Research reports better patient outcomes from North East Essex Diabetes Service

New research from the University of Suffolk has reported that a community-based diabetes service in north-east Essex has delivered better patient outcomes than other primary care services across England while reducing red tape for workers over the last decade.

Researchers from the University’s Institute of Health and Wellbeing carried out an evaluation of the North-East Essex Diabetes Service (NEEDS), a community-based care model designed to provide a single point of access with clear continuity of care for people with diabetes.

The research, which included online surveys, focus groups and analysis of secondary data from more than 20,000 patients, found that “patient outcomes were higher than those recorded for other GP surgeries across England,” while “service users reported that they received support with more control over their care”.

The study found that the service achieved higher than the national average for patients completing all eight care processes recommended by NICE (National Institute of Health and Care Excellence), putting what was then known as the CCG (clinical commissioning group) and now known as the Integrated Care Board (ICB) first out of 74 in the country, based on figures from 2022.

It reported that 67 per cent of people living with diabetes in north-east Essex received all eight care processes compared to 38 per cent nationally in 2022. Latest data to the end of 2024 from the service reported that had now increased to 76 per cent compared to 50 per cent nationally.

In addition, staff at the service said there was less bureaucracy as a result of the set-up and reported fewer hospital admissions for those patients.

It added that patients felt empowered with their care, which was instrumental in patients’ outcomes given diabetes requires self-management plans.

The study was published in the Journal of Interprofessional Care.

Professor Valerie Gladwell, Director of the University of Suffolk’s Institute of Health and Wellbeing, said: “Over the last decade nationally we have seen a rapid increase in the number of people with diabetes, causing thousands of additional deaths each year, creating further health problems and increasing demand on NHS services.

“Those with diabetes often have to navigate a piecemeal system where many providers deliver care over a range of services, which can often lead to fragmented and variable  patient outcomes.

“Our evaluation of the North-East Essex Diabetes Service has clearly found the service provides a holistic and integrated approach to care which has increased patients’ autonomy and delivered better patient outcomes than those recorded by other GP practices across England.

“The NEEDS model could have significant implications for practices within diabetes care and also for other long-term conditions.”

Diabetes UK figures presented in the research reported that more than 4.9 million people in the UK have diabetes, around 8 per cent of those type 1 diabetes and 90 per cent with type 2.

In north-east Essex alone, more than 18,400 people were reported to be living with diabetes at the time of the study, with a further 5,700 people estimated to be undiagnosed.

It means the percentage of people in north-east Essex living with diabetes equates to 7.3 per cent of the population – higher than the national average of 6.2 per cent.

Figures from the service since the research was published has indicated that the number of people in north-east Essex now living with diabetes has risen to 25,600. 

NEEDS was formed in 2014 with the input of local health commissioners and Suffolk GP Federation, aiming to address issues with fragmented care, long travel distances to healthcare services and varied patient outcomes.

The service provides a single point of access for patients and an integrated care pathway through a diabetes specialist team, podiatrists and combined specialist multi-disciplinary team clinics. An out-of-hospital specialist service designed to support healthcare in the primary sector was also developed as part of the service.

Sheila Smyth, Diabetes Service Manager, said: “We are really proud of the established diabetes services we have set-up in north-east Essex over the past 10 years. They have withstood the test of time, through the pandemic and various changes in the NHS, and we have maintained top national ranking with care and patient outcomes.

“Our close working relationship with primary care means that the patient journey is smoother and care can be provided efficiently and effectively with fewer delays. All of the team are passionate about providing an excellent, patient-led service.” 

To find out more about the North-East Essex Diabetes Service, visit the website here.

The full journal article can be found online here.