Quality Standards for Diabetes Care Toolkit

Psychologists: 0.2–0.4 FTE per 10,000. Meeting the emotional and psychological needs of people with diabetes is an integral part of diabetes care. A range of psychological skills will be required to deliver specialist psychological support to those people with diabetes with complex psychological needs associated with their diabetes. Key aspects of a psychological service include patient care, training and supervision of the wider diabetes team, research, audit and service development.
All this should be additional to any specialty expertise provided by primary health organisations, general practice teams or iwi/Māori providers as the population groups being served have differing levels of complexity requiring different skill sets. Services providing diabetes care across the spectrum of providers should also be linked to, and work as, part of the base specialist secondary care service MDT. Specialist secondary care service and primary care workforce requirements will vary by DHB, population characteristics, ethnicity, deprivation, geography and model of care. Development of the primary care workforce is important as more routine and moderate-complexity diabetes care is provided by general practice teams or PHO based teams.
According to the Health Workforce New Zealand (HWNZ) Diabetes Service Workforce Review (2011), primary health care teams should receive appropriate training and support, and should be sufficiently experienced to deliver high quality care to the increasing diabetes population. Primary health care teams should be configured to provide structured team-based long term condition care which will include:

coordination of all components of care

a comprehensive ‘free’ annual diabetes review for all patients with diabetes

adequately funded time to provide full assessment, education and ongoing monitoring of people with type 2 diabetes

Whānau Ora models of care applied in practice.
The Ministry of Health Service Specifications for Diabetes Services require nurses to be trained in accordance with the National Diabetes Nursing Knowledge and Skills Framework (NDNKSF) (Snell et al 2009). Other disciplines could also benefit from the same requirements (HWNZ 2011).
Various opportunities based on the NDNKSF exist for professional development, such as tertiary based programmes, online learning via the Health Mentor Online resources (available at: www.healthmentoronline.com/), and locally delivered programmes. Specialist diabetes services have a role in supporting the development of the primary care workforce across all disciplines; however, appropriate resourcing is required to enable this to occur.
Developing the Māori workforce across the spectrum of service providers and disciplines is essential in order for services to provide appropriate care to Māori individuals, their whānau and all New Zealanders (Ministry of Health 2013c). In 2012, there were 77,929 Māori students studying in tertiary institutions in New Zealand. Of these 12,116 (15.5%) students were enrolled in health-related subjects with 2285 (18.9%) students completing their health-related qualification in that year. Durie (2003) supports increasing the indigenous workforce and discusses pertinent points when looking at workforce issues for Māori. For example, if the doctor and patient are from different cultural backgrounds there is a greater likelihood of non-compliance and misdiagnosis. Furthermore, Durie (2003) recommends giving priority to developing an indigenous health workforce that has both professional and cultural competence, including adopting indigenous health perspectives, such as spirituality, into conventional health services. Emphasis should also be given to self-determination and autonomy. These recommendations from 2003 remain relevant for today.
Similarly, developing the Pacific workforce is also a priority. The Taeao o Tautai: Pacific Public Health Workforce Development Implementation Plan 2012–2017 supports the implementation of the national public health workforce strategy Te Uru Kahikatea 2007–2016. Based on a range of research and sector consultations, Taeao o Tautai outlines priorities and actions to:

strengthen the Pacific public health workforce

increase the capability of the non-Pacific workforce to improve Pacific health gain and reduce inequities.
www.health.govt.nz/publication/taeao-o-tautai-pacific-public-health-workforce-development-implementation-plan-2012-2017