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Two-week cancer referral rule has a ‘negative effect’

Study prompts call for deprived practices to be targeted for extra funding

By Daniel Cressey

Lack of resources is preventing practices in deprived areas from achieving good glycaemic control in patients with diabetes, a new study reveals.

Researchers found practice deprivation was more important than the background of individual patients in determining glycaemic control.

HbA1c values were 0.42 percentage points higher in patients registered at the most deprived practices than the most affluent, the researchers found.

Their study, published in Diabetic Medicine (October), estimated that the Townsend deprivation score explained a third of variation in glycaemic control between practices.

Study leader Dr Charlotte Bebb, consultant nephrologist at Nottingham City Hospital, said: ‘It is quite concerning – these are patients who are most in need. Diabetes prevalence is linked to deprivation so there will be more patients attending these practices.'

She added: ‘Perhaps these practices have fewer facilities available or it is something to do with the difficulty of being a GP in a deprived area.'

Dr Colin Kenny, chair of the Primary Care Diabetes Society and a GP in County Down, Northern Ireland, said there was ‘little doubt' practices in deprived areas needed to be targeted with extra funding.

‘Carr Hill was supposed to do some stratification but effectively deprivation payments were removed from nGMS. Many feel this was a fault.'

Dr Azhar Farooqi, a GP in Leicester and clinical diabetes lead at Eastern Leicester PCT, said: ‘There would be a whole range of factors responsible, one is resources. Having more specialist nurse support, training and intermediate services would help.'

But the study also found relying on nurse-led clinics to improve diabetes control was unlikely to be successful.

Patients whose annual reviews were carried out by nurses alone had HbA1c values 0.24 percentage points higher than those where reviews had GP involvement – a finding previously reported in Pulse (August, 2004).

Dr Bebb said: ‘It is sounding a note of caution in the current environment of having more and more non-medical reviews. It suggests a joint approach is more useful.'

dcressey@cmpinformation.com

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