So in a sign of things to come, or things that are actually happening, or things that have actually happened, depending on your particular neck of the woods, NHS Dorset CCG is intending to ‘discharge from specialist management’ 50% of type one diabetic patients. And as we all know, discharge from specialist management = dump on GPs.
In a war, there are always going to be casualties
Well, bring it on. For my next trick I’ll start giving IV chemotherapy, performing peritoneal dialysis in my treatment room and repairing aortic aneurysms with my teeth and a rolled up copy of the BJGP. Oh, no, wait, actually I won’t – on account of not having the skills, time, energy, funding etc (apart from maybe a minor surgery fee for the AAA, but I’m still not doing it).
I’m being a bit ridiculous, but then so’s NHS Dorset CCG by the sound of things. True, I probably could look after patients with T1DM, or my nurses who know one end of an insulin needle from the other, could, because there aren’t that many and they aren’t actually that difficult. But that’s not the point. The thing is, and I’m surprised that anyone has to point this out to any CCG, we GPs are at saturation point. We are Monty Python’s Mr Creosote, and the first type 1 diabetic to walk through our doors with the words ‘They’ve discharged me from the hospital’ is our wafer-thin-mint.
It is our responsibility to avoid exploding over our patients, and therefore I’m going to share with you a plan I have been cooking up in my practice. I devised it even before I heard about this latest work dump fandango and, with delicious irony, it exactly mirrors the CCGs tactic. It’s fighting fire with fire, or rather fighting T1DM with T2DM.
What you do is, first, recognise the fact that, for some time now, you and your nurses have been running, completely unfunded, a very resource and time-consuming diabetes clinic. It’s the sort of clinic which used to be the remit of the hospital, given that, back in the day, primary care level T2DM care used to involve precisely two drugs. Next, you acknowledge that you don’t have to do this at all. And finally you agree that, because you need to do lots of other things, and so do your nurses, these T2DM patients should, as of now, in a glorious reverse-dump manoeuvre, all be referred to the hospital clinic.
Bye bye type two diabetics. Hello time and space. I feel sorry for these patients being caught in a game of interprofessional diabetennis. But in a war, there are always going to be casualties.
Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield