Quality Standards for Diabetes Care Toolkit

Workforce implications

Implementation of the Standards may require investment or re-organisation of current diabetes services. Health Workforce New Zealand’s Diabetes Workforce Service Review (2011) identified the need for appropriate workforce planning in order to meet anticipated demand in the year 2020. The report identified the need for active succession planning for all disciplines involved in diabetes services as expertise required to deliver high quality care develops over time and with ongoing exposure to challenging clinical scenarios. Many of these experienced diabetes professionals are in the latter part of their career. There are limited or no training positions or resource mentors for the future diabetes workforce across the core disciplines of medicine, nursing, dietetics and podiatry. In general, workforce planning should be matched to population health needs.
Specifically, the review concluded the following: ‘People with diabetes have differing health care needs relating to their diabetes subsequently the diabetes workforce comprises a large multidisciplinary team spanning the health continuum and service providers with varying levels of expertise. As diabetes occurs across the lifespan and concomitantly with many other conditions, multiple services are required at different times or at the same time. Workforce surveys reveal inadequate provision of core disciplines in diabetes care (medical, nursing, dietetic and podiatry), little or no succession planning and inadequate training positions. Structured patient education is delivered inconsistently and is not always evidence-informed; a national curriculum in patient education is needed’ (p 2).
Specific recommendations pertaining to diabetes service delivery included the following:

implementation of the recommendations in the Cardiovascular and Diabetes Quality Improvement Plan should continue

funding models should support interdisciplinary care and innovative practice

communication between patients’ diabetes providers should be enhanced to ensure effective coordination of care

health professionals should practise to the top of their scope of practice as per the Health Practitioners’ Competency Assurance Act.
Targeted investment in workforce training and development was recommended as follows:

role delineation should be clear so that diabetes education and training can be appropriately targeted

all diabetes health care providers, both professionals and non-regulated health workers, should receive appropriate ongoing education and training from an accredited education provider

agreed national curriculum and standards should be developed for the delivery of education and training

the National Diabetes Nursing Knowledge and Skills Framework (NDNKSF) should be utilised as a foundational document to guide curriculum development for all other disciplines

ongoing education updates should be a requirement for the delivery of diabetes services

informational competency, to ensure that health professionals can effectively utilise IT systems, should be developed and/or enhanced

diabetes health care professionals should be trained and supported to enable them to deliver emotional and psychological support themselves, at an appropriate level, with the aim of embedding this as an integral part of health care professional training for the future

cultural competency should be demonstrated by outcomes’ measures

mentor programmes such as Te Ohu Rata o Aotearoa aimed at increasing the number of Māori specialists should be supported.

Diabetes UK published the Commissioning Specialist Diabetes Services for Adults with Diabetes Report in 2010. The report states: ‘Highly skilled and committed primary care teams now deliver a greater amount of routine diabetes care, including much of the day-to-day support for many people with diabetes. The role of the multidisciplinary specialist diabetes team remains the hub and spoke of high-quality care for all. Diabetes care may be delivered by a variety of providers in a range of different settings, resulting in the model of care varying from one locality to another. How specialist diabetes care is organised will vary depending on local needs, skills, resources and organisation. All integrated diabetes services must see to it that specialist diabetes expertise and support are built into the model of care’ (p 5).
Whilst the Diabetes UK report recommends minimum staffing levels (Diabetes UK 2010), to date there are no such New Zealand recommendations for minimum workforce requirements; however, various modelling exercises are under way. Current New Zealand expert opinion from clinical leaders suggests minimum staffing requirements for specialist practitioners providing secondary care level services, as per the Ministry of Health Service Specifications for diabetes care (2011), in all disciplines working within the co-located (Scottish Intercollegiate Guidelines Network 2010) multidisciplinary team (MDT):