Nora Mzaoui
Focused Care Practitioner
Wellsbourne Healthcare Community Interest Company (CIC), Brighton
Co-Director
Bridging Change
The Challenge
Having worked for a number of years in the Voluntary and Third Sector in an area of significant deprivation, Nora started working with Wellsbourne HealthCare CIC, a GP Practice, over 3 years ago, in one of the most deprived neighbourhoods in Brighton. Last year, in partnership with Bridging Change, they successfully applied for funding, from Sussex Diabetes Clinical Network, administered through a local charity, East Sussex Community Voices.
In addition, Nora is a co-director of the charity Bridging Change, which focuses on tackling health inequalities within an ethnically diverse population. After researching the scale of the problem in her practice, Nora and her colleagues realised that a significant number of patients did not engage with the National Diabetes Prevention Programme (NDPP), and many of these patients had literacy issues. Patients reported that the information provided at the time of diagnosis was vague, often misunderstood, and left them feeling unsupported.
Another complication in reaching this cohort of patients was that the NDPP only offered online sessions or sessions in a different neighbourhood, requiring them to take two buses, which excluded many who had poor digital access.
Patient feedback
“Having a nurse explain the test and facts was very helpful“
“Informative and helpful“
“I learnt a lot and the knowledge and intentions of the team to help was evident”
“I felt that the workshops were run professionally and and our views were all considered and valued”
The Innovation
After conducting a clinical systems search in the GP practice for the period 2022 to 2023, Nora and the team identified 289 patients who were either pre-diabetic or had received a Type 2 Diabetes diagnosis but had not engaged with education.
Nora, in partnership with the co-director from Bridging Change, designed a local workshop to address the lack of patient engagement. They launched the “Let’s Talk Diabetes!” project, inviting patients by both letter and text message to participate in three monthly workshops and one-to-one interviews. Co-production workshops were held with individuals diagnosed as pre-diabetic or with Type 2 Diabetes, focusing on understanding the reasons behind the lack of engagement and exploring ways to improve communication and increase participation in NHS programmes.
However, Nora and the team noticed that patients were not responding to the workshop invitations. After reaching out, they discovered that only a small group could commit to three monthly sessions, with some patients explaining they had already obtained the information they needed from other sources.
In response to these challenges, Nora and the team at the surgery adopted a different approach. They incorporated regular sessions with the Diabetes Nurse at their weekly drop-in café, where Point of Care testing is available, and where necessary, a GP appointment can be arranged for the patient. Additionally, Nora and the team partnered with Xyla Health to bring support closer to the patients.
Although the work is still in its early stages, Nora and the team have successfully engaged with 20 patients—17 attending the drop-in sessions, and 3 having one-to-one sessions for those unable to attend in person.
As this approach is proving more successful, Nora plans to make diabetes information more accessible on the surgery’s website, along with providing easier access to specialist support following diagnosis.
As a result of these efforts, Wellsbourne Healthcare has made significant improvements: simplifying text messages, holding regular diabetes awareness sessions at their community café, partnering with Diabetes UK for ongoing support, and improving the clarity of online information. These changes aim to enhance patient engagement and support in managing diabetes.
The Impact
- Patients
- Increased awareness and understanding of the condition
- Increased levels of patient self-management
- Improved patient access
- System
- Increased referrals to the National Diabetes Prevention Programme (NDPP)
- Improved use of patient communication resource through the practice website
- Increased collaboration across health and social care organisations
