Diabetes Patient Journey




A patient’s care navigation journey

What happens when you are referred to the service.

Patients can be easily referred into the service via several different streams including general practice, hospital, and community services. Once referred into the service, a one-to-one holistic needs assessment will be undertaken by the care navigator. Following this, the care navigation team will support and assist patients for up to four months. With this engagement patients will have an increased self-belief and ability to self-manage their diabetes

Step 1

You can be referred to this service by your GP, a health care professional or via a community service. When you are referred you will be contacted by a Care Navigator from the service.

  • Your Care Navigator will arrange to meet with you for a consultation. You can have a virtual consultation (over the phone) or you can have your consultation in-person.

Step 2

During your consultation, your Care Navigator will talk to you and ask you some questions about your condition, symptoms, and the help you might need.

  • They will complete a personalised assessment for you which will help identify your needs and goals.

Step 3

Your Care Navigator will work with you to identify the support or services that can help you manage your own diabetes. They will give you the information that you need to make your own decisions. They will also direct you to the most appropriate health professional or other services.

  • These might include connecting you with other organisations that can help you with healthy lifestyle choices, education and training, housing and social care matters or help with managing money.

Step 4

The Care Navigator will contact you again for a follow-up conversation.

  • This is to evaluate whether the services you have used have met your needs and to see if you need further support.