• Aimed to improve the care of people with diabetes and provide a framework for personalised care in long-term conditions, put those with diabetes in the driving seat and give them the tools and confidence to manage their conditions.
  • Run in partnership with Diabetes UK and NHS Diabetes.
  • Programme ran between 2007-2012 at three pilot sites: Tower Hamlets Primary Care Trust, Calderdale and Kirklees Primary Care Trusts and NHS North of Tyne.

The Year of Care programme aimed to take a new look at the relationship between people with long-term conditions and the NHS, using diabetes as an exmplar. The longer term goal was to enable patients to manage their own conditions and reduce the burden on the NHS in terms of avoidable admissions, ambulance call-outs and A&E costs.

Training was given to develop care planning consultation skills (using the appropriate implementation tools), allowing clinicians and patients to work together to create packages of care that were personal to the patient. Once developed, care plans were regularly reviewed.

Key outcomes

  • Care planning was adopted in a majority of practices across the pilot communities.
  • 76% of people with Type 2 diabetes on practice registers had at least one care planning consultation.
  • 1,000 health care professionals were trained.

Key benefits

  • People with diabetes reported improved experience of care and real changes in self care behaviour.
  • Professionals reported improved knowledge and skills, and greater job satisfaction.
  • Practices reported better organisation and team work.

Key learning

The Year of Care programme found that care planning was a huge cultural change for organisations and those involved, with success depending on:

  • commitment to care planning right from the top, right from the start
  • support for reorganisation of routine diabetes care from clinics and administration teams
  • robust training linked to practical approaches
  • support for those adopting this approach.