Table 2 Description of the case study sites

Implementation site (1)

(Direct relationship, active facilitation)

NHS Trust providing specialist children’s services, commissioned from a wide range of Primary Care Trusts (PCTs, 17 in total); differing arrangements in place in relation to funding and contractual agreements.

Pressure to provide IPT had particularly been driven from the patient population (children and parents); as a consequence the diabetic team were keen to become more skilled and up to date in terms of providing pump services.

Implementation site (2)

(Direct relationship, active facilitation)

NHS Trust providing acute services; formed from the previous merger of two Trusts.

Diabetic services provided at two separate sites, one with a history of using IPT and the other less receptive to the new technology.

No formalised processes or systems in place for managing the introduction of IPT at an individual patient or service level prior to involvement with NTAC.

Commissioner (PCT) instrumental in applying for NTAC project.

Mentor site

(Direct relationship, no facilitation)

NHS Trust providing an integrated hospital, community and primary care diabetic service.

Originally applied to be part of the NTAC implementation project, but already well-advanced in terms of the implementation of IPT; as a consequence the organisation was invited to act as a mentor site for IPT.

The Trust had an internal manager with responsibility for commissioning, who facilitated the relationship with the PCT to develop and negotiate contracts, an arrangement that worked particularly well in the introduction of IPT.

Non-NTAC site

(No direct relationship, passive facilitation)

Specialist Diabetes Centre, hosted by an NHS Trust, having recently moved from a primary to secondary care setting, as a result of the changes to commissioning in the NHS.

On account of its specialist status, the Centre dealt with a large number of commissioners (PCTs) across a wide geographical area.

The introduction of IPT was led by a clinical academic, who had submitted an application to become an NTAC implementation site. This application was unsuccessful; however, the consultant and some of his colleagues had continued to try and develop their pump service without input from NTAC.