NHS

Healthier You 4 Clusters

Kent & Medway

Kent, Medway

Approx. 1.9 million
Areas / Boroughs
Kent, Medway
Population
Approx. 1.9 million
LTCP Pilot
No - Kent and Medway is NOT participating in the Long Term Conditions Prevention Pilot.

Local Integration — Referral Pathways & Stakeholder Engagement

REFERRAL SYSTEMS: EMIS is the only GP clinical system used across Kent and Medway, supplemented by document database programs; referral forms uploaded to EMIS and Ardens, plus two online form databases (DXS and DORIS) used primarily in the west and north - the admin teams running these have been pivotal in making referral form completion fluid. GOVERNANCE: All implementation decisions are made with the ICB Diabetes Programme Manager and Project Manager and the Integrated Diabetes Delivery Network (IDDN) - including consultant diabetes leads, DSNs, community providers, charity partners and public health associates.

KEY STAKEHOLDERS: IDDN, primary care, community providers, Diabetes UK and other charities.

PROVIDER EXPECTATIONS: Proactive patient engagement (education sessions, Practice Learning Time (PLT), community events, online patient information sessions) to reduce burden on primary care; recorded T2DR referral-form completion sessions have helped traction; continually review eligibility/suitability with ICB leads; regular meetings between ICB and provider on capacity/issues; use the team's extensive primary care contacts to engage low-referring practices. BSOP: Referral pathway comes directly from GP practices where eligible patients have been prescribed tirzepatide.

PROGRAMME DELIVERY EXPECTATIONS: Support young parents (feeding/nappy changing facilities); accommodate working people (out-of-hours contact, weekend/evening sessions); support people with LD, mental health and physical disabilities; minimal wait between referral and course commencement; record risks/issues/mitigations and complaints; secure fast electronic transfer of patient info into primary care systems with read-coding; produce patient leaflets and signposting; participate in ICB engagement sessions. DATA: Local datasets (including practice-level) on referrals, initial assessments, starts, discharges and retention reported weekly (simplified) and monthly (full) so the ICB can manage areas/PCNs that diverge from plan.

Meeting Local Need — Health Inequalities & Underrepresented Populations

DEPRIVATION FOCUS: ICB monitors areas high in IMD using monthly diabetes programme reporting to plot focus and intervention.

MOST DEPRIVED AREAS: Sheerness (Swale), Margate Central (Thanet), Cliftonville West (Thanet), Newington (Thanet) - Swale and Thanet dominate, with only 10 of the top 45 most deprived areas outside Thanet/Swale. Thanet is in England's top 10% most deprived; Swale and Folkestone & Hythe are in the most deprived 30% nationally; Dover and Medway also fall within the 30% most deprived. East Kent and coastal Kent (Thanet, Swale) show higher rates of cardiometabolic conditions including diabetes. West Kent (Sevenoaks, Tonbridge & Malling, Tunbridge Wells) is relatively less deprived with smaller pockets. Medway shows notably lower life expectancy and poorer outcomes vs national averages.

KEY LANGUAGES: Polish (10,455 - 0.7%), Romanian (9,280 - 0.6%), Nepalese (8,763 - 0.5%), Panjabi (4,798 - 0.3%) - 2021 Census of 1,437,219 in K&M. ETHNICITY: ~11.4% identify as ethnic minority; 88.5% White British/other White heritage; diversity higher in urban areas/transport links - Medway, Dartford, Gravesham, Canterbury - vs rural/coastal Kent. Total BME population 119,984 (Kent 92,638, Medway 27,346). PARTNERSHIPS: Use IDDN data with community partners and charities (e.g. Diabetes UK) to enable pathways into populations not otherwise reached.

Localities

Primary Care Networks (PCNs)

Showing 39 of 39 PCNs

Ashford3 PCNs
ASHFORD MEDICAL PARTNERSHIP PCN
TN24 0HZ
Q3Average
ASHFORD RURAL PCN
TN26 2NJ
Q4Affluent
MID KENT PCN
TN24 9JZ
Q3Average
Canterbury3 PCNs
CANTERBURY NORTH PCN
CT4 5BL
Q4Affluent
CANTERBURY SOUTH PCN
CT4 5BL
Q4Affluent
HERNE BAY PCN
CT6 5RE
Q3Average
Cranbrook1 PCN
WEALD PCN
TN17 3AY
Q4Affluent
Dartford3 PCNs
DARTFORD CENTRAL PCN
DA1 5ND
Q2Deprived
DARTFORD MODEL PCN
DA1 1QY
Q2Deprived
SWANLEY & RURAL PCN
BR8 7AH
Q3Average
Dartford/Gravesham1 PCN
GARDEN CITY PCN
DA10 0BF
Q2Deprived
Dover3 PCNs
DEAL & SANDWICH PCN
CT14 7DN
Q3Average
DOVER TOWN PCN
CT16 1SF
Q2Deprived
TOTAL HEALTH EXCELLENCE EAST PCN
CT15 7ET
Q4Affluent
Folkestone1 PCN
TOTAL HEALTH EXCELLENCE WEST PCN
CT20 2SE
Q2Deprived
Gravesham2 PCNs
GRAVESEND ALLIANCE PCN
DA11 8BZ
Q2Deprived
GRAVESEND CENTRAL PCN
DA11 0HN
Q2Deprived
Maidstone4 PCNs
ABC PCN
ME15 6SB
Q3Average
ATHENA PCN
ME17 4PL
Q4Affluent
MAIDSTONE CENTRAL PCN
ME15 7LN
Q3Average
THE RIDGE PCN
ME14 4DS
Q3Average
Medway8 PCNs
ASPIRE MEDICAL PCN
ME2 2PW
Q2Deprived
GILLINGHAM SOUTH PCN
ME7 2BU
Q2Deprived
MEDWAY CENTRAL PCN
ME4 3EP
Q1Most Deprived
MEDWAY PENINSULA PCN
ME3 8HX
Q3Average
MEDWAY RAINHAM PCN
ME8 9RR
Q2Deprived
MEDWAY SOUTH PCN
ME5 9LD
Q2Deprived
MEDWAY VALLEY PCN
ME5 9LD
Q2Deprived
STROOD PCN
ME2 2HA
Q2Deprived
Sevenoaks1 PCN
SEVENOAKS PCN
TN13 3AQ
Q4Affluent
Swale3 PCNs
FAVERSHAM PCN
ME13 8FH
Q3Average
SHEPPEY PCN
ME12 1UP
Q2Deprived
SITTINGBOURNE PCN
ME10 4XX
Q2Deprived
Thanet3 PCNs
CARE KENT PCN
CT8 8SN
Q3Average
MARGATE PCN
CT9 3NR
Q2Deprived
RAMSGATE PCN
CT11 8AD
Q2Deprived
Tonbridge1 PCN
TONBRIDGE PCN
TN12 6AX
Q4Affluent
Tunbridge Wells1 PCN
TUNBRIDGE WELLS PCN
TN4 8UW
Q3Average
West Kent1 PCN
MALLING PCN
ME20 6QJ
Q3Average