A quality improvement facilitator was employed by the PCT and trained by the Improvement Foundation to manage the project to improve the care of diabetes and COPD.

A new diabetic one stop clinic was set up to run once a week. Before it opened, primary and secondary care clinicians both spent time in reviewing and discharging patients. New digital retinopathy services were set up and these are provided in the hospital and also in community settings. In addition, the PCT employed four case managers for long-term conditions.

Working with the PCT and the Improvement Foundation, one practice increased its proportion of the diabetic population with an HbA1c of 7.4 or less from 60% to 75% within two years, through using quality improvement methods.

The overall results from the PCT showed improvements of 151% for retinopathy, 210% for spirometry, 87% for cholesterol, plus a 49% reduction in COPD admissions to hospital.

Throughout the project, the quality improvement facilitator received support from the Improvement Foundation including:

• Quality improvement skills training
• Regular meetings to share ideas and best practice, and to develop and review progress against objectives and collaborative measures.