Following the recent DSN Forum UK survey, from your perspective, what are the biggest barriers preventing consistent implementation of advanced diabetes technologies across the UK healthcare system? 

We all know that funding is an issue, even though NHS England have provided an unprecedented amount of money to support HCL therapy. 

What the survey shows is echoed what we hear in regional meetings (like the Midlands type one network). These discussions indicate; that many centres don't have the right mix of skilled medical staff, nurses and dietitians to be able to support the increasing number of people who want these technologies or who are currently using these technologies. It appears that many of the experienced staff are concentrated in large teaching centres and many of the smaller centres tend to have less access. The competency framework we have proposed (endorsed by a number of organisations) should help reduce this inequality by identifying by helping services identify where they have a skills gap and directing them to appropriate training to ensure equitable, safe and robust services. 

What practical steps should NHS trusts and organisations take to bridge this competency gap while managing existing workforce pressures? 

There is a wealth of evidence that demonstrates the benefits of using these systems in improved clinical outcomes, reduction of risks (associated with reduction in glycaemic variance) and improvements in quality of life. My personal experience of using these technologies over the past 15 years or so is; that often the data that can be shared between individuals with diabetes and the care teams can allow more succinct consultations that focus on key areas of diabetes management, that hopefully become more meaningful /useful to the people we support. I guess the answer to the question is ensuring we have the right people, in the right place, at the right time, to support people when they are accessing services. This is a key element of the proposed competency framework as it clearly identifies different tiers of competence and links associated assessments to evidence this. This in turn, can be used to assess service level skill mix with-in teams and identify areas for development. 

While Continuous Glucose Monitoring (CGM) adoption has been relatively successful with good staff confidence, HCL implementation remains inconsistent outside specialist teams. What lessons from the CGM rollout can inform a more effective approach to scaling HCL and other emerging diabetes technologies? 

I agree. it is tricky as people living with diabetes will see so many HCPs across many different health sectors in their life and not all of them will have speciality training knowledge and skills. I think this is where collaborations with other leading organisations is so vital. In the UK we are blessed with many free training resources and guidelines to support non-specialist staff to develop skills in these areas. I think that the people working in specialist care teams at a local and national level need to feed into operational meetings and forums to highlight these resources. There is also a role with in GIRFT and national audit to promote the need for training in these areas.  

How can we ensure that advanced diabetes technologies genuinely improve outcomes for all patients? 

I think we need to ensure that the HCP, the teams and services are set up to support individual people needs. We also need to ensure that the people involved have the appropriate level of knowledge and competence to support the people they see. There has been a lot of work by NHS England (with the support of leading experts in this area) in demonstrating the benefits of using these systems and designing pathways relating to access but I am aware there is still clearly variance in access to these systems and possibly more variance in the skill sets amongst the various team. This is something we are hoping to address with the national adoption of the proposed competency framework. 

Looking ahead, what emerging diabetes technologies show the most promise for transforming care delivery in the UK?  

This is a really interesting question. We know there are various technologies currently going through clinical trials and medical device approvals. But there are really interesting developments in combined glucose and ketone sensing therapy, fully closed loop insulin delivery systems, smaller devices, combined glucagon and insulin therapies, immunotherapies and so much more. 

What specific actions need to happen in the next 2-3 years to ensure healthcare professionals are prepared to deliver these innovations safely and effectively? 

I strongly feel that integration of training, education and system delivery strategies need to be aligned. Work has started on this already, so watch this space! We are in a really exciting era of rapid developments in advanced technologies to support people living with diabetes and we all need to ensure we keep up with the changing tides.    

You’ll be speaking at DPC on diabetes technology. Could you give our delegates a preview of the key takeaways they can expect to learn from your session? 

I will be delivering 2 sessions at DPC this year, one will be alongside my colleague and friend James Ridgeway on Diabetes Technology: Where are we now? Where are we going? and how do we get there? We hope this session will give people an insight into practical strategies in providing and developing services. My second session is titled: Practical application: Using advanced technologies to support people living with diabetes. This session should give people an insight into what systems we have available, and how these can be used to support the people we see.  

Join Erica and James at Diabetes Professional Care, at 15:15-15:45 on 22nd October in the Keynote Theatre to hear more.