Michelle Smitten demonstrating some healthy snacks

Lessons learned from Pre-Diabetes referrals

The Pre-Diabetes Courses we run as part of the National Diabetes Prevention Programme have been running for over a year now. Interestingly, referrals to the course dropped (to almost unviable levels) and then rose again significantly during that time – but why? We thought we’d share some of the lessons we’ve learned about the referral process since we’ve been running the course.

During the Pre-Diabetes Course pilot period, which started in late 2015, patients came to us via a mailshot from their GP. When someone was diagnosed with Pre-Diabetes, they received a letter from their surgery, which included a leaflet from us explaining what the Gateway course offered, with contact details. If they wanted to go on the course, they called or emailed to sign up.

This worked really well. By March 2016, we’d received around 600 referrals, and had run over 30 courses, with a 92% retention rate. Feedback from patients was overwhelmingly positive. The success of our pilot, along with others, contributed to the programme being rolled out nationally.

A worrying change

However, things changed when we amended the referral process.

Under the new process, referrals came from people who had received an NHS Health Check. If a Health Check revealed Pre-Diabetes, GPs sent the patient’s details to us, and we called them on the phone to personally invite them onto the course. It sounded like a good idea.

But, despite the personal touch, the number of referrals dropped dramatically. Even worse, very few of the patients who’d agreed to go onto the course over the phone actually turned up on the day! The people who did come along were still achieving great results, so we knew the problem wasn’t with the course itself, but we were struggling to get enough people through the doors to make each course viable.

So we approached our commissioners (Birmingham South Central CCG) and worked with them to go back to mailshots. We picked up the cost of the leaflets and postage ourselves, and started working with GPs to start getting them sent out to patients again.

Back on track

Now – happily – the number of referrals is shooting up again. In just the last four weeks, we’ve run ten courses (with 15 people on each course) and more than 65 people are on the waiting list to go on a course in the next few weeks.

So why do the mailshots work so much better than a personal phonecall? We think it’s down to the following factors:

  • Awareness. Put simply, fewer people were hearing about the course. When we switched to the phone method, we were only passed the details of people who’d had a Health Check, rather than everyone who’d been diagnosed. Without leaflets, GPs were less likely to suggest the course to people, and we weren’t able to promote it as easily.
  • GPs’ authority. People take more notice of something when they hear it from their GP, so when the GPs sent our leaflet to their patients, it implied that the course was “approved”. When we contacted people ourselves – even though we were phoning people personally, telling them their GP had asked us to call, and allowing them to sign up there and then – it just didn’t hold the same weight.
  • Letting the patient lead. Perhaps counter-intuitively, requiring the patient to refer themselves turned out to be a lot more successful than phoning and asking them to sign up. Why? Well, we’ve said this before, but letting the client lead their own support is beneficial for everyone. Giving the patient the reins and allowing them to decide what action to take and when (rather than telling them what to do, and suggesting we know best) creates resilience and sustainability. In other words, those who make the decision to refer themselves to the Pre-Diabetes Course are much more likely to turn up, and much more likely to stay on track once they’ve joined.

The Gateway Pre-Diabetes Course – better than a handout!

Anyone can read about taking steps to reduce their HbA1c levels, but going on a course with other people is much more likely to make it happen.

Course attendees making healthy salsa!

The biggest difference is the social interaction. When people with similar conditions get together and start talking about their experiences, they receive extra benefits that they wouldn’t get from making changes on their own. They are happier to talk about things like weight loss and physical exercise without feeling judged, and they inspire each other.

We’ve seen people who meet on the course start their own walking groups, share healthy recipes and exercise tips, and start good habits that spread throughout whole families!

Learning is a lot more fun in a group, and the Gateway Pre-Diabetes Course includes many hands-on activities, like games and cooking sessions.

If you’ve been diagnosed with Pre-Diabetes and you’d like to take part in a Gateway Pre-Diabetes Course, call Gateway on 0121 456 7820 and ask to speak to someone from the Pre-Diabetes team.

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