out the process by which thisreview will be conducted.
• this should also identify how complianceagainst the specification will be monitored in year.
17. Agreed by:• this should set out who agrees/accepts the
specification on behalf of all parties.
• this should include the diabetes eye serviceproviders, commissioner and network.
Further copies of this publication can be ordered from Prontaprint, by emailing [email protected] or tel: 0116 275 3333, quoting DIABETES 143
www.diabetes.nhs.uk
