COLLABORATION: Provider must work in collaboration with NEL aligning closely with General Practice, the ICB, PCNs, community providers and existing diabetes services for seamless referral pathways and minimal primary care burden. The ICB will work with the provider to streamline referral pathways.

KEY STAKEHOLDERS: ICB prevention and long-term conditions teams; PCNs; GP practices; pharmacies; community and mental health providers; LA public health teams; social prescribing link workers; VCSE; digital and F2F education providers.

REDUCING PRIMARY CARE BURDEN: Develop simple referral mechanisms including referral forms embedded within existing clinical systems; support proactive patient engagement; ensure clear feedback loops.

F2F LOCATIONS: Identify community-based locations informed by population need, deprivation and transport access - including evening and weekend delivery.

T2D BURDEN: ~160,000 diagnosed people with rising prevalence and growing burden of risk factors concentrated in the most deprived neighbourhoods and among younger age groups. NEL is the top-performing ICB for eight care processes, but access and outcomes vary by age, ethnicity and deprivation - people aged 20-30, residents of deprived areas and some ethnic minority groups face the greatest inequalities.

KEY LANGUAGES: Services must be multilingual and culturally appropriate. Priority languages include Bengali, Urdu, Punjabi, Albanian, Polish, Turkish, Romanian, Somali, Arabic, Gujarati, Portuguese, Lithuanian, French and Nepali.

ACCESSIBLE FORMATS: Subtitled videos for Deaf and hard-of-hearing users must be considered.

DATA EXPECTATION: ICB would benefit from high-quality, disaggregated data to identify inequalities in access and outcomes across eligible populations.