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A decade in diabetes specialist services, 2000 to 2011, in England: the views of consultant diabetologists and diabetes specialist nurses amidst persistent healthcare delivery change

A decade in diabetes specialist services, 2000 to 2011, in England: the views of consultant diabetologists and diabetes specialist nurses amidst persistent healthcare delivery change
A decade in diabetes specialist services, 2000 to 2011, in England: the views of consultant diabetologists and diabetes specialist nurses amidst persistent healthcare delivery change
Aims: To assess the impact of continual major National Health Service reorganization on commissioning, organizational and delivery arrangements for secondary care diabetes services. To explore how consultant diabetologists and diabetes specialist nurses perceive the issues facing diabetes specialist services in 2011 and how these have changed in the preceding decade.

Methods: We used a longitudinal case study approach that combined quantitative and qualitative methods. Five locations in England were purposively selected to represent the wider diabetes specialist community, and seven semi-structured interviews were conducted. Interviews were recorded, transcribed verbatim and analysed using Framework analysis. Findings were compared with and contrasted to results from national quantitative surveys of diabetes specialist services undertaken in 2000 and 2006.

Results: Clinicians viewed positively the expertise and commitment of multidisciplinary teams and their ability to adapt to new situations. Negative perceptions persisted throughout the decade, relating to the continual change that threatens to dismantle relationships and services which had taken many years to establish. Lack of resources, inadequate manpower planning and poor access to psychological support for people with diabetes remained constant themes from 2000 to 2011.

Conclusions: A willingness to innovate and work differently to improve services was identified; however, clinicians must be supported through organizational changes to ensure people with diabetes receive high-quality care. The disruptive nature of organizational change was a recurrent theme throughout the decade. Periods of stability must exist within commissioning to allow relationships, which are key to integration, to be maintained and permit service improvements to develop.
0742-3071
1662-1666
Gosden, C.A.
d965519c-7091-4126-a95b-730b39c2b3c0
Barnard, K.
1ade2840-48a4-4bb3-b564-0a058df8297f
Williams, D.R.
116ed98d-8a4a-4511-9dba-00fb6cfb7c98
Tinati, T.
cd5da855-0c1a-4831-bd3d-6baeafa3ae07
Turner, B.
de2c6fb8-a72d-4d79-bf9a-b46b2807690b
Holt, R.I.G.
d54202e1-fcf6-4a17-a320-9f32d7024393
Gosden, C.A.
d965519c-7091-4126-a95b-730b39c2b3c0
Barnard, K.
1ade2840-48a4-4bb3-b564-0a058df8297f
Williams, D.R.
116ed98d-8a4a-4511-9dba-00fb6cfb7c98
Tinati, T.
cd5da855-0c1a-4831-bd3d-6baeafa3ae07
Turner, B.
de2c6fb8-a72d-4d79-bf9a-b46b2807690b
Holt, R.I.G.
d54202e1-fcf6-4a17-a320-9f32d7024393

Gosden, C.A., Barnard, K., Williams, D.R., Tinati, T., Turner, B. and Holt, R.I.G. (2015) A decade in diabetes specialist services, 2000 to 2011, in England: the views of consultant diabetologists and diabetes specialist nurses amidst persistent healthcare delivery change. Diabetic Medicine, 32 (12), 1662-1666. (doi:10.1111/dme.12786). (PMID:25916313)

Record type: Article

Abstract

Aims: To assess the impact of continual major National Health Service reorganization on commissioning, organizational and delivery arrangements for secondary care diabetes services. To explore how consultant diabetologists and diabetes specialist nurses perceive the issues facing diabetes specialist services in 2011 and how these have changed in the preceding decade.

Methods: We used a longitudinal case study approach that combined quantitative and qualitative methods. Five locations in England were purposively selected to represent the wider diabetes specialist community, and seven semi-structured interviews were conducted. Interviews were recorded, transcribed verbatim and analysed using Framework analysis. Findings were compared with and contrasted to results from national quantitative surveys of diabetes specialist services undertaken in 2000 and 2006.

Results: Clinicians viewed positively the expertise and commitment of multidisciplinary teams and their ability to adapt to new situations. Negative perceptions persisted throughout the decade, relating to the continual change that threatens to dismantle relationships and services which had taken many years to establish. Lack of resources, inadequate manpower planning and poor access to psychological support for people with diabetes remained constant themes from 2000 to 2011.

Conclusions: A willingness to innovate and work differently to improve services was identified; however, clinicians must be supported through organizational changes to ensure people with diabetes receive high-quality care. The disruptive nature of organizational change was a recurrent theme throughout the decade. Periods of stability must exist within commissioning to allow relationships, which are key to integration, to be maintained and permit service improvements to develop.

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DME Paper Revision Jan 2015 v2.doc - Accepted Manuscript
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Accepted/In Press date: 23 April 2015
e-pub ahead of print date: 16 May 2015
Published date: December 2015
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 380222
URI: http://eprints.soton.ac.uk/id/eprint/380222
ISSN: 0742-3071
PURE UUID: 2c8d2f39-5685-490f-ab1f-1efa39263b8a
ORCID for R.I.G. Holt: ORCID iD orcid.org/0000-0001-8911-6744

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Date deposited: 07 Sep 2015 13:34
Last modified: 18 Feb 2021 16:56

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Contributors

Author: C.A. Gosden
Author: K. Barnard
Author: D.R. Williams
Author: T. Tinati
Author: B. Turner
Author: R.I.G. Holt ORCID iD

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