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GPs set to face contractual diabetes screening targets

Exclusive NHS chiefs are planning to introduce incentives for GP practices to carry out targeted screening and follow-up of patients at high risk of diabetes, under the new national prevention programme announced this week.

Pulse can reveal that the new drive, aimed at curbing the growing incidence of type 2 diabetes, will see practices paid to create a register of patients at high risk of going on to develop diabetes and for reaching targets on follow-up interventions.

The national diabetes prevention strategy, led jointly by NHS England, Public Health England and Diabetes UK, will see at-risk patients receive free cooking classes and Zumba on prescription, and is set to be rolled out nationally from April next year.

In the meantime, seven pilots have been set up to assess ways to identify people at risk, for example through GP practice-run schemes and the NHS Health Checks programme, as well approaches to help people lose weight and normalise their blood glucose.

But Dr Jonathan Valabhji, NHS England’s clinical director for obesity and diabetes, told Pulse the programme is likely to involve ‘levers’ such as the QOF and enhanced services, in order to make targeted screening and prevention – in line with NICE recommendations – more systematic in general practice.

Dr Valabhji told Pulse: ‘We’re exploring those options – it’s an obvious place to look, computer systems can generate a register of those at high risk of diabetes.

‘We have a separate workstream as to how we will embed this in practice and what levers we will use – not just the formation of a risk register but for many aspects of the programme.’

Asked if this would involve QOF and enhanced services specifically, Dr Valabhji said NHS England was exploring the options, although he would not be drawn on specific mechanisms or targets and emphasised managers were ‘acutely’ aware of the pressures facing GPs in devising the programme.

Dr Valabhji said: ‘We are looking at levers – I’m not going to commit to which one it will be, but we’re exploring the options, which I’m sure you can guess what we’re thinking around that.

‘We have to be acutely aware of the capacity in general practice [and] create this programme without massively increasing the ask on GPs who are already at the limits of capacity.’

He acknowledged that services for GPs to refer to were currently inadequate but said the national strategy would bring them up to scratch and provide the ‘impetus’ for more screening in practices.

‘There’s not a huge incentive to make your practice IT system create a robust register for those in the middle category of glucose intolerance, unless there is somewhere to send them on to. Once we have that in place, the impetus to actually get the register and all these other things will be there.’

GPC chair Dr Chaand Nagpaul said GP practices are already ‘over-saturated’ and questioned what the screening could achieve without guaranteed investment in other areas.  

Dr Nagpaul says: ‘We need to be careful not to continue this mantra that everything has to be done through GPs. General practice is already over-saturated and there are many factors that create obesity – simply giving practices incentives isn’t going to solve the rising rates of obesity in the UK.

‘Even if GPs identify high-risk patients, it’s often the lack of provision of interventions that is the limiting factor. It’s of little value diagnosing obesity if there isn’t easy access to affordable exercise programmes or enough trained counsellors, and if the Government won’t address the availability of healthy foods, the way food is advertised, education and school meals.’

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Readers' comments (12)

  • Free cooking classes, great!
    But these people also need support from Government in pushing food industry to change ingredients, label food properly.......
    It's a Public Health issue, so get some form of Public Health initiative rather than dumping more on GPs.

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  • "levers".......I'm not a ******* machine....some puppet that responds to being poked.
    we need some investment, not bloody "levers" which sounds more like something used at Crufts dog show.

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  • Check out this "Recipient for Inequality" http://foodandpoverty.org.uk/wp-content/uploads/2015/03/ARecipeforInequality_WEB.pdf

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  • Peter Swinyard

    We really have got to the "one in, one out" stage in what we can cope with in practice.
    In isolation, no doubt this looks like a good idea.
    In practice, there is no slack for us to be levered into doing this unless there is a suggestion of what we could stop doing. Agree with the first comment that this is primarily a public health issue but of course, "GPs are ideally placed to,,,,,," (those that remain, at least)

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  • I'll tell you who I'd ideally placed to carry this out

    Public health.

    GPs are not convenient screening tool. I would have welcomed improved public health if my working hours are not 50+. I can barely core with current daily demands of worried well, never mind adding fuel to this.

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  • This is a public health issue. Let Public Health take it on, not GPs. We are more than fully occupied with our main job.

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  • No

    Already doing far too much

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  • Agree with all said above

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  • Vinci Ho

    Perfect idea in a perfect world . Easy said than done.
    Primary prevetion to be implemented by primary care.
    What is reality? Primary care is overcompensating to take up a lot of work from secondary care because of cost cutting . Politicians have to be honest about what can be delivered in NHS if they are not really going to pump in more funding.

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  • It's only coming our way because we are perceived as cheap workers . We need to convince them otherwise .

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