Endocrine Abstracts

Introduction: It was recognised there was a need to improve the current diabetes service provision at a District General Hospital in Yorkshire to meet the payment by results (PBR) best practice tariff. This tariff is based on recommendations by NICE, the Department for Health and the regional tertiary centre.

Objective: The main change to be implemented by this district general hospital was the creation of a 24 h diabetes service staffed by trained professionals. This would allow the trust to meet the best practice tariff and aim to reduce the number and length of hospital admissions for young people with diabetes.

Method: The strengths and weaknesses of the current service provision were examined. The case for change looked at 7 specific aspects: risk management; productivity and cost effectiveness; recruitment and retention of staff; modernisation of service provision; patient choice and implementation of national guidance.

Three options for implementation of proposed change and their consequences were then examined: no change to current practice (option 1); a 24 h on call service staffed by specialist nursing staff (option 2) and a 24 h on call service staffed by a combination of trained medical staff and nurses (option 3).

Results: The additional cost to the trust of implementing option 2 was £30 560 versus a cost of £86 020 to implement option 3. The financial incentive for meeting the PBR best practice tariff would be £30 340. The additional savings that could be made by reducing admission rates and length of admissions was calculated to be between £21 846 and £159 552.

Conclusions: The most cost effective option would be option 2 which involved setting up a 24 h on call service staffed by specialist nursing staff. This service would meet current government recommendations and the PBR best practice tariff. These options were presented to the trust and are currently under review.