The Big Interview – Dr Dinesh Nagi

Dr Dinesh Nagi is a diabetes and endocrinology consultant at Mid Yorkshire NHS Trust and is based at Pinderfields Hospital Wakefield.  He has been instrumental in setting up the local managed diabetes network and was director of the local Retinal Screening Programme till recently. He also led the service redesign locally, leading to  commissioning of  integrated diabetes care supporting primary care in Wakefield.

He has just become the chairman of the Association of British Clinical Diabetologists (ABCD), and here he tells The Diabetes Times his plans for the future and lays out his priorities for the next year.

What’s the biggest challenge today for consultants in diabetes care?

These are extremely challenging but exciting times, where resources are limited and demands are unprecedented. The consultant colleagues in diabetes are striving hard to continue to deliver high quality services with good outcomes. Hospital based diabetologists are struggling to cope with the high demands imposed by acute and general medicine workload while trying to balance their job plans to deliver specialist services in diabetes and endocrinology. The ABCD is committed to support its membership through these times.

What are your priorities now you have taken as the chairman of ABCD?

The main priorities as a new chair will be to ensure continuity of mainstream ABCD work, collaborating with other diabetes/endocrine societies and DOH to deliver on main priorities as outlined in the five year forward. More recently, ABCD committed to work with the GIRFT programme to address unwarranted variations in care in diabetes and endocrinology.  This is a new initiative by the NHS.

I would like to focus on improving care of people with type 1 diabetes through establishing a Type 1 Diabetes Collaborative, supporting the recently established Insulin pump Network (hosted by ABCD), and ensuring educational support is provided for healthcare professionals and patients.

What can we expect to see from ABCD over the next year?

As a relatively young organisation, we have progressed significantly and now have a solid infrastructure to provide support needed to build and progress further. We would like to increase our core membership year on year. ABCD will continue to work with ABCD representative from Wales, Scotland and Northern Ireland to ensure we are not seen as a predominant English organisation.

The short term and intermediate term priorities will include ensuring robust infrastructure and governance. ABCD is committed to work with our pharmaceutical partners who continue to support the organisation year by year. We have recently introduced regular meeting with our key sponsors so that we can take their view on board to improve this partnership, which supports ABCD but also indirectly contribute to the Specialist Society.

How does ABCD influence improvements in diabetes care?

ABCD’s main task is to support the specialists in D&E to deliver a high quality of diabetes services. ABCD achieves this by providing high quality CME for its members through twice yearly clinical meetings which are highly valued by its members. ABCD has also been at the forefront of supportive an innovative mentor ship programme for new consultants, within the first two years of their appointment.

This is a unique programme of its kind and ABCD has been at the forefront of this development. Professional input into consultations from NICE. ABCD works closely with NHS on work priorities and providing society support wherever needed. A significant work is to provide professional and expert input into all the work NICE does, especially on guideline development and other technology appraisals. ABCD has been at the forefront, raising profile of service for people with type 1 diabetes and establishing an insulin pump network and now more recently with plans to establish a type 1 diabetes collaborative, which are well advanced.

What is your assessment of the latest results from the National Diabetes Inpatient Audit?

NADIA was put into place in 2009, by an innovative idea by one of the ABCD members, Dr Gerry Rayman from Ipswich. This National Audit platform allows us to collect data as a snap shot of in-patient diabetes care in acute trusts. The participation in NADIA is 97 per cent, which is an excellent achievement, but does need to be 100 per cent. Plans are in place to achieve that.

The audit, with all its limitations will form an important data source to address the variations in care for in-patient care, under the GIRFT programme (Getting it Right First Time). The national lead for this for D&E has been appointed. I believe that the audit data will contribute significantly to improve in-patient care.

What’s your assessment of the updated diabetes NICE guidelines published last year now there has been time for them to be digested and implemented?
ABCD was one of the key stakeholders for the guidance and responded by consulting on the updated guidance. Through our professional input, NICE introduced several changes to this consultation, where this new updated guidance is more representative and reflects what happens in real life. I am very proud of this positive influence on this guidance, which will ultimately help clinicians in primary and specialist teams make better choices and benefit patients.

Should the role of the diabetes specialist doctor always remain in secondary care?

The role of specialist diabetes doctors is to provide specialist care to those who require it. This is irrespective of where they are based. Recently, there has been a move of specialist moving to work in integrated care settings and support primary care.  I personally believe that this new way of specialist input into primary care is the key to upskilling the GPs and practice nurses to deliver good quality diabetes care and for future sustainability of diabetes service. There are several advantages of this way of working.  This, in my view, could be adopted by several other specialties in medicine.

What has been the biggest innovation in inpatient care since you began practicing?

There have been many, but the biggest innovation in in- patient diabetes has been advent in-patient diabetes teams, and technological advances (such as insulin pumps and continuous blood glucose monitoring) and structured diabetes education for both type 1 and type 2 diabetes.

What’s been your biggest achievement?

My biggest achievement has been to lead and develop the Wakefield Service Redesign and implement the integrated diabetes care model. We started this new model in 2009 and overall making contribution to help patients to live with diabetes successfully.

What is the future of diabetes care in the UK?

The future of diabetes care in the UK is bright, but we all need to learn to work differently and collaboratively ensure we deliver good patient, experience and outcomes and reduce variations in care. That is the only way forward and a big challenge facing the NHS and all of us who work in the specialty. I am positive that we will see significant changes in the next five years.

Finally, it is an honour to be ABCD’s seventh chairman. As one of the founding members of the association, it is a privilege to lead the organisations during these exciting times where there are a lot of initiatives and opportunities to improve the health of People with Diabetes. We must not let these slip by!

ABCD is the main diabetes specialist society, which supports the specialists in diabetes and endocrinology as well as trainees. ABCD was established in 1997 and celebrates its 20th birthday this year.

ABCD has been part and parcel of Joint British Diabetes Societies (JBDS) and has worked to deliver several high quality  National Guidelines relevant to the people with diabetes who get admitted to  hospital or are cared by hospital teams. I, as a chair of ABCD, will be working with the JBDS to  support this excellent work”.