Published on 27 November 2023

A ground-breaking diabetes “prehabilitation” service has been launched in Wirral, to support people at risk of not having diabetes treatment needs met.

The service aims to reduce surgery postponements, tackle waiting lists, and improve post-operative outcomes for people living with diabetes.

The service uses population health tools and analysis of hospital waiting lists to identify and support those most at risk of having surgery postponed.

Since April 2023, the service has supported two Primary Care Networks – Moreton and Meols Primary Care Network and North Coast Alliance Primary Care Network, funded by the North West Coast Clinical Networks.

The service has recently extended across Wirral to all Primary Care Networks. The goal is for the approach to be adopted nationally. 

The diabetes prehabilitation service uses the Cheshire and Merseyside Combined Intelligence for Population Health Action (CIPHA) population health management system, on Graphnet Health’s CareCentric platform.

CIPHA surgical waiting lists at Wirral’s Arrowe Park Hospital are used to identify patients with diabetes who are awaiting surgery and have a HbA1C over 69mmol/mol or a BMI over 40.

The early identification of patients at risk of having their surgery postponed removes the need for GP surgeries to make referrals. The service also receives referrals directly from secondary care, for people that have had their surgery postponed, and have diabetes-related risks to their health.

Once identified, patients are contacted within 48 hours and booked in for an appointment with a diabetes prehabilitation health coach, in a local community setting, such as a library.

Diabetes Prehab Service Launched

Picture: Josh Grace, Elaine Anderson, Steph Hartley, Lucy Holmes, Rhian Davies, Lucia Wheeler, Felipe Davis-Guzman – the One Wirral CIC Prehabilitation team

If a person’s HbA1c is over 69, they are automatically booked in for an appointment with a diabetes specialist nurse, who will look at medicines management and optimisation.

Once they have seen the health coach and nurse, they commence a personalised prehabilitation lifestyle plan, which they follow up until surgery, whether that is a matter of weeks or months.

Lucy Holmes, Wellbeing Lead at One Wirral Community Interest Company, said: “The population health and data-driven approach means we are able to contact the right people at the right time and give them the best intervention before their procedure, without anyone slipping through the net.

“We look at their lifestyle and they are encouraged to participate in activities, including the free diabetes exercise sessions that are held in the community each week. Their medications are also assessed. It means we are looking at a person from a holistic point of view, not just clinically and not just non-clinically. It is a true community-based, multi-disciplinary team approach.

“We are so pleased to be able to roll this out across Wirral, but it is an approach that could easily be lifted and shifted. We would love to see it adopted nationally, because we have seen the many benefits of getting people fit before surgery.”

Dr Dave Thomas, Wirral Diabetes GP Lead, added: “With diabetes, we know that if someone is living with excess weight or their sugar levels are very high, then that comes with additional surgical risks, higher complication rates, they are more likely to have a longer hospital stay, and they are more likely to generally have a poorer outcome. So, a service where we are getting people fit and healthy and optimising their diabetes care prior to their operation can only benefit the patients. From a Wirral-wide point of view, it’s going to help reduce surgical waiting times, reduce complication rates, and it will allow us to reduce hospital stays.

“This really is a fantastic service. We haven’t seen anything like it anywhere else, which is really exciting and hugely positive for the patients that we are supporting.”

More about the benefits of the diabetes prehabilitation service in this video


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