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Should practices be paid to screen for type 2 diabetes risk?

Professor David Haslam and Dr Kathryn Griffith debate whether practices should be paid to screen patients at risk of type 2 diabetes

Yes

Prof David Haslam - online - 330x330

GP practices do need to be incentivised, although the assessment can really be done in the last two minutes of a consultation.

The QOF would be the quickest and easiest route, because that could be done tomorrow by taking money away from useless indicators. Currently, we’re incentivised for making an obesity register and the bigger the register the more we get paid, which makes no sense.

It is early days and NHS England has got its work cut out to think of something that the BMA is going to let happen – but I think at least managers have finally woken up. They have twigged that – as we have been telling them all along – if diabetes doesn’t get sorted out, that’s the end of the NHS. If they take steps to tackle obesity, they will also be doing a lot to prevent sleep apnoea, fatty liver disease and cardiovascular disease.

Of course, the scheme should also ensure there’s some investment around the interventions – there needs to be better access to  activity and good nutrition, and that involves public health as much as the NHS, in terms of food reformulation and sugar reduction.

Professor David Haslam is a GP in Bedfordshire specialising in obesity and chair of the National Obesity Forum.

No

Dr Kathryn Griffith - online - 330x330px - square

If we don’t do anything about diabetes then the situation is just going to be completely out of control, but there’s no point GPs finding someone at high risk of diabetes if there are no services available to help them.

It’s important we get the support set up to help people take more exercise, lose weight and adjust diet. Once that is available then there’s a reason for GPs to do something. Otherwise you’re hitting people with a stick by telling them they are at risk and not actually helping them.

Some areas have got fantastic support set up already – but in areas like mine, where we’re always struggling with underfunding and overspending, prevention is always the first thing that gets cut. We don’t have community dietetics, we have very little additional exercise support.

I know that there is evidence that we can prevent people progressing to diabetes, or progressing as rapidly, but please don’t get the GPs to do it all – there’s no point detecting people and saying ‘this is going to happen to you’, and then saying ‘well there’s nothing you can really do about it’.

Dr Kathryn Griffith is a GPSI in cardiovascular medicine in York and the RCGP clinical champion for kidney disease.



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Readers' comments (6)

  • Prof Haslam - " Currently, we’re incentivised for making an obesity register and the bigger the register the more we get paid, which makes no sense."

    You don't seem to grasp QOF registers at all, which is alarming for someone claiming to be a Prof and a GP. The register is a yes or no, all or nothing. You get paid the same whether there are are 5 or 5000 on the register.

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  • Ivan Benett

    I must say I'm disappointed in Kathryn's line on this, especially as she is a close friend and colleague in CVD & renal disease.
    Many people present with complications of diabetes which CAN be prevented by care BP control primarily, but also managing glyceamia we can reduce the risk of microvascular disease. Statins will reduce the risk of CVD events. When established comlications appear we can prevent disability and decline, for example in renal disease, but giving ACEIs.
    So the sooner we find people with diabetes the more likely we are to prevent, identify and manage complications.
    Preventing diabetes itself is beyond the scope of general practice, although we have our part to play in advocating weight and dietary control, and exercise.
    I believe we have a duty to diagnose people with diabetes early. Whether that's incentivised or not is for others to argue about. I shall continue to look for it in at risk populations.
    See you soon K

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  • WAKE UP - No new work for free. Screening is a new activity, not included in the GP contract - therefore it should be paid for. Do you expect to go to Tesco and take an extra load of bread home without paying at the till (not on BOGOF before we get a smart arse)?

    It is the job of the commissioner to ensure they commission appropriate services for their population. If is the jobs of the provider (Ie GP Practices) to deliver ONLY what they are commissioned to do, and to highlight to the commissioner where additional activity could be commissioned to the benefit of the patient and the system as a whole. If they don't commissiong (PAY) don't do it. Otherwise you end up with General Practice drowning.

    We should not be even contemplating taking on new work for free. We should be considering which activities we currently do unpaid (ECG, Spirometry, ABPM) that we will give notice on and cease UNLESS THEY ARE COMMISSIONED.

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  • Anonymous | Practice Manager | 07 April 2015 12:44pm

    I'm afraid you're mistaken. The QOF formula adjusts the value of the points you are paid by your prevalence adjusted against the national average. Therefore, if you have a higher obesity register than the national average the value of the QOF points you get paid increases - ie, you get more money for having a bigger register. Instruct your clinicians to BMI everyone who looks a little portly and see how your income adjusts.

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  • Pipin Singh

    Any extra work at present is very tough! Where does the line get drawn. We are currently coding all our new pre diabetics and providing all the relevant information to them in the hope that this will prevent progression to diabetes. Should we get paid for it? Well a general practice is crumbling as we speak because the morals of most clinicians is abused; as a profession for some reason we find it difficult to say no and the consequences of that are currently speaking for themselves!

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  • I disagree that there is no point of screening for diabetes if there are no services available to help them. This actually discriminates against people who would be willing to help themselves and modify their own diet and exercise regime armed with the knowledge that they are at risk of type 2 diabetes. How the screening is commissioned is another matter.

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