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GPs to manage up to 50% of type-1 diabetic patients under CCG plans

Exclusive General practice could be managing as many as 50% of type-1 diabetes patients under plans drawn up by a CCG, which would see many discharged from specialist management.

NHS Dorset CCG’s proposal for a new community diabetes scheme suggests that ‘stable’ patients with type-1 diabetes – as many as 50% – could be discharged from secondary care management, with commissioners monitoring practices’ referrals and admissions rates. 

The CCG has said that the ‘commissioning intention’ it has issued is a first step before consultation with GPs, but one practice told Pulse it was already being presented to staff as a ‘done deal’.

The GPC has said it is ‘flabbergasted’ that a service could propose such a high level of specialist management from practices without details of how GPs would be supported or funded.

GPs have said that practices don’t have the capacity, resources or expertise to take on a significant increase in patients – particularly those patients who require significant specialist input.

The Adult Diabetes Service Model for Dorset highlights that GPs and practice nurses will continue to act as ‘care co-ordinators’ and supervise multidisciplinary care of a patient by specialists.

But it adds that ‘up to 50% of Type 1 and 90% of Type 2 people with diabetes will have their care provided in primary care with support, if clinically indicated, from the Dorset Diabetes Care Service’(DDCS).

Support will be through ‘virtual’ and face-to-face multidisciplinary team meetings, telephone or email advice and consultations, but the document states all practices will provide certain ‘core services’. 

Its commissioning intentions document says:  ‘All newly diagnosed Type 1 people with diabetes will have a rapid initial assessment of treatment needs and referral to the Dorset Diabetes Care Service to agree a joint personalised care plan.

’It is expected that a significant number of these people will have their care provided within primary care with support from specialist services as needs change.’

The new proposed service will:

  • Triage all referrals;
  • Offer practices an annual visit by a consultant from the service, to update on best practice and services;
  • Monitor practices’ referral and admissions rates for diabetes.

It also highlights that: ‘Individuals will be discharged from specialist care and the discharge information will be shared with the person with diabetes and GP and include future management plan and indications for re-referral.’

Dr Nigel Price, a GP in Bournemouth, told Pulse that his practice’s nurse diabetes lead attended a local diabetes management meeting where ’it was presented by the CCG as a done deal and our practice nurse was very surprised that none of the doctors knew anything about it’.

He added: ‘Shifting up to 50% of type-1 diabetics into primary care, we just haven’t got the resources in terms of time, knowledge, or money. Anything that’s required to deliver a safe service for our diabetics.’

Chair of the GPC’s clinical and prescribing subcommittee Dr Andrew Green told Pulse: ‘This is quite clearly a transfer of work into general practices and the absence of any mention of funding is simply flabbergasting.

‘This proposal, and in particular the training requirements mentioned, go clearly beyond essential services and if adequate funds are not provided GPs should use the resources available from the BMA to ensure that their practices and patients are not damaged by this transfer of work.’

A spokesperson for NHS Dorset CCG told Pulse: ‘NHS Dorset CCG has issued a commissioning intention and is currently working with local providers, including primary care, to develop an implementation plan.

‘The changing role and responsibilities of primary care providers will need to be supported through the release of resources from our current model of care.’

Readers' comments (20)

  • 'continue to act as ‘care coordinators’'

    = primary dumping ground for services that can't work out how to safely follow up their own patients or results

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  • Not this GP. No way.

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  • Ya right... More work... Take a hike....
    I know smell of some money initially some of us will sign up..lets be honest.. Then u guys make it compulsory for all of us.

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  • Already happening in Liverpool. However, some of those being discharged are only classifiable as "stable" in that their IFCC is persistently dreadful, not because their diabetes is well controlled! Yes, it's cheaper in the community but which part of the job can we choose to eliminate in order to look after these patients? Oh, yes.........that's right.........none

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  • We need to stand firm. any transfer of work must be negotiated and resourced.
    When the figures are done properly GP management often comes out more expensive because we go for a truly holistic approach

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  • NICE Guideline CG15 Nov 2015 1.2.2 Advice to adults with type 1 diabetes should be provided by a range of professionals with skills in diabetes care working together in a coordinated approach. A common environment (diabetes centre) is an important resource in allowing a diabetes multidisciplinary team to work and communicate efficiently while providing consistent advice.
    1.2.3 Provide adults with type 1 diabetes with: •open-access services on a walk‑in and telephone‑request basis during working hours •a helpline staffed by people with specific diabetes expertise on a 24‑hour basis

    Not many GP practices can provide this. (I'm not claiming that hospital-based services do much better). Any GP trying to look after a T1DM without a specialist involved is hostage to fortune, and had better have balls of steel and great MDO cover the first time there's a ketoacidosis or an amputation because they are going to need them!

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  • I think it is achievable in some specific circumstances, where the GP has a specialist interest in diabetes, and has some experiencing in managing insulin. However, it cannot be unfunded, as it requires a considerable amount of time to be spent with the patients, which will further limit access and have a knock-on effect on everything else.

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  • Beware your risk, and monitor your data. I am not clear this will be safe or effective.

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  • This is 100% due to cost, not quality. It seems even a consultant supported but specialist nurse delivered secondary care service is too much to ask for nowadays.

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  • This happened two years ago in North East Essex when all outpatient diabetes care moved out of the hospital. Practices are paid for the work and have access to really good and responsive clinical support. Outcomes have improved and it has worked well. It was done as part of an initiative to improve outcomes not cost cutting.

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