Table 3.

Development themes, data extracts, and survey responses (n = 315)

Theme – CCM area		Response rate
Clinic visits and organization of clinic – delivery system design		84 (27)
Appointment systems	SD: “more flexible later appointments;” “interactive booking systems;” “producing a leaflet guide to all the diabetes services available with relevant phone numbers for self-referral;” “one stop shop for all health appointments could be co-ordinated to save time.” FG: “I get appointment letters, reminder letters, that’s good. But they just say ‘diabetes.’ And it can be a nurse appointment or a doctor. And I just don’t know what they are.”
Clinic organization (maximizing the time)	FG: “So it’s something about making sure that all the information that’s needed for the consultation is on the table, ready to roll when you’re actually going to have the dialogue, rather than, ‘Oh we need this, we need that, and, you know, it won’t work so well.” FG: “If there were two rooms available, one waiting for people watching the telly if that’s what they want to do for their own well-being, others might want to go in an education room, and there could be videos on the telly about products or ways to handle certain things. But they wouldn’t be forced on people, is what I’m saying.”
Interaction with health professionals – productive relationships (patient/professional)		82 (26)
Continuity	FG: “I would prefer to see the same doctor each time.” SD: “Seeing the same clinician so they can follow your care plan.”
Access to health professional	FG: “I call the nurses up...very helpful talking to her, because sometimes, you know, when you’re really high and you’ve been doing great for a while, it’s hard to think clearly, isn’t it.” SD: “More time from professionals to check on me between appointments.”
Patient involvement	SD: “Being able to talk and ask questions freely without feeling you are taking up too much time;” “Trying to build up a relationship with doctor and nurse;” “Doctor very passionate about his subject but needs to explain in layman’s terms;” “Take more time to listen to patients.” FG: “I think what would be really useful is if you had a plan, that each doctor updated a plan that they discussed with you in terms of what you’re going to do … I think that would be really, really useful, because then you could coordinate everything.”
Self-management support – self-management support		82 (26)
Technology support	SD: “More available help on using the pump;” “Keeping us up-to-date with latest technology. I would like a way of knowing my sugar levels 24 hours a day (like a watch);” “Updates on the latest treatments.” FG: “Use of and support for technology is so big in this hospital, I think we should have somebody who is on call on clinic day, so that they can talk about some aspects of using electronic products. So it’s not just the doctors and nurses.”
Telecare use support	FG: “For email contact, the response should preferably be the same day, when you need it.” SD: “Faster response time to email enquiries and telephone messages, sometimes this takes 48 hours plus.”
Educational resources	FG: (about DAFNE) “It’s brilliant, it is brilliant. It’s a little group like this and everybody talks and it really is fantastic.” SD: “It would be good to be part of a support network of diabetics of a similar age so you could discuss and; compare experiences – especially when it comes to exercise;” “Information of educational classes available – when and where!”
Emergency support	FG: “I’ve rung the GP, I’ve rung NHS Direct, I’ve rung all sorts of people but they were not able to help me...having emergency numbers would be good.” SD: “Perhaps a between appointment online trouble shooting service for unpredictable problems.”
Psychosocial support	SD: “Better understanding of the emotional impact of diabetes.” FG: “I think it all comes down to sort of emotional and mental support, which I know that doctors and nurses now are fully aware, you know.”
Care integration – delivery system design		24 (8)
Holistic model of care	SD: “Any complication arises like heart problem, kidney, eyes should all be looked after in the same hospital so they can communicate easily with other specialists and would not be extra time consuming like trying to find out other results.”
Integration of services	FG: “I do wish that all the facilities were here though, so that I didn’t have to get a letter from my doctor basically and have to have the same tests again.”
Not sure	Not able to identify anything specific to improve.	25 (8)
Usual care	These comments were generally saying just keep providing the current service.	19 (5)

Abbreviations: CCM, chronic care model; DAFNE, Dose Adjustment for Normal Eating; FG, focus group; GP, general practitioner; NHS, National Health Service; SD, survey data.