The feasibility of a potentially 'ideal' system of integrated diabetes care and education based on a day centre.

A new system of clinical and educational care designed to replace traditional diabetic clinics is described. The overall aims were to provide adequate consultation time, patient access according to diabetic and social needs, minimal waiting time, continuity with experienced staff and objective based learning programmes in an environment suited to learning. This was achieved by changing the role of the diabetes nurse specialist from undertaking delegated tasks to providing primary consultative care, reorganization of existing staff and provision of a purpose designed unit. This gave sufficient flexibility to arrange daily early morning and weekly evening clinic sessions for routine diabetes counselling and medical audit with primary education scheduled at other times. A year's experience showed that our major targets had been met, with the provision of adequate consultation time, halving of waiting time, ease of patient access and continuity with either the doctor or nurse in consulting role. Default rates have fallen and patient and staff morale has improved substantially. Apart from an underestimate of receptionist and a small increase in technician hours, these changes have been achieved within the predicted small revenue cost.