Improving care for all individuals living with diabetes in Haringey

This service works collaboratively with the Bridge Renewal Trust to support vulnerable/poorly controlled patients to optimise their diabetes control.

A patient-focussed approach sits at the heart of the service model which follows the ‘right care at the right time, right place’ for appointments and consultations. Patients can now benefit from a choice of face-to-face or remote appointments offering them the flexibility and convenience needed to support service utilisation and reduce non-attendance.

The service provides high quality support for patients who are identified as having uncontrolled diabetes or those finding navigation though existing services difficult. This includes a strong focus on vulnerable patients or those in harder to reach/engage communities.

Case Study: Supporting Turkish speakers living with diabetes in Haringey

Despite the offer of a new diabetes service to support newly diagnosed patients and those with difficulty controlling their symptoms, take-up among Turkish speaking patients in Haringey remained low. In response, the Haringey GP Federation established language group clinics facilitated by a Turkish language-speaking care navigator.

Following GP referrals to the clinic, one-to-one holistic needs assessments were undertaken by the care navigator. In addition a clinical pharmacist diabetes specialist undertook a desk-top medication review for each patient and was available for patient consultations at group clinics. Advice from a dietician was also key to the success of this service, with specialist dietician-led group clinics providing further support.


“People loved talking about their medication. They did not want to leave the group.” Service Care Navigator

  • GP teams received 10 medication reviews per session, saving practices time
  • The involvement of the pharmacist, ensured identification of medicine ‘red flags’
  • 10 patients were enrolled to the gym by the care navigator
  • The group clinic enabled people to bring along relatives for support
  • Culturally specific diet myths were busted
  • Patients with diabetes engaged and started to self-manage