Project overview:

Swaffham & Downham PCN is partnering with ECLIPSE to supply the region with a wellbeing review programme. The focus of this programme is analysing and reducing the number of A&E admissions in adult patients who have or are at risk of developing Type 2 Diabetes and have had a high A&E attendance rate in the past 12 months. 

The solution being offered utilises ECLIPSE’s digital patient engagement platform which will automatically identify your eligible patients, engage with them via SMS, provide programme guidance using a lander page, and consenting them via access to their secure questionnaire portal. Once patient consent is given, they will be eligible for a variety of helpful review and health optimisation options that would ultimately support their needs instead of A&E attendance.

COHORTS: The cohort will be those over the age of 18 with hbA1c levels under 220 and are considered high intensity users of A&E due to having more than three A&E visits over the past twelve months. 

Once identified in Eclipse, the cohort will receive questionnaires that will inform clinicians about which reviews and optimisations to pursue for each individual patient. 

 This programme enables patient access to the following reviews and optimisations: 

• Wellbeing Review  

• SMR 

• Vaccinations 

• Monitoring Optimisation  

• LTC Optimisation  

• Mental Health Review  

• Admissions Review 

Based on the measures taken as consented to by the patient, a personalised care plan and follow-up measures will be provided.

EVALUATION: Quantitative data will be collected with Eclipse. Patient-reported outcomes and perceptions of the new pathway will be collected through patient questionnaires.

If your practice would like to take part: Please complete the below pro forma, expressing your interest and permissions for patient engagement.

Please note that you will be notified prior to any active patient engagement, and your practice will be issued with a guide on how to view patient lists and document patient reviews.