Shared learning database

Type and Title of Submission


Supporting local healthcare providers to embed quality, clinically effective and cost effective structured education in the care pathway for people with Type 2 diabetes


The DESMOND Central Team identified a gap in the knowledge of local healthcare providers commissioning DESMOND structured education for people with Type 2 diabetes, preventing them from successfully embedding group education into the local care pathway for diabetes. The team developed a process for supporting local healthcare providers to identify gaps in their systems, develop flexible and sustainable infrastructures for integrating structured education in the care pathway, and explore meaningful local evaluation of performance. In organisations where this process has been adopted, structured education operates to a greater level of clinical and cost effectiveness, reaches greater numbers of people with diabetes, and provides an exemplar for the future adoption of group education in other long term conditions.


2010-11 Shared Learning examples

Does the submission relate to the general implementation of all NICE guidance?


Does the submission relate to the implementation of a specific piece of NICE guidance?


Full title of NICE guidance:

CG66 - Type 2 diabetes (partially updated by CG87)

Category(s) that most closely reflects the nature of the submission:

Is the submission industry-sponsored in any way?


Description of submission


To support healthcare providers to develop a robust infrastructure to support the local implementation of clinically effective structured education for people with Type 2 diabetes. This ensures that provision not only meets NICE guidelines, but is cost effective, sustainable in the long term, and has capacity to reach greater numbers of people potentially benefiting from this intervention.


We aimed to support healthcare providers to: 1) understand that infrastructure is a critical component of successful structured education provision; 2) identify what kind of infrastructure would suit local needs, how best to implement it, and what staff roles would be required to support it; 3) explore options for meaningful local evaluation of the service performance.


Implementation of structured education in the real world requires a methodical approach in order to guarantee success. Training staff to deliver the education is only one component for success. However, there is still a persistent view, despite the availability of NICE guidance and guidelines, that structured education for self management is an 'add-on' and not an integral part of therapeutic management for the person with diabetes. Our general experience of over 5 years of providing training and support to healthcare providers commissioning education programmes is that the most common approach is made by a 'clinical champion' within the organisation. This individual, although well intentioned, is likely not to have engaged with commissioners or the leads for long term conditions in terms of the longevity of the approach, nor have the skill, experience or necessary seniority to establish the intervention on more than an 'ad hoc' footing. In providers where structured education was not subsequently 'adopted' by a clinical lead or commissioner, it inevitably fell by the wayside in times of financial restrictions or service redesign. An event more pertinent observation in the current climate of NHS restructuring. However, where there was engagement with our team, a receptiveness to advice on practical arrangements, and an openness to shared learning from the experience of other healthcare providers, structured education as an intervention was more valued and appreciated, and the service established on a firmer footing. In turn, this generated more favourable results and opinions from all stakeholders, the public, people with diabetes and primary care clinicians. From these experiences we have developed a structured logistical pathway which is demonstrating results in healthcare providers where it has been adopted.


1) We increased our personal contacts with organisations seeking to provide our programmes, and invested staff time in building more sustainable relationships with them. 2) We supported healthcare organisations to better understand the value of a service needs assessment and to promote use of the tools provided via the Public Health Observatory website. 3) We instituted an early visit from one of the Central Office team to meet with representatives of the organisation to discuss options for implementation and to provide support based on our extensive experience and that of over 100 healthcare organisations implementing our programmes. 4) Over the course of 12-18 months of this activity, Central Office team members noted the most frequently asked questions, and highlighted the most common needs for support/ information. We also added to our data bank of successful examples - and unsuccessful ones, to form a 'Top Tips' for implementation, and a list of 'What not to Do'. 5) We strongly advocated to organisations the appointment of a local co-ordinator to handle administration of the service, referral process etc. 6) We provided more robust guidance on selecting healthcare professionals to become educators, and on the numbers of educators appropriate for a healthcare service to send for training. 7) Even before the NHS structures emerged, we future-proofed our approach so that it can be replicated with whatever provider takes on the future commissioning of structured education.

Results and evaluation

1) As part of standard practice, each organisation seeking to take on our education programme, is offered an early visit. 2) We have instituted an InfoBank of standard forms, templates and exemplars ranging from sample patient letters, to sample referral pathways, and make these available as part of our routine service to healthcare organisations. 3) We provide each new organisation taking on our structured education programme with a CD containing a basic electronic 'pack' of guidance and sample forms. Feedback from healthcare providers using a toolkit to inform their implementation of structured education has demonstrated a greater level of confidence in their long-term approach and commitment to structured education. 4) We have instituted a series of Local Co-ordinator study days to mirror the ongoing training for educators which we offer, recognising that administrators often work in isolation and need access to their own networks and support. These have been well supported and evaluated as excellent or very good by attendees. 5) We have updated our Educator manual to include a chapter on logistical issues and administration of courses in response to feedback. 6) We plan to extend our website services (secure sections) in the future to provide on-line support to enhance our relationships with provider organisations. 7) We have made these improvements at no additional cost to providers, finding it possible to absorb costs over and above personnel time in the general cost of providing our programme. We have achieved this by streamlining the way we ourselves work as a central co-ordinating centre, and making cost savings in our central operation budget.

Key learning points

1) Organisations benefit from understanding that a logistical pathway is just as critical as educator training to successful implementation of structured education. 2) Organisations who have an established infrastructure for one structured education programme, can use this equally successfully for other programmes, whether in diabetes or other long term conditions. 3) Our method of engagement promotes the value and use of NICE guidelines and quality standards. 4) Providing structured education in this way supports and provides evidence for the QIPP agenda. 5) Shared learning, for example, that a pathway or process which works well in one local area may well be relevant to another, or at the least, provide a starting point, has practical as well as theoretical benefits.

View the supporting material

Contact Details

Name:Dr Marian Carey
Job Title:National Director: DESMOND Programme
Organisation:University Hospitals of Leicester NHS Trust
Address:DESMOND Office, Ward 5/6, Leicester General Hospital, Gwendolen Rd
Postcode:LE5 4PW
Phone:0116 258 7757


NICE handles personal information provided to the Institute in accordance with the Data Protection Act 1998. Find further details in our data protection policy.

This page was last updated: 11 February 2011

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.