REFERRAL PATHWAYS NDPP: Searches, referral forms and alerts embedded in primary care clinical systems. Majority of activity uses a 'search and refer in bulk' approach, with letters/texts sent to eligible patients by GP practices - this generates much higher referrals and supports venue coordination.

REFERRAL PATHWAYS T2DR: Majority of referrals occur opportunistically through Primary Care consultation due to referral criteria (medication adjustments/patient activation) and limited places. A small number of practices search and invite in bulk. Approach has resulted in high rate of referral/uptake.

REFERRAL PATHWAYS BSOP: Tirzepatide (Mounjaro) prescribing in General Practice triggers automatic referral into BSOP; SNOMED codes used to track participation and oversee compliance. INCENTIVES: NDPP - various approaches over recent contracts; T2DR - no incentive; BSOP - local enhanced service funds GPs for prescribing Tirzepatide, BSOP referral and engagement monitoring.

REDUCING PRIMARY CARE BURDEN: North West Coast Clinical Network (NWCCN) facilitates a Diabetes Programme Delivery Steering Group attended by ICB Place Leads, NHSE, Public Health, Diabetes UK and provider - manages strategic identification/targeting of practices and risk management. Funding has been used for an NDPP Engagement Lead hosted by the provider. STAKEHOLDERS: NWCCN; ICB Place Leads; NHSE; Public Health; Diabetes UK; primary care; provider.

F2F LOCATION PLANNING: NWCCN holds a well-developed list of risk-assessed and actively used venues across the ICB - this list will be shared with the new provider or expanded with ICB commissioning leads.

DEPRIVATION: 35.7% of the population in C&M live in the most deprived 20% of neighbourhoods in England. Knowsley is the second most deprived borough in England, followed by Liverpool. Life expectancy is 12 years fewer in the most deprived areas than the least deprived; women in most deprived areas live 12 years less than those in least deprived (13 years for men). DEMOGRAPHICS: Population 2.8M; Under 18s 19.1%; 65+ 19.6%; BAME 5.4%; Core 20 35.7%. Population forecast to grow 10.8% by 2040 with 45% more over-75s.

KEY LANGUAGES: Limited official translation across the ICB. Place-level top non-English languages: Cheshire East/West - Polish then Romanian; Halton - Polish then Romanian (occasional Chinese, Indian languages); Knowsley - Polish; Liverpool - Arabic (most diverse area, highest variety/prevalence); Sefton - Polish/Romanian (white EU growth); St Helens - Polish then Romanian; Warrington - Polish/Romanian; Wirral - Polish. Top five overall: Polish, Arabic, Romanian, Chinese, Urdu.

DIABETES PREVALENCE: Cheshire 6.2%, Halton 7.4%, Knowsley 7.2%, Liverpool 6.0%, St Helens 7.3%, South Sefton 6.8%, Southport & Formby 6.6%.

PRIORITY GROUPS: Higher prevalence of smoking and unhealthy weight in most deprived communities; clear inequalities across wider determinants (education, housing, employment) split by age, ethnicity, gender, deprivation and place. COVID-19 mortality rate was 5% higher than national average between March 2020 and April 2021.