Commissioning Guide Pregnanacy and Diabetes Care · Commissioning Pregnancy and Diabetes Care NHS...
31
Commissioning Pregnancy and Diabetes Care June 2011 Supporting, Improving, Caring
Transcript of Commissioning Guide Pregnanacy and Diabetes Care · Commissioning Pregnancy and Diabetes Care NHS...
Commissioning Pregnancy and Diabetes Care
June 2011
Supporting, Improving, Caring
NHS Diabetes Information Reader Box
Review Date 2013
Commissioning Pregnancy and Diabetes Care
NHS Diabetes would like to thank the following for their advice and contribution to the development ofthis commissioning guide:
Rosemary Temple Consultant in Diabetes, Norfolk and Norwich University Hospitals NHSFoundation Trust
Gillian Hawthorne Consultant in Community Paediatrics, Newcastle PCT
Cathy Moulton Diabetes UK
Heather Stephens NHS Diabetes
And to Thoreya Swage who wrote this publication.
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Page
Commissioning Pregnancy and Diabetes Services 5
Features of Pregnancy and Diabetes Services 6
Pregnancy and Diabetes Services Intervention Map 8
Contracting Framework for Pregnancy and Diabetes Services 14
Standard Service Specification Template for 26Pregnancy and Diabetes Services
Contents
5
Commissioning Pregnancy andDiabetes 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 localHealth Needs Assessment and setting up a steeringgroup with key stakeholder involvement includinga lead clinician, lead commissioner, lead diabetesnurse and lead service user.
Step 2 – involves the development of a servicespecification to describe the model of care to becommissioned. This becomes the document onwhich tenders may be issued.
Step 3 – involves monitoring the delivery of theservice specification by the provider and evaluatingthe performance of the service. Input from thesteering group with service user representation willbe an important mechanism for monitoring theservice as well as patient surveys.
This commissioning guide has been developed byNHS Diabetes with key stakeholders includingclinical and social services professionals and patientgroups represented by Diabetes UK.
It is not designed to replace the Standard NHSContracts as many of the legal and contractualrequirements have already been identified in thisset of documents. Rather, it is intended to form thebasis of a discussion or development of pregnancyand diabetes services between commissioners andproviders from which a contract for services canthen be agreed.
This commissioning guide consists of:
• A description of the key features of goodpregnancy and diabetes
• A high level intervention map. This interventionmap describes the key high level actions orinterventions (both clinical and administrative)pregnancy and diabetes services shouldundertake in order to provide the most efficientand effective care, from admission to discharge(or death) from the service.
It is not intended to be a care pathway or clinicalprotocol, rather it describes how a true ‘diabeteswithout walls’ service1 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 pregnancy and diabetes services.
• A contracting framework for pregnancy anddiabetes services that brings together all the keystandards of quality and policy relating todiabetes and the care of pregnant women
• A template service specification for pregnancy anddiabetes services that forms part of schedule 2,part 1 or section 1 (module B) of the StandardNHS Contract covering the key headings requiredof a specification. It is recommended that thecommissioner checks which mandatory headingsare required for each type of care as specified bythe Standard NHS Contracts.
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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A high quality pregnancy and diabetes serviceshould:
• provide preconception counselling care for allwomen with diabetes who are of reproductiveage
• provide prepregnancy care for all women withdiabetes who are of reproductive age to helpthem plan their pregnancy
• ensure that women with diabetes who are ofreproductive age are able to have urgent accessthe diabetic antenatal clinic if an unplannedpregnancy occurs
• provide appropriate and responsive antenatal,intra partum and post natal care for womenwith diabetes and for women who have ahistory or develop gestational diabetes
• provide immediate assessment and care ofbabies born to women who have diabetes orgestational diabetes
• provide education to other health and socialcare professionals about pregnancy and diabetes
In addition the service should:
• be developed in a co-ordinated way, taking fullaccount of the responsibilities of other agenciesin providing comprehensive care and placingusers at the centre of decisions about their careand support - "no decision about me withoutme" (Equity and Excellence: Liberating theNHSi).
• 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 as
described by the generic model for themanagement of long term conditionsii
• deliver the outcomes for diabetes as determinedby the NHS Outcomes Frameworkiii
• provide effective and safe care to women withdiabetes in a range of settings including thewomen’s home, according to recognisedstandards including the quality standards forclinical practice for diabetes set by the NationalInstitute for Health and Clinical Excellenceiv
• take into account the emotional, psychologicaland mental wellbeing of the womanv
• take into account all diverse and personal needswith respect to access to care
• ensure that services are responsive andaccessible to women with Learning Disabilitiesvi
• ensure that the family/carers of women withdiabetes have access to psychological support
• take into account race and inequalities withrespect to access to care
• have effective clinical networks with clear clinicalleadership across the boundaries of care whichclearly identify the role and responsibilities ofeach member of the diabetes healthcare team
• ensure that there are a wide range of optionsavailable to women with diabetes to support selfmanagement 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 level of care
Features of high quality Pregnancyand Diabetes Services
i Available on the DH websitehttp://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 Available on the DH website athttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122944
iv http://www.nice.org.uk/guidance/qualitystandards/qualitystandards.jsp
v Emotional and Psychological Support and Care in Diabetes, Joint Diabetes UK and NHS Diabetes Emotional and PsychologicalSupport Working Group, 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 education on diabetes management toother staff and organisations that supportwomen with diabetes
• have a capable and effective workforce that hasthe appropriate training and updating andwhere the staff have the skills and competenciesin the management of women with diabetes
• provide multidisciplinary care that manages thetransition between children and adult services
• have integrated information systems that recordindividual 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 Outcome Measures, in thedevelopment and monitoring of servicedeliveryviii
• actively monitor the uptake of services,responding to non-attenders and monitoringcomplaints and untoward incidents
vii http://www.diabetes.nhs.uk/year_of_care/it/
viii http://www.ic.nhs.uk/proms
8
Pregnancy and Diabetes CareIntervention Map
Hea
lth
Nee
ds
Ass
essm
ent
Rai
sin
g
awar
enes
s
-id
entif
y vu
lner
able
co
mm
uniti
es
and
indi
vidu
als
- ed
ucat
ion
on
diab
etes
and
pr
egna
ncy
- th
e ne
ed f
or
con
trac
eptio
n
- lif
esty
le, d
iet,
sm
okin
g ce
ssat
ion
advi
ce
Co
ntr
acep
tio
n
-ad
vice
-ap
prop
riate
m
edic
atio
n
-di
scus
s at
re
gula
r re
view
of
dia
bete
s ca
re
-im
port
ance
- e
ncou
rage
atte
ndan
ce o
f
part
ner
of m
aint
aini
ng
glyc
aem
ic c
ontr
ol
- Ri
sks
of u
npla
nned
p
regn
ancy
Plan
nin
g
pre
gn
ancy
?(p
rep
reg
ancy
ca
re)
-ad
vice
re:
st
oppi
ng
cont
race
ptio
n
-ad
vice
on
diet
, bo
dy w
eigh
t,
exer
cise
and
bl
ood
gluc
ose
cont
rol
-pr
escr
ibe
folic
ac
id
-bl
ood
test
s fo
r re
nal f
unct
ion
-en
cour
age
atte
ndan
ce o
f pa
rtne
r
-co
ntac
t de
tails
/em
erge
ncy
phon
e nu
mbe
rs
Ref
erra
l fo
r re
tin
al
asse
ssm
ent
Ren
al r
efer
ral,
if in
dic
ated
Reg
ula
rre
view
-gl
ycae
mic
co
ntro
l
-m
edic
atio
n re
view
-fo
lic a
cid
- ed
ucat
ion
-m
onth
ly
HbA
1c
-co
ntin
ue t
o m
onito
r re
nal
fun
ctio
n an
d s
cree
n fo
r r
etin
opat
hy
Preg
nan
t?
No
Yes
Imm
edia
tere
ferr
al t
o jo
int
dia
bet
es a
nd
an
ten
atal
cl
inic
Go
to
Pag
e 9
NH
S D
iab
etes
Preg
nan
cy a
nd
dia
bet
es c
are
–p
reco
nce
pti
on
-se
ttin
g ta
rget
s fo
r g
lyca
emic
con
trol
-re
view
med
icat
ion
-st
art
care
pla
nPr
eco
nce
pti
on
co
un
selli
ng
disc
ussi
on a
bout
:
- fu
ture
pre
gnan
cy p
lans
-m
anag
emen
t of
a
pre
gnan
cy t
o en
sure
a
hea
lthy
outc
ome
-ap
prop
riate
med
icat
ion
for
dia
bete
s ca
re
-co
ntac
t de
tails
of
pre
preg
ancy
car
e te
am
-ac
tion
to b
e ta
ken
if an
u
npla
nned
pre
gnan
cy o
ccur
s
-en
cour
age
atte
ndan
ce o
f p
artn
er/f
amily
mem
ber
- ris
ks o
f un
plan
ned
pre
gnan
cy
9
NH
S D
iab
etes
Preg
nan
cy a
nd
dia
bet
es c
are
–an
ten
atal
car
e
Fro
m
pag
e 8
Firs
tjo
int
diab
etes
an
d a
nte
nat
al
clin
ic
-ad
vice
on
glyc
aem
ic c
ontr
ol
-ge
nera
l adv
ice
on p
regn
ancy
-hi
stor
y
-re
view
m
edic
atio
n
-re
ferr
al f
or r
etin
al
and
rena
l as
sess
men
t
-ru
bella
sta
tus
Dev
elo
p in
div
idu
al
care
pla
n
-ta
rget
s fo
r gl
ycae
mic
co
ntro
l
-ad
vice
on
hypo
and
hy
per
glyc
aem
ia
-re
tinal
and
ren
al
scre
enin
g sc
hedu
les
-fe
tal s
urve
illan
ce
- pl
an f
or d
eliv
ery
-di
abet
es c
are
post
del
iver
y
Co
nti
nu
ing
an
ten
atal
car
e
-fo
llow
NIC
E gu
idel
ine
on
diab
etes
and
pr
egna
ncy
-ca
re p
an
Co
nta
ct w
ith
d
iab
etes
car
e te
am a
s n
eed
ed
-as
sess
men
t of
gl
ycae
mic
con
trol
-ca
re p
lan
Dia
bet
icke
toac
ido
sis?
-ca
re p
lan
Adm
it t
o L2
cri
tica
l car
e fo
r ob
serv
atio
n or
inte
rven
tion
Dis
char
ge
wh
enre
cove
red
Intr
apar
tum
ca
reG
o t
o
pag
e 11
Mis
carr
iag
e?
Ap
pro
pri
ate
trea
tmen
t an
d
sup
po
rt f
ollo
win
g
mis
carr
iag
e
Co
nti
nu
e d
iab
etes
ca
re
Info
rm d
iabe
tes
team
10
NH
S D
iab
etes
Preg
nan
cy a
nd
dia
bet
es c
are
–an
ten
atal
car
e (G
esta
tio
nal
Dia
bet
es)
Bo
oki
ng
clin
ic f
or
ante
nat
al c
are
Ris
k o
r h
isto
ry o
f g
esta
tio
nal
d
iab
etes
?
No
Yes
Co
nti
nu
e w
ith
ro
uti
ne
ante
nat
al c
are
-ad
vice
on
poss
ible
co
mpl
icat
ions
-di
et
-m
edic
atio
n, if
ap
prop
riate
-ex
tra
mon
itorin
g, if
re
quire
d
-ca
re p
lan
For
wom
en w
ho h
ave
had
gest
atio
nal
diab
etes
in a
pre
viou
s pr
egna
ncy
-Sel
f m
onit
orin
g of
glu
cose
or
Ora
l Glu
cose
To
lera
nce
Test
(O
GTT
) at
16-1
8 w
eeks
Repe
at O
GTT
at
28
wee
ks, i
f pr
evio
us t
est
norm
al
-re
view
med
icat
ion,
if
appr
opria
te
Intr
apar
tum
car
eG
o t
o
pag
e 11
-ch
eck
usin
g ris
k fa
ctor
s
For
wom
en w
ith
any
of
the
othe
r ri
sk f
acto
rs
for
gest
atio
nal
diab
etes
–O
GTT
at
24-2
8 w
eeks
11
NH
S D
iab
etes
Preg
nan
cy a
nd
dia
bet
es c
are
–In
trap
artu
m c
are
Fro
m
pag
es 9
an
d 1
0
In f
inal
tri
mes
ter
of
pre
gn
ancy
-as
sess
ris
ks a
nd
bene
fits
of v
agin
al
birt
h, in
duct
ion
of
labo
ur a
nd c
aesa
rean
se
ctio
n if
baby
has
m
acro
som
ia
-po
ssib
ility
of
vagi
nal
birt
h in
wom
en w
ith
retin
opat
hy o
r af
ter
prev
ious
cae
sare
an
-ca
re p
lan
Pre-
term
lab
ou
r?
Yes
-an
tena
tal s
terio
ds-
toco
lytic
med
icat
ion
- m
onito
r gl
ucos
e le
vels
-ca
re p
lan
No
Car
e af
ter
38
wee
ks
-of
fer
caes
area
n se
ctio
n or
indu
ctio
n of
la
bour
if n
orm
al f
etal
gr
owth
-of
fer
test
s of
fet
al
wel
lbei
ng if
wai
ting
for
spon
tane
ous
labo
ur
-C
are
plan
Du
rin
g la
bo
ur
and
b
irth
-m
onito
r gl
ucos
e
-co
nsid
er I/
V
dext
rose
and
insu
lin,
if re
quire
d
-ca
re p
lan
Neo
nat
al
care
Post
nat
al
care
Go
to
Pa
ge
12
Go
to
p
age
13
Still
bir
th?
Ap
pro
pri
ate
trea
tmen
t an
d
sup
po
rt
follo
win
g
still
bir
th
Co
nti
nu
e d
iab
etes
car
e
Info
rm d
iabe
tes
team
12
NH
S D
iab
etes
Preg
nan
cy a
nd
dia
bet
es c
are
–N
eon
atal
car
e
Fro
m p
age
11Ex
tra
neo
nat
al
care
req
uir
ed?
-se
e N
ICE
guid
elin
e on
di
abet
es a
nd
preg
nanc
y-
care
pan
Yes No
Ad
mit
to
neo
nat
al
un
it
Feed
bab
y w
ithin
30
min
utes
of b
irth
Test
fet
al b
lood
gl
ucos
e 4-
6hou
rs
afte
r bi
rth
or s
igns
of
hyp
ogly
caem
ia
Esta
blis
h r
egu
lar
feed
ing
Dis
char
ge
bab
y af
ter
24 h
ou
rs if
wel
l
-di
scha
rge
lett
er t
o G
P
-fe
ed b
aby
2-3
hour
ly
until
pre
-fee
ding
blo
od
gluc
ose
leve
ls
mai
ntin
ed
I/V
dex
tros
e /t
ube
feed
ing/
ex
pres
sed
milk
if
baby
is
hypo
glyc
aem
ic o
r no
t fe
edin
g ef
fect
ivel
y
Enco
urag
e/ad
vise
m
othe
r to
bre
ast
feed
13
NH
S D
iab
etes
Preg
nan
cy a
nd
dia
bet
es c
are
–Po
stn
atal
car
e
Fro
m
Pag
e 11
Wo
men
wit
h p
re-e
xist
ing
d
iab
etes
-ad
vice
on
cont
race
ptio
n
-ad
vice
on
pre-
conc
eptu
al c
are
- br
east
feed
ing
and
avoi
danc
e of
dru
gs f
or
com
plic
atio
ns t
hat
wer
e di
scon
tinue
d fo
r sa
fety
rea
sons
-re
view
med
icat
ion
- ris
k of
hyp
ogly
caem
ia w
hile
bre
astf
eedi
ng
-fo
od a
vaila
ble
whi
le b
reas
tfee
ding
-ca
re p
lan
Wo
men
wit
h g
esta
tio
nal
d
iab
etes
-re
view
med
icat
ion
-ad
vice
on
wei
ght,
die
t, e
xerc
ise
-su
bseq
uent
ris
k of
ges
tatio
nal
diab
etes
-bl
ood
gluc
ose
Oph
thal
mol
ogic
al
follo
w u
p fo
r at
leas
t 6
mon
ths
afte
r bi
rth,
if
indi
cate
d
Dis
char
ge
to d
iab
etes
ca
re t
eam
Post
nat
al f
ollo
w u
p a
t 6
wee
ks
Co
nti
nu
ing
car
e w
ith
d
iab
etes
car
e te
am
Dis
char
ge
fro
m o
bst
etri
c te
am
-ca
re p
lan
Post
nat
al f
ollo
w u
p a
t 6
wee
ks
-Po
st n
atal
glu
cose
tol
eran
ce a
sses
sed
acc
ordi
ng t
o lo
cally
agr
eed
gui
delin
es u
sing
fas
ting
glu
cose
or
GTT
Dis
char
ge
to G
P
-an
nual
fas
ting
plas
ma
gluc
ose
- ad
vice
for
fut
ure
preg
nanc
ies
- pl
ans
for
prev
entio
n or
ear
ly
iden
tific
atio
n of
typ
e 2
diab
etes
14
IntroductionThis contracting framework sets out what isrequired of clinically safe and effective services thatare providing care for women with diabetes whoare pregnant as well as those who developgestational diabetes. The framework is designedto be read in conjunction with the high leveldiabetes and pregnancy services intervention map,which describes the interventions and actionsrequired along the patient pathway as well as entryand exit points and the standard servicespecification template for diabetes and pregnancyservices.
The framework brings together the key qualityareas and standards that have been identified bythe Pregnancy and Diabetes Advisory Group.
The principles that establish a safepathway for patient care Establishing the principles that underpin thesystems and processes of pathways for patient careleads to more efficient patient throughput and canreduce risk of fragmentation of care and seriousuntoward incidents. The principles operate at fourlayers within a 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 clinicalservice or process sits (the provider organisation)
A straightforward or simple pathway is one inwhich the overall management including bothClinical Case Direction or Care Plan and thedelivery of the clinical processes conventionally sitswithin one organisation. However, with a morecomplex pathway, there is a danger that fracturingthe overall management pathway into componentscarried out by different clinical teams andorganisations will require duplication of effortleading to inefficiency and increased risk athandover points.This can be managed byestablishing clear governance arrangements for allthe layers in the pathway.
In addition, Commissioning Bodies must balancethe benefits of fracturing the pathway againstincreased complexity and ensure that the increasedrisks are mitigated.
The governance arrangements required for allthree layers and the commissioner responsibilitiesare shown below:
Contracting Framework forPregnancy and Diabetes Services
15
The services themselves will also have clinicaloversight for governance purposes
Pregnancy and diabetes servicesThe key principles of good care for women withdiabetes, including gestational diabetes, is to providea high quality service that is reliable in terms ofdelivery and timely access for women requiring thatcare.
The care of a pregnant woman with diabetes,including gestational diabetes, should be provided bya multidisciplinary team present at the same time inthe same setting and as minimum, should comprisean obstetrician, diabetes physician, diabetes specialistnurse, diabetes midwife and dietitian1. It is essentialthat there is co-ordination of care of the womenthrough the care planning process and that theobstetrician/diabetes physician retain jointresponsibility for overall patient care across the wholepathway and retain overall responsibility for themanagement of side effects and complications.
The management of a pregnant woman withdiabetes, including gestational diabetes, shouldinclude an assessment of their emotional andpsychological well-being, together with timely accessto appropriate psychological andbiological/psychiatric interventions. Mental healthdisorders can pose significant barriers to diabetescare and therefore mental health stability is vital forgood self care2.
The services themselves will also have clinicaloversight for governance purposes.
This contracting framework should also be read inconjunction with the diabetes commissioning guidefor children and young people and follow theprinciples for the effective commissioning of servicesfor people with Learning Disabilities3.
Ensuring qualityCommissioning Bodies should ensure that thepregnancy and diabetes services commissioned are ofthe highest quality. There may, in addition, be someorganisations that wish to offer their services, but donot have a history of providing such care.
i) For provider organisations already involved in thedelivery of pregnancy and diabetes services,there should be retrospective evidence ofsystems being in place, implemented andworking.
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 services for pregnantwomen with diabetes (including gestationaldiabetes) to be provided.
This framework describes what theCommissioning Body needs to ensure is presentor addressed in its discussions with the providerorganisation.
Under the ‘elements’ column there are crossreferences to the Standard NHS Contract for AcuteServices – bilateral (main clauses and schedules)4 Thisis to assist commissioners and providers in having anoverview of how the elements link to the StandardNHS Contracts. Some of the areas are open tointerpretation and consequently the references arenot exhaustive.
16
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
Lead
ersh
ip
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
3,48
,49,
51,5
3, 6
0
Sche
dule
s: 1
0
Cla
rity
of t
he o
rgan
isat
ion’
spu
rpos
e w
ith e
xplic
itco
mm
itmen
t to
pro
vidi
ng h
igh
qual
ity s
ervi
ces
A c
ultu
re t
hat
dem
onst
rate
s an
open
lear
ning
eth
os
An
orga
nisa
tion
that
is le
gal a
ndet
hica
l in
all i
ts a
ctiv
ities
Prov
ider
mus
t ha
ve o
rgan
isat
iona
l str
uctu
reth
at p
rovi
des
lead
ersh
ip f
or a
ll pr
ofes
sion
san
d di
scip
lines
In p
artic
ular
, the
re m
ust
be a
cor
pora
tecl
inic
al d
irect
or w
ith t
he r
espo
nsib
ility
and
acco
unta
bilit
y fo
r th
e cl
inic
al s
ervi
ce
Ther
e m
ust
be a
lear
ning
fra
mew
ork
in t
heor
gani
satio
n
Ther
e sh
ould
be
a de
signa
ted
clin
ical
dire
ctor
with
resp
onsib
ility
and
acco
unta
bilit
y fo
r the
pre
gnan
cy a
nd d
iabe
tes
serv
ice
Gov
erna
nce
Inte
grat
ed G
over
nanc
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:11
,19,
27,4
8,49
,51,
53,5
4,56
, 60
Sche
dule
s:
10
An
orga
nisa
tion
that
is g
uide
d by
the
prin
cipl
es o
f goo
d go
vern
ance
:
- cla
rity
of p
urpo
se- p
artic
ipat
ion
and
enga
gem
ent
- rul
e of
law
- tra
nspa
renc
y- r
espo
nsiv
enes
s- e
quity
and
incl
usiv
enes
s- e
ffec
tiven
ess
and
effic
ienc
y- a
ccou
ntab
ility
An
orga
nisa
tion
that
acc
epts
resp
onsib
ility
and
acc
ount
abili
tyfo
r all
its a
ctio
ns
Cle
ar o
rgan
isat
iona
l and
int
egra
ted
gove
rnan
ce s
yste
ms
and
stru
ctur
es in
pla
cew
ith c
lear
line
s of
acc
ount
abili
ty a
ndre
spon
sibi
litie
s fo
r al
l fun
ctio
ns
This
incl
udes
inte
rfac
es b
etw
een
serv
ices
Qua
lity
Gov
erna
nce
in t
he N
HS.
A g
uide
for
pro
vide
r bo
ards
5
Gov
erna
nce
Clin
ical
Gov
erna
nce
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,6
,9,1
0,12
,14,
15,1
6,1
7,19
,21,
27,2
9,31
,32,
33,
48,
49,
51,
53, 5
4
Sche
dule
s:
3(pa
rts1
,2,4
,4A
,4B,
4C,5
,6)
, 7,1
0,12
,18,
20
Expl
icit
com
mitm
ent t
o qu
ality
and
patie
nt s
afet
y
Patie
nt fo
cuse
d w
ith re
spec
t for
the
pers
onal
wish
es o
f pat
ient
s in
all a
spec
ts o
f the
ir ca
re
A c
omm
itmen
t to
inno
vatio
n an
dco
ntin
uous
impr
ovem
ent
Clin
ical
Gov
erna
nce
syst
ems
and
polic
ies
shou
ld b
e in
pla
ce a
nd in
tegr
ated
into
orga
nisa
tiona
l gov
erna
nce
with
cle
ar li
nes
ofac
coun
tabi
lity
and
resp
onsib
ility
for a
ll cl
inic
algo
vern
ance
func
tions
e.g.
•
Clin
ical
Aud
it•
Clin
ical
Risk
Man
agem
ent
• U
ntow
ard
Inci
dent
Rep
ortin
g•
Infe
ctio
n C
ontr
ol•
Med
icin
es M
anag
emen
t•
Info
rmed
Con
sent
• R
aisin
g C
once
rns
• S
taff
Dev
elop
men
t•
Com
plai
nts
Man
agem
ent
All
sub-
cont
ract
ors
mus
t mee
t gov
erna
nce
and
lead
ersh
ipar
rang
emen
ts o
f the
mai
n pr
ovid
er o
rgan
isatio
n
Com
miss
ione
r, pr
ovid
er a
nd N
HSL
A m
ust r
evie
w C
NST
arra
ngem
ents
/or o
ther
org
anisa
tiona
l / p
rofe
ssio
nal i
ndem
nity
arra
ngem
ents
The
serv
ice
shou
ld h
ave
in p
lace
writ
ten
prot
ocol
s an
dpr
oced
ures
def
inin
g cl
ear l
ines
of a
ccou
ntab
ility
and
resp
onsib
ility
.
The
serv
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,
7
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
Gov
erna
nce
Clin
ical
Gov
erna
nce
• P
atie
nt a
nd P
ublic
Invo
lvem
ent
•Pa
tient
dig
nity
and
res
pect
•
Equ
ality
and
div
ersi
ty•
Intr
oduc
ing
new
tech
nolo
gies
and
trea
tmen
ts•
An
exte
rnal
ly a
ccre
dite
d Q
ualit
y A
ssur
ance
syst
em a
nd in
tern
al e
rror
repo
rtin
g in
volv
ing
all s
taff
gro
ups.
CG
sys
tem
s sh
ould
hav
e cl
ear a
ndde
mon
stra
ble
links
to o
ther
NH
S sy
stem
s w
ithco
llabo
rativ
e C
G a
ctiv
ities
and
sha
ring
ofex
perie
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
ee C
omm
issio
ning
for Q
ualit
y an
d In
nova
tion
(CQ
UIN
) sch
emes
for
wom
en w
ith d
iabe
tes
and
gest
atio
nal
diab
etes
e.g
. mod
el C
QU
IN s
chem
e pr
opos
edby
the
NH
S In
stitu
te fo
r Inn
ovat
ion
and
Impr
ovem
ent 9
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 8
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,
18,1
9,20
,21
, 31,
32,3
3, 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
qual
ity
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
safe
ty, e
xper
ienc
e an
d ou
tcom
es
Prov
ider
s sh
ould
par
ticip
ate
in n
atio
nal a
udit
prog
ram
mes
Acc
ess
targ
ets:
On
conf
irmat
ion
of p
regn
ancy
in a
wom
an w
ith d
iabe
tes
10:
• Im
med
iate
ref
erra
l (id
eally
at
six
wee
ks o
f ge
stat
ion)
to
join
tdi
abet
es a
nd a
nten
atal
ser
vice
s is
ess
entia
l •
Reg
ular
revi
ew w
ith d
iabe
tes
care
team
to a
sses
s gl
ycae
mic
cont
rol
• T
he f
irst
scan
sho
uld
be p
erfo
rmed
at
eigh
t w
eeks
ges
tatio
n
The
serv
ice
is re
quire
d to
par
ticip
ate
in th
e fo
llow
ing
natio
nal
audi
t act
iviti
es/p
rogr
amm
es:
• C
entr
e fo
r M
ater
nal a
nd C
hild
Enq
uirie
s11
• N
atio
nal D
iabe
tes
Aud
it 12
• D
iabe
tes
E 13
Loca
l aud
its c
ould
incl
ude:
• a
udit
of p
roto
cols
and
impr
ovem
ent p
lans
for t
he d
eliv
ery
ofpr
e-pr
egna
ncy,
pre
gnan
cy a
nd p
ostp
artu
m c
are
• a
udit
of p
re-c
once
ptio
n H
bA1c
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
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
tfo
r 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 s
atisf
y co
mm
issio
ner t
hat t
hey
can
recr
uit (
or p
rocu
re)
and
reta
in a
com
pete
nt c
linic
al te
am to
del
iver
the
serv
ice
Spec
ific
qual
ifica
tions
requ
ired
of h
ealth
pro
fess
iona
ls pr
ovid
ing
the
serv
ice
are:
• F
or d
iabe
tes
phys
icia
ns: r
egist
ratio
n w
ith th
e G
MC
and
evid
ence
of f
urth
er q
ualif
icat
ion
in d
iabe
tes
care
or e
xper
ienc
ew
ithin
dia
bete
s cl
inic
• F
or o
bste
tric
ians
: reg
istra
tion
with
the
GM
C a
nd e
vide
nce
offu
rthe
r qua
lific
atio
n in
obs
tetr
ics
• N
urse
s: re
gist
ratio
n w
ith th
e N
MC
and
furt
her e
vide
nce
ofqu
alifi
catio
n in
dia
bete
s ca
re o
r exp
erie
nce
with
in d
iabe
tes
clin
ic
• M
idw
ives
: reg
istr
atio
n w
ith t
he N
MC
and
fur
ther
evi
denc
eof
qua
lific
atio
n in
mid
wife
ry c
are
and
diab
etes
(see
als
o‘L
ead
Mid
wife
in D
iabe
tes:
Sta
ndar
ds, R
ole
and
Com
pete
ncie
s’)14
• D
ietit
ians
: reg
istra
tion
with
the
HPC
and
abl
e to
dem
onst
rate
com
pete
nce
in d
eliv
erin
g ed
ucat
iona
l sup
port
All
heal
thca
re p
rofe
ssio
nals
invo
lved
in d
eliv
erin
g ca
re to
preg
nant
dia
betic
wom
en (i
nclu
ding
ges
tatio
nal d
iabe
tes)
are
requ
ired
to h
ave
the
rele
vant
com
pete
ncie
s (s
ee S
kills
for H
ealth
-D
iabe
tes
Com
pete
ncie
s fo
r dia
bete
s an
d di
abet
ic re
tinop
athy
): 15
Clin
ical
qua
lity
Wor
kfor
ce/ s
taff
Clin
ical
sta
ff c
ompe
tenc
ies
in u
se o
f equ
ipm
ent
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,
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 di
abet
es c
are
are
requ
ired
to h
ave
the
rele
vant
com
pete
ncie
s in
usin
gap
prop
riate
equ
ipm
ent,
e.g.
blo
od g
luco
se a
nd k
eton
em
onito
rs, i
nsul
in d
eliv
ery
devi
ces
incl
udin
g in
sulin
pum
ps
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
Wor
kfor
ce /
staf
fD
evel
opm
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,
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
Hea
lth C
are
prof
essio
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
: 2,
3,4,
5,6,
8,10
,12
,13,
15,1
7,
19, 2
0
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
atis
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:
• N
SF fo
r Chi
ldre
n, Y
oung
Peo
ple
and
Mat
erni
ty S
ervi
ces16
Com
plia
nce
with
Car
e Q
ualit
y C
omm
issio
n Re
view
s
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
k17C
ompl
ianc
e w
ith th
e Q
ualit
y St
anda
rds
for D
iabe
tes,
sp
ecifi
cally
: 18
‘Qua
lity
Stat
emen
t 7
Wom
en o
f chi
ldbe
arin
g ag
e ar
e re
gula
rly in
form
ed o
fpr
econ
cept
ion
glyc
aem
ic c
ontr
ol a
nd o
f any
risk
s, in
clud
ing
med
icat
ion,
that
may
har
m th
e un
born
chi
ld. W
omen
with
diab
etes
pla
nnin
g a
preg
nanc
y ar
e of
fere
d pr
econ
cept
ion
care
and
thos
e no
t pla
nnin
g a
preg
nanc
y ar
e of
fere
d ad
vice
on
cont
race
ptio
n.’
20
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
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,
14,1
5,16
,17,
18,1
9,20
,21,
27,2
9,32
,33,
34,
35,3
6,54
Sche
dule
s:
3 (p
arts
1 a
nd 2
)
Clin
ical
qua
lity
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
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
If pa
rt o
r who
le o
f the
ser
vice
is to
be
tran
sfer
red
to o
ther
pro
vide
rs, t
here
mus
t be
clea
r and
agr
eed
sub
cont
ract
s on
refe
rral
crite
ria a
nd a
cces
s to
thes
e se
rvic
es.
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
i) re
gist
er p
atie
nts
ii) c
olle
ct re
leva
nt c
linic
al a
nd a
dmin
istra
tive
data
iii) m
anag
e th
e ap
poin
tmen
t pro
cess
,(re
appo
intm
ent a
nd D
NA
pro
cess
, if
appr
opria
te)
iv) p
rovi
de in
form
atio
n to
pat
ient
sv)
und
erta
ke in
itial
ass
essm
ent i
n th
eap
prop
riate
loca
tion
Key
prio
ritie
s fo
r goo
d qu
ality
car
e fo
r pre
gnan
cy a
nd d
iabe
tes
serv
ices
are
.
Con
trac
eptio
n ad
vice
• R
egul
ar d
iscus
sions
at d
iabe
tes
revi
ew•
Impo
rtan
ce o
f mai
ntai
ning
gly
caem
ic c
ontr
ol•
Risk
s of
unp
lann
ed p
regn
ancy
Prec
once
ptio
n co
unse
lling
:D
iscus
sion
abou
t:•
futu
re p
regn
ancy
pla
ns•
man
agem
ent o
f a p
regn
ancy
to e
nsur
e a
heal
thy
outc
ome
• a
ppro
pria
te m
edic
atio
n fo
r dia
bete
s ca
re•
con
tact
det
ails
of p
repr
egna
ncy
care
team
• w
hat a
ctio
n sh
ould
be
take
n if
an u
npla
nned
pre
gnan
cy o
ccur
s
Ther
e sh
ould
also
be
educ
atio
n of
oth
er h
ealth
and
soc
ial c
are
prof
essio
nals
abou
t dia
bete
s an
d pr
egna
ncy
Pre-
preg
nanc
y ca
re10
:•
wom
en w
ith d
iabe
tes
who
are
pla
nnin
g to
bec
ome
preg
nant
shou
ld b
e in
form
ed th
at e
stab
lishi
ng g
ood
glyc
aem
ic c
ontr
olbe
fore
con
cept
ion
and
cont
inui
ng th
roug
hout
pre
gnan
cy w
illre
duce
the
risk
of m
iscar
riage
, con
geni
tal m
alfo
rmat
ion,
still
birt
h an
d ne
onat
al d
eath
.•
In d
iabe
tes
educ
atio
n - t
he im
port
ance
of a
void
ing
unpl
anne
dpr
egna
ncy
shou
ld b
e st
ress
ed fr
om a
dole
scen
ce fo
r wom
enw
ith d
iabe
tes
• P
re-c
once
ptio
n ca
re a
nd a
dvic
e be
fore
disc
ontin
uing
cont
race
ptio
n sh
ould
be
offe
red
to w
omen
with
dia
bete
s w
hoar
e pl
anni
ng to
bec
ome
preg
nant
Ant
enat
al c
are8 :
• If
it is
saf
ely
achi
evab
le, w
omen
with
dia
bete
s sh
ould
aim
toke
ep a
fast
ing
gluc
ose
betw
een
3.5-
5.9
mm
ol/li
tre
and
1 ho
urpo
stpr
andi
al b
lood
glu
cose
bel
ow 7
.8 m
mol
/litr
e du
ring
preg
nanc
y•
Wom
en w
ith in
sulin
-tre
ated
dia
bete
s sh
ould
be
advi
sed
of th
eris
ks o
f hyp
ogly
caem
ia a
nd h
ypog
lyca
emia
una
war
enes
s in
preg
nanc
y, p
artic
ular
ly d
urin
g th
e fir
st tr
imes
ter
• D
urin
g pr
egna
ncy,
wom
en w
ho a
re s
uspe
cted
of h
avin
gdi
abet
ic k
etoa
cido
sis s
houl
d be
adm
itted
imm
edia
tely
for l
evel
2cr
itica
l car
e, w
here
they
can
rece
ive
both
med
ical
and
obs
tetr
icca
re
TOPI
C
21
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
Patie
nt p
athw
ayC
linic
al q
ualit
yA
t poi
nt o
f int
erve
ntio
n:Th
e C
omm
issio
ner s
houl
d as
sure
them
selv
esth
at th
e pr
ovid
er h
as s
yste
ms
and
proc
esse
sin
pla
ce to
ens
ure
that
:
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 C
omm
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
:
i) un
dert
ake
tele
phon
e tr
iage
ii) m
ake
urge
nt o
nwar
d re
ferr
als
whe
re li
fe-
thre
aten
ing
cond
ition
s or
ser
ious
un
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
• W
omen
with
dia
bete
s sh
ould
be
offe
red
ante
nata
l exa
min
atio
nof
the
four
-cha
mbe
r vie
w o
f the
feta
l hea
rt a
nd o
utflo
w tr
acts
at 1
8-20
wee
ks
• F
or w
omen
with
ges
tatio
nal d
iabe
tes
ther
e sh
ould
be
rout
ine
scre
enin
g of
gly
caem
ic c
ontr
ol d
urin
g pr
egna
ncy
at 1
6-18
wee
ks (p
revi
ous
hist
ory
of g
esta
tiona
l dia
bete
s) o
r 24-
28 w
eeks
of p
regn
ancy
(for
the
othe
r risk
fact
ors
of g
esta
tiona
l dia
bete
s)
• F
or w
omen
who
exp
erie
nce
misc
arria
ges
or h
ave
post
par
tum
deat
hs, t
here
sho
uld
be c
lose
mon
itorin
g an
d m
anag
emen
t of
bloo
d gl
ucos
e ac
cord
ing
to a
gree
d pr
otoc
ols
as w
ell a
sap
prop
riate
sup
port
follo
win
g th
e ev
ent
Intr
apar
tum
car
e:•
Ens
ure
that
wom
en w
ith d
iabe
tes,
incl
udin
g ge
stat
iona
ldi
abet
es g
ive
birt
h in
a s
ettin
g w
here
exp
ert a
sses
smen
t and
stab
ilisa
tion
of th
e ba
by is
ava
ilabl
e, in
the
even
t it i
s re
quire
d
Neo
nata
l car
e10:
• B
abie
s of
wom
en w
ith d
iabe
tes
shou
ld b
e ke
pt w
ith th
eir
mot
hers
unl
ess
ther
e is
a cl
inic
al c
ompl
icat
ion
or th
ere
are
abno
rmal
clin
ical
sig
ns th
at w
arra
nt a
dmiss
ion
for i
nten
sive
orsp
ecia
l car
e
Post
nata
l car
e10:
• W
omen
who
wer
e di
agno
sed
with
ges
tatio
nal d
iabe
tes
shou
ldbe
off
ered
life
styl
e ad
vice
(inc
ludi
ng w
eigh
t con
trol
, die
t and
exer
cise
) and
off
ered
a fa
stin
g pl
asm
a gl
ucos
em
easu
rem
ent(b
ut n
ot o
ral g
luco
se to
lera
nce
test
) at t
he 6
–w
eek
post
nata
l che
ck a
nd a
nnua
lly th
erea
fter
• T
here
sho
uld
be p
lans
for t
he p
reve
ntio
n (o
r ear
ly id
entif
icat
ion)
of ty
pe 2
dia
bete
s an
d su
bseq
uent
ges
tatio
nal d
iabe
tes
Ther
e sh
ould
be
an in
divi
dual
ised
care
pla
n, id
eally
usin
g a
stan
dard
tem
plat
e, fo
r all
preg
nant
wom
en w
ith d
iabe
tes
cove
ring
the
preg
nanc
y an
d po
stna
tal p
erio
d up
to 6
wee
ks.
The
care
pla
n sh
ould
be
impl
emen
ted
from
the
outs
et o
fpr
egna
ncy
by th
e m
ultid
iscip
linar
y te
am.
As
a m
inim
um th
e ca
re p
lan
shou
ld in
clud
e1 :•
Tar
gets
for g
lyca
emic
con
trol
• R
etin
al s
cree
ning
sch
edul
e•
Ren
al s
cree
ning
sch
edul
e•
Fet
al s
urve
illan
ce
TOPI
C
22
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
Patie
nt p
athw
ayC
linic
al q
ualit
yiv
) pro
vide
tim
ely
feed
back
to th
e re
ferr
erre
inte
rven
tion,
com
plic
atio
ns a
ndpr
opos
ed fo
llow
up
v) e
nsur
e th
at th
e pa
tient
rece
ives
requ
ired
drug
s/dr
essin
gs/a
ids
vi) e
nsur
e th
at s
uppo
rt is
in p
lace
with
othe
r car
e ag
enci
es a
s ap
prop
riate
• P
lan
for d
eliv
ery
• D
iabe
tes
care
aft
er d
eliv
ery
Preg
nanc
ies
with
ultr
asou
nd e
vide
nce
of m
acro
som
ia s
houl
dha
ve a
cle
ar m
anag
emen
t pla
n pu
t in
plac
e by
a c
onsu
ltant
obst
etric
ian.
Thi
s sh
ould
incl
ude
timin
g of
follo
w-u
p sc
ans,
feta
lsu
rvei
llanc
e, m
ode
and
timin
g of
del
iver
y1 .
Ther
e sh
ould
be
loca
lly a
gree
d gu
idel
ines
for l
abou
r war
ds a
nddi
ffer
ent m
odes
of d
eliv
ery
for d
iabe
tes6 .
Ther
e sh
ould
be
a ca
re p
lan
for t
he p
ostn
atal
man
agem
ent f
or a
llw
omen
with
dia
bete
s. A
s a
min
imum
the
care
pla
n sh
ould
incl
ude1 :
• P
lan
for t
he m
anag
emen
t of g
lyca
emic
con
trol
• N
eona
tal c
are
• S
uppo
rtin
g br
east
feed
ing,
giv
ing
supp
lem
enta
l fee
ds o
nly
whe
n cl
inic
ally
indi
cate
d•
Con
trac
eptio
n•
Fol
low
-up
care
aft
er d
ischa
rge
from
hos
pita
l
Patie
nts
may
nee
d to
be
refe
rred
to th
e fo
llow
ing
serv
ices
as
part
of th
eir d
iabe
tes
care
(see
rele
vant
inte
rven
tion
map
, con
trac
ting
fram
ewor
k an
d se
rvic
e sp
ecifi
catio
n3 ):
• d
iabe
tes
emer
genc
y an
d in
patie
nt c
are
• s
ervi
ces
for c
ompl
icat
ions
of d
iabe
tes
– fo
ot c
are,
eye
s, re
nal,
card
iova
scul
ar a
nd n
euro
path
y •
chi
ldre
n an
d yo
ung
peop
le
The
preg
nanc
y an
d di
abet
es s
ervi
ce s
houl
d pr
ovid
e re
gula
red
ucat
iona
l day
s fo
r all
prim
ary
and
seco
ndar
y ca
re p
rofe
ssio
nals
likel
y to
be
invo
lved
in th
e ca
re o
f wom
en w
ith d
iabe
tes
in th
elo
cal p
opul
atio
n, to
cov
er a
ll as
pect
s of
pre
-con
cept
ion,
prep
regn
ancy
, pre
gnan
cy a
nd p
ostn
atal
car
e1 .
Neo
nata
l car
e of
term
bab
ies
of w
omen
with
dia
bete
s1 :•
ther
e sh
ould
be
a w
ritte
n po
licy
for t
he m
anag
emen
t of t
heba
by. T
he p
olic
y sh
ould
ass
ume
that
bab
ies
will
rem
ain
with
thei
r mot
hers
in th
e ab
senc
e of
com
plic
atio
ns•
mot
hers
sho
uld
be in
form
ed a
nten
atal
ly o
f the
ben
efic
ial
effe
cts
of b
reas
tfee
ding
on
met
abol
ic c
ontr
ol fo
r bot
hth
emse
lves
and
thei
r bab
ies
• m
othe
rs w
ith d
iabe
tes
shou
ld b
e of
fere
d an
opp
ortu
nity
for
TOPI
C
23
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
Patie
nt p
athw
ayC
linic
al q
ualit
ysk
in-t
o-sk
in c
onta
ct w
ith th
eir b
abie
s im
med
iate
ly a
fter
deliv
ery.
Bre
astf
eedi
ng w
ithin
30
min
utes
of b
irth
shou
ld b
een
cour
aged
• w
omen
una
ble
to b
reas
tfee
d sh
ould
rece
ive
educ
atio
n in
vario
us fo
rmul
a pr
epar
atio
n an
d st
erili
sing
equi
pmen
t•
blo
od g
luco
se te
stin
g pe
rfor
med
too
early
sho
uld
be a
void
edin
wel
l bab
ies,
with
out s
igns
of h
ypog
lyca
emia
. Tes
ting
shou
ldbe
don
e be
fore
a fe
ed, u
sing
a re
liabl
e m
etho
d; a
not
e sh
ould
be m
ade
of ti
me
the
test
is p
erfo
rmed
, res
ult a
nd a
ctio
n ta
ken
• ju
nior
pae
diat
ric s
taff
and
mid
wiv
es s
houl
d ha
ve a
nun
ders
tand
ing
and
trai
ning
in th
e tim
ing
of b
lood
glu
cose
test
ing,
the
impo
rtan
ce o
f ear
ly b
reas
tfee
ding
and
a w
ritte
nca
re p
lan
agre
ed w
ith th
e m
othe
r
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
19
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, 5
4
Sche
dule
s:
2,12
,20
Clin
ical
qua
lity
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
mis
sion
ers
shou
ld s
atis
fyth
emse
lves
tha
t pr
ovid
er h
as s
yste
ms,
proc
esse
s an
d co
mpe
tent
per
sonn
el a
re in
plac
e an
d im
plem
ente
d to
ens
ure
that
all
clin
ical
em
erge
ncie
s an
d co
mpl
icat
ions
are
hand
led
in a
ccor
danc
e w
ith b
est
prac
tice
Dur
ing
preg
nanc
y, w
omen
who
are
sus
pect
ed o
f hav
ing
diab
etic
keto
acid
osis
shou
ld b
e ad
mitt
ed im
med
iate
ly fo
r lev
el 2
crit
ical
care
, whe
re th
ey c
an re
ceiv
e bo
th m
edic
al a
nd o
bste
tric
car
e 8
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
Clin
ical
qua
lity
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
miss
ione
rs m
ust a
ssur
e th
emse
lves
that
patie
nt c
are
is de
liver
ed in
app
ropr
iate
ly b
uilt
and
equi
pped
faci
litie
s w
hich
mee
t rel
evan
tH
TMs
and
Build
ing
Not
es, a
nd, w
here
appr
opria
te, a
re re
gist
ered
and
are
saf
e an
dcl
ean.
Equi
pmen
t mus
t be
fit fo
r pur
pose
Com
mitm
ent t
o ef
ficie
nt u
se a
nd s
atisf
acto
rym
aint
enan
ce o
f equ
ipm
ent
Preg
nant
wom
en s
houl
d ha
ve e
noug
h te
stin
g st
rips
to c
over
the
use
incr
ease
d us
e in
pre
gnan
cy
TOPI
C
24
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
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
Clin
ical
qua
lity
Und
erst
andi
ng o
f clin
ical
acco
unta
bilit
ies
of h
ealth
and
safe
ty p
olic
ies
H&
S st
rate
gy a
nd p
olic
ies
in p
lace
and
impl
emen
ted
with
aw
aren
ess
thro
ugho
utth
e or
gani
satio
n
Acc
essi
bilit
y to
exe
cutiv
e re
spon
sibl
e fo
rH
&S
for
quic
ker,
first
con
tact
ser
vice
s
Hea
lth a
nd s
afet
y po
licie
s as
per
pro
vide
r agr
eem
ent w
ithco
mm
issio
ners
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,
32,
33,5
4
Sche
dule
s: 5
,7,1
5,16
,18
Dat
a an
din
form
atio
nm
anag
emen
t
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
The
abili
ty to
cap
ture
evi
denc
eba
sed
prac
tice
from
R&
D N
atio
nal
Serv
ice
Fram
ewor
ks, N
ICE
guid
ance
The
abili
ty to
use
dat
a an
din
form
atio
n ap
prop
riate
ly to
impr
ove
patie
nt c
are
Tran
spar
ency
and
obj
ectiv
ity
The
Prov
ider
sho
uld
have
an
expl
icit
data
and
info
rmat
ion
stra
tegy
in p
lace
tha
tco
vers
• T
ypes
of
data
• Q
ualit
y of
dat
a•
Dat
a pr
otec
tion
and
conf
iden
tialit
y•
Acc
essi
bilit
y•
Tra
nspa
renc
y•
Ana
lysi
s of
dat
a an
d in
form
atio
n•
Use
of
data
and
info
rmat
ion
• D
isse
min
atio
n of
dat
a an
d in
form
atio
n•
Ris
ks•
Sha
ring
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
Ther
e sh
ould
be
polic
ies
in p
lace
tha
tin
clud
e:
• C
onfid
entia
lity
Cod
e of
Pra
ctic
e•
Dat
a Pr
otec
tion
• F
reed
om o
f In
form
atio
n•
Hea
lth 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
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 20
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
k 17
• Q
ualit
y an
d O
utco
mes
Fra
mew
ork21
• H
ospi
tal E
piso
des
Stat
istic
s da
ta 22
• P
atie
nt E
xper
ienc
e 19
,23
• P
atie
nt s
atisf
actio
n 19
• N
atio
nal D
iabe
tes
Aud
it 12
• D
iabe
tesE
13
• N
atio
nal D
iabe
tes
Info
rmat
ion
Serv
ice
24
• N
atio
nal D
iabe
tes
Con
tinui
ng C
are
Dat
aset
25
TOPI
C
25
Source documentsCommissioners and providers should takeresponsibility for making references to thelatest version of the various documents andguidance.
1. Diabetes in pregnancy: are we providing the bestcare? Findings of national enquiry, ConfidentialEnquiry into Maternal and Child Health, February2007, http://www.cemach.org.uk/Programmes/Maternal-and-Perinatal/Diabetes-in-Pregnancy.aspx
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, 2011 http://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 Pregnancy guidance,http://www.nice.org.uk/guidance/index.jsp?action=byTopic&o=7261&ht=7252
8. NICE, Medicines adherence: involving patients indecisions about prescribed medicines andsupporting adherence, Jan 2009,http://guidance.nice.org.uk/CG76
9. NHS Institute for Innovation and Improvement,model CQUIN scheme: inpatient care for peoplewith diabetes, 2009
10. NICE, Diabetes in pregnancy : management ofdiabetes and its complications from pre-conception to the post natal period,www.nice.org.uk/Guidance/CG63, reissued July2008
11. Centre for Maternal and Child Enquiries ,http://www.cmace.org.uk/
12. National Diabetes Audit.www.ic.nhs.uk/services/national-clinical-audit-support-programme-ncasp/diabetes
13. DiabetesE - https://www.diabetese.net/
14. Lead Midwife in Diabetes: Standards, Role andCompetencies, 2010,http://www.diabetes.nhs.uk/
15. Skills for Health, Diabetes CompetencyFramework, https://tools.skillsforhealth.org.uk/
16 National Service Framework for Children, YoungPeople and Maternity Services, 2004http://www.dh.gov.uk/en/Healthcare/Children/DH_4089111
17. Department of Health, The NHS OutcomesFramework 2011/12, December 2010http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122944
18. NICE, Quality Standards: Diabetes in adults,March 2011, http://www.nice.org.uk/guidance/qualitystandards/qualitystandards.jsp
19. Healthcare Commission, National Survey ofPeople with Diabetes, 2006,www.cqc.org.uk/usingcareservices/healthcare/patientsurveys/servicesforpeoplewithdiabetes.cfm
20. York and Humber integrated IT systemhttp://www.diabetes.nhs.uk/
21. Quality and Outcomes Framework,http://www.nice.org.uk/aboutnice/qof/qof.jsp
22. Hospital Episode Statistics,www.ic.nhs.uk/statistics-and-data-collections/hospital-care/hospital-activity-hospital-episode-statistics--hes
23. The King’s Fund, The point of care. Measures ofpatients’ experience in hospital: purpose,methods and uses. July 2009
24. National Diabetes Information Service,www.diabetes-ndis.org
25. National Diabetes Continuing Care Dataset,www.ic.nhs.uk/webfiles/Services/Datasets/Diabetes/dccrdataset.pdf
26
This specification forms Schedule 2, Part 1, orsection 1 (module B), ‘The Services - ServiceSpecifications’ of the Standard NHSContractsa.
Service specifications are developed in partnershipbetween commissioners and provider agenciesand are 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/carercan expect to receive.
The following documentation, developed bythe Pregnancy and Diabetes Advisory Group,provides further detail/guidance to supportthe development of this specification:
• The pregnancy and diabetes care interventionmap
• The contracting framework for pregnancy anddiabetes services
This specification template assumes that theservices are compliant with the contractingframework for pregnancy and diabetes services.
This template also provides examples of whatcommissioners may wish to consider whendeveloping their own service specifications.
Description of pregnancy anddiabetes services:Pregnancy and diabetes services provide the fullrange of preconception, prepregnancy, antenatal,intrapartum and postpartum care for all womenwith diabetes, including gestational diabetes,who are of reproductive age.
The final specification should takeinto account:• national, network and local guidance and
standards for pregnancy and diabetesservices.
• local needs.
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 service relates toothers and within the whole system, should beincluded describing the keystakeholders/relationships which influence theservices, e.g. diabetes care team and maternityteam etc
• Any relevant diabetes clinical networks andscreening programmes applicable to theservices
• Details of all interdependencies or sub-contractors for any part of the service and anoutline of the purpose of the contract shouldbe stated, including arrangements for clinicalaccountability and responsibility, as appropriate
Standard Service SpecificationTemplate for Pregnancy andDiabetes Services
a Standard NHS Contracts http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_124324
27
Purpose, Role and Clientele1. A clear statement on the primary purpose of
the services and details of what will beprovided and for whom:
• Who the services are for (e.g. women withdiabetes, including women with gestationaldiabetes, requiring maternity care)
• What the services aim to achieve
• 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 whatthe services are and how they are used;how women with diabetes who requirepreconception counselling, prepregnancyadvice and planning or are pregnant(including gestational diabetes) enter thepathway/journey; what are the stagesundertaken and continuing management upto six weeks post natal care and handoverto the diabetes team. The aims of serviceplanning are 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/obstetric multi-disciplinary team (as defined locally)with a clear care co-ordination function
• Holistic review of patients in themanagement of their diabetes andpregnancy that is patient-centred, includingself 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.the contracting framework for pregnancyand diabetes services, guidance producedby the Royal College of Physicians, RoyalCollege of Obstetricians, Diabetes UK, etc
Service Delivery3. Patient Journey/ intervention map
Flow diagram of the patient pathway showingaccess and exit/transfer points – see pregnancyand diabetes care intervention map frompreconception to post natal care as a startingpoint
4. Treatment protocols/interventionsInclude all individual treatment protocols inplace within the services or planned to beused
5. This will include a breakdown of how thepatient will receive the services and fromwhom. It should be a clear statement of staffqualifications/experience and/or training (if appropriate) and clinical or managerialsupervision arrangements. It should specify, as appropriate:
• Geographical coverage/boundaries – i.e. theservices should be available for women withdiabetes who require preconception advice,prepregnancy planning or are pregnant(including gestational diabetes) who live inthe clinical commissioning group area
• Hours of operation including, week-end,bank holiday and on-call arrangements
• Minimum level of experience andqualifications of staff (i.e. doctors –diabetologists, obstetricians, Nursing staff –diabetes nurse specialists, midwives withskills in managing pregnant women withdiabetes, etc, other allied healthprofessionals, e.g. podiatrists, dietitians,optometrists, pharmacists etc and othersupport and administrative staff)
28
• Confirmation of the arrangements toidentify the Care Co-ordinator for eachpregnant woman with diabetes (i.e. whoholds the responsibility and role)
• Staff induction and developmental training
6. Equipment• Upgrade and maintenance of relevant
equipment and facilities
• Technical specifications (if any)
Identification, Referral andAcceptance criteria7. This should make clear how women with
diabetes who require preconception orprepregnancy advice or are pregnant (includinggestational diabetes) will be identified,assessed (if appropriate) 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 thereclear exclusion criteria or set alternatives tothe service? How might a patient betransferred?
• Response time detail and how patients areprioritised
Discharge/Service Complete/PatientTransfer criteria9. The intention of this section is to make clear
when a patient should be transferred from thepregnancy and diabetes service to another andwhen this would be reached.
• How is a treatment pathway reviewed?
• How does the service decide that a patientis ready for discharge/transfer?
• 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 practiceset by the National Institute for Health andClinical Excellenceb
11. As a minimum, the Provider is required toagree a local Commissioning for Quality andInnovation scheme for services for peoplewith diabetes. (Insert details of the CQUINScheme agreed)
12. The service is required to deliver the outcomesfor diabetes as determined by the NHSOutcomes Frameworkc
Activity and PerformanceManagement13. This must include performance indicators,
thresholds, methods of measurement andconsequences of breach of contract. Thesewill be set and agreed prior to the signing ofthe overall agreement.
14. Activity plans – Where appropriate, identifythe anticipated level of activity the servicemay deliver; provide details of any activitymeasures and their description/method ofcollection, targets, thresholds andconsequences of variances above or belowtarget.
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 offeredand work to ensure unmet need is bothidentified and brought to the attention of thecommissioner.
b http://www.nice.org.uk/guidance/qualitystandards/qualitystandards.jsp
c http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122944
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16. ReviewThis 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 inyear.
17. Agreed byThis should set out who agrees/accepts thespecification on behalf of all parties.
This should include the diabetes andpregnancy providers and commissioner.
Further copies of this publication can be ordered from Prontaprint, by [email protected] or tel: 0116 275 3333, quoting DIABETES 125
www.diabetes.nhs.uk
