Co-production is essential to effective commissioning and service development, says London’s diabetes care pathway

Sugar lumps with a dice in the middle with the options of yes or no

This guide is the result of discussions with health professionals and people with diabetes Types 1 and 2, and surveys investigating the levels of service provision in London.

The reason for this work is because people with from diabetes often suffer from mental health issues, such as depression, anxiety, phobias, adjustment to their condition, eating disorders, and sexual problems.

Psychological wellbeing

Being diagnosed with a long-term condition, particularly diabetes, can be life-changing, and people may find it hard to:

  • Accept the initial diagnosis
  • Adjust their lifestyle, especially diet and blood sugar monitoring
  • Live with the condition and its consequences
  • Deal with the potential complications
Hands holding a paper fortune-teller

Being diagnosed with diabetes can be life-changing


Therefore, it is essential that adequate psychological support is available for all diabetic patients, particularly those who are harder to reach, such as young people at transition, and black and minority ethnic groups. This guide brings together the views of professionals, patients, and carers in London, and produces a range of recommendations for commissioners and policy-makers to apply when commissioning psychological support services for people with diabetes, so that services can be improved.

The recommendations in the guide include:

  • Improving access to services by providing “a range of interventions” depending on the severity of the support need – useful pyramid model has been developed to help measure the severity of the mental state.
  • Involving patients and carers in the design of services and apply NICE Quality Standards when delivering care
  • Ensuring that the diabetes workforce is adequately trained to identify people who may need additional support.

The guide has been written for a London audience, but the recommendations are relevant to the wider UK audience, because diabetes is a national problem, and while demand for psychological support may vary from region to region, it is important for commissioners to be aware of resources available to help them design relevant and effective services for their patients and with their patients. Relieving the symptoms of mental health, will help people manage their diabetes better, which will improve their quality of life, while reducing the burden on the health system.

Person comforting another person in distress

It is essential that adequate psychological support is available for all diabetic patients


This is a really useful guide full of practical examples, clear and focused recommendations, and a useful framework upon which to measure the severity of psychological issues suffered by people with diabetes. It is all about looking after the individual, patient-centred care, rather than the condition.

Organisations commissioning diabetes services should think about how they can build stronger partnerships with mental health teams, raising their awareness of diabetes and the mental health needs of diabetic patients. The guide contains a very useful set of resources. It does focus on London, but organisations can see how their service provision and population compares, and adjust what they can take from this document as a result. To illustrate the recommendations they are presenting, the authors have supplied case studies with contact details, so that if you want to find out more you can get in touch and perhaps even visit to learn more. Spend some time in your teams and look at how big the need for improved psychological support in the diabetic community is. Look at the recommendations in this guide and see which are most applicable to your organisations. And, when changing services, remember to involve the service users as they will have a different perspective, which will make the service redesign even more effective.

Two versions of A to B - one a scribbled line and the other a straight line

Organisations commissioning diabetes services should think about how they can build stronger partnerships with mental health teams


London’s diabetes care pathway: Commissioning recommendations for psychological support (PDF)
London Strategic Clinical Networks
August 2014

Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+
Mark as read
Create a personal elf note about this blog
Caroline De Brún

Caroline De Brún

Caroline has been a medical librarian in a variety of NHS and academic roles since 1999, working in academic, primary and secondary care settings, service improvement, knowledge management, and on several high profile national projects. She has a PhD in Computing and currently develops resources to support evidence-based cost and quality, including QIPP @lert, a blog highlighting key reports from health care and other sectors related to service improvement and QIPP (Quality, Innovation, Productivity, Prevention). She also delivers training and resources to support evidence identification and appraisal for cost, quality, service improvement, and leadership. She is co-author of the Searching Skills Toolkit, which aims to support health professionals' searching for best quality clinical and non-clinical evidence. Her research interests are health management, commissioning, public health, consumer health information literacy, and knowledge management. She currently works as a Knowledge and Evidence Specialist for Public Health England, and works on the Commissioning Elf in her spare time.

More posts - Website

Follow me here –