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GP-led diabetes model 'saved NHS £2m by cutting heart attacks and amputations'

A new model of diabetes care that saw GPs taking over the care of nearly half of patients with type-2 diabetes saved the NHS £2m in just one year, an evaluation has claimed. 

The 'Super Six' model of diabetes care run by Portsmouth Hospitals NHS Trust helped reduce hospital admissions and prevent complications such as heart attacks and amputations since it was started five years ago, a study published in the journal Diabetes and Primary Care found.

The findings come as NHS chiefs are planning to roll out similar schemes getting GPs to take on management of a range of conditions usually dealt with in hospitals.

The Portsmouth scheme - led by Dr Partha Kar, who has been appointed associate clinical director for diabetes at NHS England - is one of a number of schemes championed by NHS chief Simon Stevens as the kind of GP ‘one-stop shop’ approach the Government wants to see shifting care for a raft of conditions out of hospital and into general practice.

Under the scheme, which first started in 2010, GPs across the six CCGs in the area were invited to take over the care of around half of patients who were under the management of specialist diabetes clinics based in hospital.

Consultants committed to continuing the management of six key groups of patients requiring complex, specialist care, such as those with type 1 diabetes with poor blood sugar control, on insulin pumps, or requiring intensive diabetes foot care – which amounted to around half of the patients.

Of the remaining half, GPs agreed to take on 95% - most of whom were patients with type-2 diabetes who required some specialist support.

Practices were then supported in caring for these patients by a community diabetes team which included both consultants and specialist nurses from the hospital; each GP practice was visited by the consultants twice a year and GPs also had access to the team via email and telephone.

In the evaluation of the scheme at five years, consultants at the Trust estimated that, for 2014/15, the rates of both MIs and strokes had been reduced by a fifth, and the rate of amputations cut by two-fifths, compared with projected rates of each event that year.

The study also found big relative decreases in the rate of hospital admissions over the five years, including a 30% drop in admissions for diabetic ketoacidosis, and a 40% reduction in those for hypoglycaemic events.

Based on the average costs associated with these hospital admissions and complications, the team estimated the Trust had saved £1.9m in 2014/15 alone as a direct result of discharging care to GPs.

The consultant team – led by Dr Kar, who is a consultant in diabetes and endocrinology – concluded: ‘The restructuring of our services, while not always perfect or easy, has led to improvements in patient and practitioner satisfaction, HbA1c and long-term complications.

‘This has been achieved without major uplift in resources and has resulted in cost savings, both in real time by reducing follow-up appointments and hospital bed days, and long-term by optimising the health of our community.’

Speaking to Pulse in a personal capacity, Dr Kar said: 'One fundamental point is that there was investment to make it happen with for example LES schemes, so investment into community services and specialist nurses going in to train practices. Otherwise this can't happen.'

He said that funding of 'around £150,000 to £200,000' had been ploughed into the programme for enhanced services to get GPs and community nurses upskilled in diabetes management.

Dr Kar stressed that NHS England is looking at a range of different models and that the Portsmouth version  'is not a one size fits all' and 'would not be forced onto CCGs'.

Dr Andrew Green, GPC clinical and prescribing lead, said: 'Diabetes is, and will become increasingly, a huge challenge. It is recognised that the current model of care often leaves GPs struggling to get prompt advise when it is needed.

'I believe that model of care such as the "Super Six" model have great potential to improve outcomes for patients, and ensure that the skills of everyone in the diabetes care-chain is used appropriately. Successful models do, however, have a number of common features; adequate funding, full engagement with GPs, and rapid access to specialist advice.'

GPs set to take over care of hospital patients

The Portsmouth 'Super Six' model is one of the new models of care tested out by NHS 'vanguard areas' that are now being promoted by NHS England in a bid to shift more hospital care into the community, with the aim of reducing unnecessary hospital use and cutting costs.

NHS chief executive Simon Stevens recently said this could see GPs taking on management of outpatient care for 'all the -ologies' .

And Health secretary Jeremy Hunt has given the approach his full backing, saying he wants GP practices ‘one-stop shops' to 'revolutionise' GPs' role.

However, as plans for shifting hospital to community care could become a vehicle for swinging cuts under the Sustainability and Transformation Plans, there are concerns over whether sufficient funding will ever materialise.

Readers' comments (10)

  • The core success of the QA model is getting some very motivated GP practices on board.

    they have also been some of the first to move to new drug regimes despite pressures to stick to old treatments.

    But bottom line is - this was done with increased funding up front

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  • Dr Kar is a Consultant and a GP? . Not many of these hanging about.

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  • This is poor reporting. Ask the GP's on the ground how it has been for them. The degree of clinical risk involved is staggering. I have not met any who are happy with this process, except the hospital who have managed to halve their work load by dumping it on untrained GP's. well done.

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  • We have been doing this for the last year in Dorset but we haven't been paid a jot for taking on all that extra care and responsibility. We have also been criticised for increases in our drugs spending on diabetes care. Agree with above - this needs to be funded properly or we should not take it on.

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  • Does it mean the hospital care for diabetes is poor than provided by GP's ? Are they worth the resources ?

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  • Unfunded therefore will collapse crack handed
    Extra work in GP land means less will be done elsewhere
    Cloud cuckoos

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  • As there is no control group it is hard to know if Portsmouth's reductions in admissions are any more than found anywhere else. Nationally there was a 25% reduction in admissions for diabetes related complications reported by a group in Imperial College from 2004 to 2009. So this kind of change in admissions can happen anyway.

    Unfortunately we can't know if this worked from this evaluation. As Marmaduke points out it will collapse if unfunded and it is unlikely to be funded without a convincing evidence base. Particularly given some of the other concerns raised.



    Authors: A. Calderón-Larrañaga, M. Soljak, E. Cecil, J. Valabhji, D. Bell, A. Prados Torres, A. Majeed
    Does higher quality of primary healthcare reduce hospital admissions for diabetes complications? A national observational study
    Diabetic Medicine June 2014; 31(6): 657–665.

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  • This article doesn’t make much sense. In the first place, I don’t understand how a 30% reduction in admissions for diabetic keto-acidosis can be attributed to a new system for managing type 2 diabetes. Can someone explain?
    Secondly, I really do get angry when GPs are expected to do the work of hospital doctors with a fraction of the time. 10 minutes is just not long enough. Hospital consultants get much longer. The reason that it was possible to eliminate the much valued general physician role from hospitals is that GPs are now the general physicians, managing the bulk of chronic diseases in a fraction of the time with a fraction of the resources and training for those roles. Practice nurses also have an important role to play in managing these conditions but there is no proper training and career pathway to produce the practice nurses we need. So the whole things is being done on the cheap with GPs taking on massive risk due to the increased likelihood of making mistakes as they rush through their complex cases. (Or run late and get complaints). It all creates huge stress. No wonder GPs are voting with their feet. I’d love to have the time to manage problems like diabetes properly. The same goes for the other chronic conditions. But you would need to double the number of GPs and practice nurses to make that possible.

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  • I've been to a number of meetings where GPs proudly say "we are the new general physicians".

    It isn't true, we are the dumping ground for secondary care work.

    Wouldn't it be more sensible to improve the secondary care service?

    Let's be honest eventually it'll just be an excuse to blames GPs, for poor diabetic care.

    The NHS doesn't need to work smarter, it needs more money/staff

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  • Healthy Cynic

    Is no-one out there going to question these results?

    The claim is that by switching diabetes care from consultant to GP they have achieved, within 5 years, a 20% reduction in MI and stroke, and a 40% reduction in amputation.

    Is it only me who finds these statistics entirely implausible?

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