Abstract
Background: Our health our say (1) and Diabetes Guide for London (2), recommend a move from hospital services to the community encouraging collaborative working between primary and secondary care. At a foundation hospital a joint Diabetes Rapid Access clinic (RAC) has been established to provide prompt access to specialist care, with a hospital Consultant Diabetologist and Community Diabetes Specialist Nurses (CDSN) from two local Primary Care Trusts. Patients are seen within 4 weeks of referral, with a view to a single assessment visit, with a discharge action plan and support from the Community DSN for implementation. Aims: To evaluate the dynamics and outcomes of a newly established Diabetes RAC, responding to the needs of the local diabetes population. Method: We looked at clinic attendance; route of follow up and glycaemic control at six month. Results: An analysis of the clinic dynamics including attendance rate showing low non-attendance at 10% (national average 18%). A comparison with a previous new patient clinic’s audit (3) with an 18% discharge to primary care; whilst RAC follow up was 61% to primary care (21% CDSN support; 21% primary care alone and 19% RAC follow up for 1 to 2 appointments). Only 39% required referral into secondary care services. The median HbA1c improved at 6 months by -0.9%, with an interquartile range between 1.85 and 0.2. Conclusions: The RAC has shown: improved access to specialist support, with high rates of attendance, joint working across primary and secondary care associated with positive patient benefit in improved glycaemic control.