Objectives: To assess the cost-effectiveness of the WISDOM self-management intervention for type 2 diabetes compared with care as usual. Design:We performed a difference-in-differences analysis to estimate differences in risk factors for diabetes complications between people in the WISDOM group (n = 25, 276) and a control group (n = 15, 272) using GP records. A decision analytic model was then used to extrapolate differences in risk factors into costs and outcomes in the long term.Setting: Participating GP practices in West Hampshire and Southampton, UK.

Introduction: The West Hampshire Community Diabetes Service replaced traditional hospital-based diabetes outpatients in 2010 and has been successfully recommissioned, one of the first community diabetes services to complete the commissioning cycle. Method: The successful introduction of traditional diabetes services into the community requires clear leadership and a strategic vision. Unlike many hospital-based services, the community setting is at the frontline of Clinical Commissioning Group (CCG) targets for recommissioning. Thus, the threat of change is relentless and must be embraced rather than feared. As a result, the community setting can offer a new approach to the management of long-term conditions, with healthier and more productive partnerships between healthcare professionals and patients. We have identified four success criteria: skills for leadership, strategic vision, stakeholder partnerships, and shared learning. Results: The success of the diabetes service redesign in West Hampshire is reflected in successful recommissioning of the service by the West Hampshire CCG. This is one of the first such services to be successfully recommissioned in the country. Conclusions: Relocating general diabetes services into the community has been a catalyst for improved integration between specialist and primary care in West Hampshire. The process of service redesign and recommissioning is not widely communicated between consultant diabetologists, who will be pivotal to developing and delivering high-quality community care. Communicating these messages to doctors in training will ensure newly-appointed consultants have the skills required to lead change in local diabetes services and ensure high performing services are recommissioned successfully.

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