Maintaining quality

Guidelines and quality standards

Diabetes and endocrinology (D&E) physicians work through NICE, SIGN and their professional societies, Society for Endocrinology, Diabetes UK and ABCD, to produce a comprehensive range of up-to-date clinical guidelines, quality standards and guidance documents.

In addition, are there comprehensive European and North American evidence-based guidelines from the European, and American Endocrine Societies, which also heavily influence UK clinical practice.

Audit and peer review

Within the UK, an extensive programme of mandatory data collection and audit has been developed to inform and improve practice. This has been largely progressed by the profession but is now at least in part supported by NHS funds. The main hub is the National Diabetes Audit (NDA), which includes the National Inpatient Diabetes Audit (NaDIA), the National Pregnancy in Diabetes Audit, the National Insulin Pump Audit and the National Diabetes Foot Care Audit. The Society for Endocrinology coordinates a programme of audits, seeking to improve patient care.

An extensive programme of audit and outcome standards partly informed by these datasets is also used to evaluate the quality of care for patients with diabetes and endocrine disorders. Specialised endocrine services commissioned by NHS England are subject to data quality collection through quality dashboards and QIPPs. Data collected from primary care now allows us to benchmark the Quality outcome Framework (QoF) and provision of basic diabetes care. NICE guidelines include quality standards for common diabetes disorders. Payments frameworks and local commissioning agreements typically include key performance indicators based on these standards.

All D&E teams participate in regular national audits and other quality improvement projects. The SFE run a peer review programme to assess standards of care for patients with endocrine diseases.

The National Diabetes Audit for England and Wales is published annually and reports on variations in uptake of care processes, achievement of treatment targets, and morbidity and mortality. Separate national audits of inpatient care (NaDIA), insulin pump services and foot care have been incorporated. It is hoped that an audit of patient experience will be incorporated in future. In the past, focus has been mainly designed to measure and improve on processes of care (QOF-quality outcome Framework for Primary Care). Diabetes was a prominent part of the national QOF, and the proportion of people with diabetes receiving the eight or nine care processes rose as a consequence. Further improvement will need a different lever. The NHS England Mandate 2016–17 (opens PDF, 503.09KB) has introduced CCG ‘scorecards’ which will include diabetes metrics. Outlying CCGs will be held accountable for improving performance.

The CQC has included diabetes in its inspections of acute trusts since 2015, and relies on national audit data. It is good practice for diabetes departments to hold monthly mortality and morbidity meetings to identify avoidable factors in patients discussed and to address them.

NICE has produced a series of guidelines and Health Technology Assessments (HTAs) relevant to diabetes care, type 1 diabetes, type 2 diabetes, diabetes in pregnancy, diabetes in children and adolescents, management of blood pressure in diabetes, etc.

The Joint British Diabetes Societies for inpatients (JBDS-IP) have produced some excellent guidelines on many aspects of inpatient diabetes care.