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.’