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  • Embedding self-management support through the three strands of the Co-creating Health programme.
  • Run by Guy’s and St Thomas’ NHS Foundation Trust diabetes team in partnership with Southwark Primary Care Trust.
  • The project ran from September 2007 until November 2012.
  • The programme was rolled out to both secondary and primary care.

Overall, the team’s aim was to better support people with diabetes to self-manage their condition, improving their quality of life and helping to relieve the burden on the NHS. To achieve this they rolled out the three elements of the Co-creating Health programme:

  • Self-management Programme (SMP) for people with long term conditions
  • Advanced Development Programme (ADP) for clinicians
  • Service Improvement Programme (SIP) to redesign services.


The team focused on training clinicians within whole GP practices in self-management support skills. This led to a more integrated approach to providing care for people with diabetes. Achieving commitment from an entire surgery required input from senior clinical champions to encourage sign up. GP practices were keen and interested once the programme and its objectives were made clear to them.

The profile of self-management was significantly raised, evidenced by a new diabetes training package for district nurses developed by Southwark PCT which included a self-management component.

Self-management support was also placed at the core of the organisation’s £4.5 million modernisation initiative, funded by Guys and St Thomas’ Charity, aiming to transform the diabetes service across the entire local area. The team also ensured that self-management and collaborative care planning were included in the commissioning guides and local performance indicators for the PCT.

To ensure sustainability and spread in the long-term the team planned to mainstream the Advanced Development Programme by incorporating it into the core professional training for all health professionals across the area.

This project was twinned with the Co-Creating Health project at Whittington Health.

Further reading

About this programme

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