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Tier 3 community specialist care

Tier 3: Community specialist care

Referrals will be triaged to tier 3 team members for:

  • Type 2 insulin or GLP-1 initiation & follow up for patients attending Tier 1 practices
  • Pre-conceptual advice for people from Tier 1 practices, more complicated Type patients from tier 2 practices + all type 1 patients
  • Group 2 licence holders for annual reviews only
  • Short term cover for Tier 2 patients if GP practice has lack of expertise/new staff.
  • Suspected autonomic neuropathy
  • Rapid access to avoid admission /recurrent severe hypoglycaemia
  • Persistent elevated Hba1c for last 12 months despite active titration of treatment
  • Referral from severe hypoglycaemia requiring 3rd party intervention for recovery (ie ambulance)
  • Referral from West call or CDU
  • Intensive support by DSN/Dietician after non-elective admission.
  • Hypoglycaemic unaware patients
  • People with Type 1 Diabetes to be offered at least a yearly care plan review.
  • People who have had an amputation
  • Moderate / high risk podiatry: foot prevention team

Mentor support and management of the HCP training model for tier 1 and 2

  • Type 2 insulin/ triple therapy mentor support in the form of Tier 3 DSN facilitation clinics or Consultant virtual clinics
  • email and phone support

Provision of structured patient education

  • Type 2 structured patient education (X-PERT)
  • Type 1 structured patient education (DAFNE)
  • Hospital in-patient