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The waiting game

An introduction to diabetes care and PBC

Primary Care Diabetes Society executive member Dr Azhar Farooqi puts diabetes into the context of practice based commissioning.

Primary Care Diabetes Society executive member Dr Azhar Farooqi puts diabetes into the context of practice based commissioning.

PBC is about giving commissioners the freedom to acquire services they feel are appropriate for their populations. The ultimate aim is to ensure the best possible services within the resources available.

PBC presents a great opportunity for diabetes services. Commissioners can ensure appropriate investment and develop services that are more suitable – both in terms of being closer to patients and being delivered by staff with appropriate training and skill mix.

One of the key steps in commissioning is to identify the needs of the local population. With prevalence rising and an increased focus on prevention and patient education, it should not, in most areas of the country, be difficult to argue for greater investment in diabetes services.

A service specification for diabetes (a key part of the commissioning process), once developed, should identify that services can be better delivered in the community by a combination of improved care in general practice and the use of specialist teams in the community.

Existing specialists have nothing to fear if they can be flexible in how services are delivered – in fact, specialists could see increased influence as they take up greater responsibility for training and supervising health professionals. They will also be able to develop the more specialist aspects of diabetes care.

So how can we make this happen? While the potential is there, specific drivers are needed to ensure that diabetes is a priority for service development.

Key to this is clinical leadership. In PCT areas where diabetes has become a priority, the role of clinicians has been vital. However, to have maximum influence and credibility, leadership needs to be multidisciplinary and cross sector (across primary and secondary care).

If this fails to materialise, it is likely that GPs and specialists will develop very different views on how services are to be delivered.

A further catalyst to change is having the right tools to support the commissioning process. An excellent example is the Diabetes Commissioning Toolkit (Department of Health, 2006), developed by the Primary Care Diabetes Society (PCDS) with the National Diabetes Support Team, the Association of British Clinical Diabetologists and Diabetes UK.

This template guides commissioners through the key processes in a systematic way, including needs assessment, development of a service specification, procurement and monitoring and quality assurance.

There is no shortage of authoritative clinical guidance to support this process, for example, NICE guidance on type 2 diabetes and on patient education. The aims of the NSF for diabetes are also still valid, and should be incorporated in any specification.

The key advice to clinicians who have an interest in developing diabetes services must be to form a local clinical network across the primary-secondary care interface. This should then be followed by lobbying of the key commissioning groups to develop a PBC specification for diabetes. The rest should fall into place, with local solutions emerging for specific scenarios.

Dr Azhar Farooqi is a GP in Leicester and executive committee member of PCDS. He is chair of the Leicestershire Primary Care Research Alliance and sat on the external reference group of the Diabetes National Service Framework

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