Exclusive GPs are being hamstrung in their attempts to improve their patient’s lifestyles, with patchy access to NICE-recommended diabetes, obesity and alcohol services, and waits of up to six months in some areas, Pulse can reveal.
Data obtained under the Freedom of Information Act from 50 PCTs in March has shown that almost a year after the NICE guidance on diabetes prevention was published, almost half – 42% – still do not provide any lifestyle-change programme for patients diagnosed at risk of developing diabetes, as recommended by NICE.
Further, one in five of the PCTs that responded did not have the NICE-recommended referral services in place for childhood obesity, hypertension or alcohol dependence. Waiting times for some services were up to six months – a delay that experts warn risks undermining the GP’s intervention.
he figures come as GPs are expected to take more responsibility for their patient’s lifestyles, with NHS England currently reviewing ways to incentivising primary care to undertake more prevention of diseases, such as cardiovascular disease.
As of 1 April, GPs also have a new statutory duty in the NHS Constitution to make ‘every contact count’ to tackle lifestyle change. This requires GPs to provide brief lifestyle advice and/or refer patients to an appropriate service to help them understand how they can improve their health.
However Pulse’s investigation has uncovered patchy support for GPs who decide to undertake the recommended work and wish to follow NICE advice (see box).
GPs in almost all areas of the country were able to refer to a specialist programme for smoking cessation, although waiting times were up to three months. Some 22% of PCTs said they did not have the NICE-recommended intervention for mild alcohol dependency, with waiting times of up to six months in those that did.
Professor Mike Kirby, professor of medicine at the University of Hertfordshire and a GP in Radlett, said the results of the survey showed that GPs needed much greater support in order to make a difference to their patient’s lifestyle decisions.
He said: ‘In terms of making every consultation count, there is no point in asking patients [to make changes] if there’s nowhere to direct them. This is a big issue and a significant problem with the NHS health checks.
‘You need plenty of support. In six months’ time they may well have totally forgotten about it. For lifestyle interventions to be effective, patients need full-on support.’
GPC deputy chair Dr Richard Vautrey added: ‘It is easy to criticise general practice but the reality is that if GPs want to refer patients to local services they either don’t exist or the waiting time is so long as to make them worse than useless.
‘The real focus has to be on ensuring that there is consistent provision of services for GPs to be able to refer to. GPs know what services the patients want and all too often they are either not available or there are very long waiting times. That leads to difficult consultations because GPs have to explain why another service isn’t provided where it should be.’
Professor Mike Richards, domain director for reducing premature mortality at NHS England, says: ‘NHS England has set out its intention to further develop incentives and levers within the new commissioning system in the coming years.
‘We are currently considering how best to incentivise good practice in primary care health promotion and early diagnosis.’