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GP diabetes education is set to be standardised

GPs will have to provide specialist

education clinics to all patients with diabetes and 'rigorously' train practice staff who deliver advice under proposed National Institute for Clinical Excellence guidance. But GPs have warned there are no resources immediately available to set up any new initiatives.

The NICE appraisal consultation document said that although GPs may already be providing some sort of education to diabetics, the advice was not standardised.

Instead, practices will have to use education teams comprising a minimum of one specialist diabetes nurse and one dietitian. The draft guidance said the teams could also benefit from podiatry specialists.

Patient education models should offer structured advice on vascular risk factor control, managing diabetes-associated complications and improving quality of life.

The guidance, which will feed into the national service framework for diabetes, said: 'Some of the educational programmes offered are unstructured, very few have been formally evaluated, and few individuals who deliver education have been formally trained for this purpose.'

Patients with type 1 diabetes should be offered the Dose Adjustment For Normal Eating (DAFNE), a specialist eating programme for diabetics which costs £545 per patient and is currently only available at 10 sites in England and Wales.

Dr Neil Munro, a GP in Claygate, Surrey, and associate specialist in diabetes at the Chelsea and Westminster Hospital in London, said lack of

resources and money would make the recommendations difficult to


He added: 'From my hospital-based experience, it would be very difficult for a practice to set up an educational team. The nurses and clinicians would need a lot of training.'

Dr Munro said DAFNE clinics were a good idea but there were no resources in place to set one up locally. 'There isn't a DAFNE near us and I doubt patients would be prepared to travel far enough to access it,' he added.

GP Dr Mike Knapton, Cambridge City PCT diabetes lead, said he already had staff in place to fulfil most of the NICE requirements, but he believed it would be 'unrealistic' for GPs to take on the recommendations by themselves and suggested that they work together locally.

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