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Background  Standardised delivery of patient care remains an essential facet of the NHS. In 2004, the general practice contract for delivering specific primary medical services incorporated a financial payment: Quality Outcomes Framework (QOF). In majority of practices, these reviews are completed by the practice nursing healthcare team.    Aim  To understand if the combined care (CC) clinic improves the efficiency in delivering patient reviews.    Method  The CC clinic was designed in 2015 inviting patients with diabetes; who may also have other long-term conditions, to be addressed in a ‘one stop’ approach. It is implemented by healthcare assistants (HCAs) supported by apprentices, who perform standard checks such as blood pressures, urine dipstick checks, smoking data, and health promotion that are protocolled. Where there are abnormalities noted, the HCA is able to escalate to the practice nurses who are supported by a GP lead.    Results  QOF diabetes data were reviewed from 2015–2016 (636 patients on register) and 2016–2017 (649 patients on register). Results showed a marked percentage increase between years in the following indicators: DM003 (last blood pressure measurement ≤140/80 mmHg) 7.29%; DM006 (proteinuria/microalbuminuria) 6.20%; and DM009 (foot exam) 3.21%. All other diabetic indicators apart from two showed a percentage increase. The proportion of patients seen between April–October also increased in the subsequent year.    Conclusion  The CC clinic provides a method of patient review in an efficient process, without the need for multiple visits, thereby increasing practice capacity to focus on other aspects of patient care and work streams.

The combined care clinic: a strategy in improving quality and efficiency related to essential patient reviews in the UK