Local Organisations Work Together To Increase Uptake In Annual Diabetes Checks

Local partners are improving health outcomes for people with diabetes by working together and making it easier for people to get their annual checks.

The Mid and South Essex Community Collaborative; a partnership between Essex partnership University Trust (EPUT), North East London Foundation Trust (NELFT) and Provide Community Interest Company (Provide) has been selected by NHS England to take part in the Diabetes Innovation Recovery Fund, a pilot which aims to support people with diabetes, to get their annual checks.

There are approximately 69,000 (5.7% population) people living with Diabetes across mid and south Essex (MSE) who could be at risk from diabetes complications, and additionally 28,705 people with Non-Diabetic Hyperglycaemia (NDH) at risk of developing T2 Diabetes within 3 years.

Despite the serious complications of diabetes, often called ‘the silent killer’, not all people with diabetes are attending their annual health checks, which are called the key diabetes care processes.

This pilot project has selected to work with Southend Victoria and Chadwell and Tilbury Primary Care Networks to increase recovery of treatment targets to pre-pandemic levels by 2025.

In addition to getting their annual checks done at their local GP surgeries, people are being offered additional locations and times to make it easier for them. As well as being given local information to support them with their mental health and wellbeing, diet and exercise, and educational programmes.

Dr Deepa Shanmugasundaram, a local GP and System Clinical Lead for Diabetes at MSE Integrated Care Board says, “We have been able to identify two areas of need within mid and south Essex (MSE) from available data and we are working with those GP practices in Southend Victoria PCN and Tilbury and Chadwell PCN alongside our local partners, such as Health Watch, the local councils, Diabetes UK, and support groups. We are reaching out to individuals to gain an understanding of what our services could do better to support people to get the annual health checks, and access the services and resources available locally.”

Ryan Cossington-Webb, Associate Director Intermediate Care, AHP and Specialist Services and Diabetes Lead for the Mid and South Essex Community Collaborative says, “It is important to ensure equity across our services and allow everyone an opportunity to receive high quality care. This is why we are engaging with our local communities and allowing people to co-produce the way we deliver services and the experiences people have. We want to hear from you about how we can improve your experiences.”

Dr Chris Olukanni, a GP and Clinical Director for the Chadwell and Tilbury PCN says, “We want to ensure that everyone gets the support they need, especially those more at risk. People from Black African, African Caribbean and South Asian (Indian, Pakistani, Bangladeshi) backgrounds are at a higher risk of developing type 2 diabetes from a younger age. Research has shown that there are several risk factors linked to this, and we want to educate people about managing their health regarding diabetes.”

If you have diabetes and have a doctor’s surgery within Southend Victoria PCN or Chadwell and Tilbury PCN, we would love to hear from you on how we can improve your experiences. You can check the GP surgeries involved by visiting the websites:

If you are an individual with diabetes, a local support group, organisation or business which could help support this project please email: [email protected]