# GPs to manage 50% of Type-1 diabetic patients under CCG plans



## Northerner (Jun 22, 2016)

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 schemesuggests 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 was ‘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.

http://www.pulsetoday.co.uk/news/co...tic-patients-under-ccg-plans/20032125.article

(free registration)

Already happened to me here in Hampshire - no longer see my consultant, just practice nurse. Also, reviews have gone from 6 monthly to annual. Thought the following comment was interesting/scary:



> 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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## trophywench (Jun 22, 2016)

I think it's disgusting !

In Poole, the practice nurses were told last week, but no-one has mentioned it to the doctors yet ! Apparently - the normal GP contract actually states 'no extra work without training and pay'.

So - if you get into trouble, where/who have you been told to ring?


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## Northerner (Jun 22, 2016)

trophywench said:


> I think it's disgusting !
> 
> In Poole, the practice nurses were told last week, but no-one has mentioned it to the doctors yet ! Apparently - the normal GP contract actually states 'no extra work without training and pay'.
> 
> So - if you get into trouble, where/who have you been told to ring?


I still have the ability to phone a DSN. I used to enjoy my twice-yearly chats with my consultant though, I used to bring him up to date with all the appalling treatment people were talking about on the forum!   

I can understand that I'm not a priority for specialist treatment, my highest HbA1c since diagnosis was 6.2% and the last one was 5.3%, but it is worrying if they are not necessarily talking about good control when they say 'stable', but could mean someone whose HbA1c is always around 10%!


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## grovesy (Jun 22, 2016)

My reservations would be that staff would need to be appropriately trained! I know the GP at my surgery who was so called Diabetic doctor retired a year ago and has not been replaced!


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## Ljc (Jun 22, 2016)

IMO This is so wrong and more likely to be to do with cost cutting.


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## grovesy (Jun 22, 2016)

Ljc said:


> IMO This is so wrong and more likely to be to do with cost cutting.


Exactly but false economy!


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## trophywench (Jun 22, 2016)

I'm stable though - but how the hell would my GP surgery be able to keep the track on my results that my hospital clinic do?  Pumping is more and more commonplace, isn't it?

And let's not forget that the time when young people's control usually goes out of the window if it's going to, is around the time they get transferred to adult services.  I fear that even more of them will fall by the wayside.

Alan - have you drawn this to DUK's attention?


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## Northerner (Jun 22, 2016)

trophywench said:


> I'm stable though - but how the hell would my GP surgery be able to keep the track on my results that my hospital clinic do?  Pumping is more and more commonplace, isn't it?
> 
> And let's not forget that the time when young people's control usually goes out of the window if it's going to, is around the time they get transferred to adult services.  I fear that even more of them will fall by the wayside.
> 
> Alan - have you drawn this to DUK's attention?


No, but I will do. There's also the little point of GP surgeries already being massively overstretched already - where are they going to find all these extra resources from?


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## grovesy (Jun 22, 2016)

I recently heard a practice nurse on a phone in saying they were having problems recruiting an retaining staff!


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## Ljc (Jun 22, 2016)

Northerner said:


> No, but I will do. There's also the little point of GP surgeries already being massively overstretched already - where are they going to find all these extra resources from?


Very true.


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## Robin (Jun 22, 2016)

All this happened in Oxfordshire several years ago. I was discharged back to my GP because my hospital consultant said there was a 'specialist diabetic nurse' at our surgery. Who turned out to be the Asthma nurse, the Travel Clinic nurse, the Lord High Everything Else nurse...Actually, she's great, I get on well with her, and she's keen to learn ( mostly from me) But the surgery have declined her request to be sent on a course to learn how to deal with Type 1s, 'because it's not worth it as I'm her only one!' 
I was discharged with the proviso that I could ask to be referred back at any point if I had problems, but as I said to the nurse last year, the problem is, what I don't know that I don't know.


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## Northerner (Jun 22, 2016)

Robin said:


> but as I said to the nurse last year, the problem is, what I don't know that I don't know.


Indeed - whilst many people may look to the internet for information about new treatments etc., what about those who don't? Is an untrained practice nurse going to be bang up to date with the latest information?  It's OK being able to ask for help if you know you have a problem, but what if you don't know you have a problem, but a specialist would?


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## grovesy (Jun 22, 2016)

My nurse was retiring just after my last review before Xmas , said as she was only part time she was struggling to keep up to date with everything! She did not think they would be replacing her , as the other nurse was full time! So I was surprised when I saw the Doctor for reauthorisation  of medications last week she happened to mentioned there was now another Diabetic nurse! 
Though I believe my up coming appointment is with the one who has been there a while! I have my bloods tomorrow !


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## Redkite (Jun 22, 2016)

Oh no that's awful .  GPs have no clue about type 1, no clue about pumps and CGM, and are totally overstretched as it is.  Surely this is an area that MUST have a specialist consultant?


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## Matt Cycle (Jun 22, 2016)

I was similar to Robin in that I was seen at the surgery.  The nurse is lovely but covers various things at the surgery as well as diabetes.  The majority of her diabetes time will be spent dealing with T2's.  From a T1 point of view I think she simply doesn't have the depth of knowledge that you get at a hospital clinic keeping abreast of the latest technology, insulins, pumps etc. I asked about pumps last December and have been referred back to the hospital clinic and seen the consultant.  I have since been on a DAFNE course and now have access to the DSN's at the hospital clinic.


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## trophywench (Jun 22, 2016)

Redkite said:


> Oh no that's awful .  GPs have no clue about type 1, no clue about pumps and CGM, and are totally overstretched as it is.  Surely this is an area that MUST have a specialist consultant?



Well that's what the NICE Guidelines dated September 2015 say they should have, so you aren't the ONLY one that thinks we should !!!!

Diabetes Voices just today have asked me to get my MP to attend a thing they are presenting to Parliament to try and get at least 50% of D patients (all types) access to training courses.

I was going to do this - but what's the ruddy point, when they aren't even going to be able to TREAT people properly in the first place?

And every surgery everywhere has terrible problems recruiting every type of MEDICAL staff they need (still OK on the 'office' side) and most now are staffed 50% or more by locums.


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## KookyCat (Jun 22, 2016)

Good God, if they did that here I'd have to move, my GP surgery don't have a clue, and frankly I'd probably just disengage from it altogether.  I go to their reviews now under duress because it's a waste of my time, the diabetic nurse is a wasp, very sharp, so sharp she could cut herself, but then I'm like a serrated knife if I get started so that'll be great then.


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## Flower (Jun 22, 2016)

Really alarming  On what criteria would they select the 50% to manage?  In the last State of the Nation only 7.6% of T1's had an HbA1c of 6.5% or less and only 27.6% an HbA1c of 7.5% or less and that is supposing lower HbA1c values equal stability which we know isn't necessarily true as they can hide a multitude of control issues.


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## Pumper_Sue (Jun 23, 2016)

The first and last time I had a review the practice nurse turned round and said I know nothing about those new fangled pump things and don't want to know either.

Each year I have a request to attend a yearly review latest is at *6.50pm on 27th July *I have cancelled with the reason being waste of time and pointless box ticking exercise.


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## pottersusan (Jun 23, 2016)

Flower said:


> Really alarming  On what criteria would they select the 50% to manage?  In the last State of the Nation only 7.6% of T1's had an HbA1c of 6.5% or less and only 27.6% an HbA1c of 7.5% or less and that is supposing lower HbA1c values equal stability which we know isn't necessarily true as they can hide a multitude of control issues.


Living under Dorset CCG's umbrella, it does concern me somewhat (slight understatement). I suspect mine would be viewed as stable, but would they view me as T1? Though on the other hand I'm going to meet my 6th diabetes consultant in less than 5 years in a couple of weeks. I might get more continuity of care. But then what does the average GP know about pumps, cgms...


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## AndBreathe (Jun 23, 2016)

@Northerner - Do you use Twitter at all?  A chap called Partha Kar, who seems to be Head Honcho is all sorts of governing bodies these days is very active, and very T1 biased.  As you might expect, he's receiving some "special feedback" today about this news.  If you, or anyone else for that matter, care to add your own feelings to his feed, at least you could feel you have offered your own views to someone at the hub of diabetes decision making these days.

He and I have already crossed swords over some of his apparent views on T2.


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## Northerner (Jun 23, 2016)

AndBreathe said:


> @Northerner - Do you use Twitter at all?  A chap called Partha Kar, who seems to be Head Honcho is all sorts of governing bodies these days is very active, and very T1 biased.  As you might expect, he's receiving some "special feedback" today about this news.  If you, or anyone else for that matter, care to add your own feelings to his feed, at least you could feel you have offered your own views to someone at the hub of diabetes decision making these days.
> 
> He and I have already crossed swords over some of his apparent views on T2.


Thanks @AndBreathe - I am on twitter, but only tweet about twice a year. I could never keep up with it!  Will follow them though and have a look


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## Northerner (Jun 30, 2016)

*Put your questions to NHS Dorset Clinical Commissioning Group at AGM*

The Annual General Meeting of NHS Dorset Clinical Commissioning Group will take place on Wednesday 13th July at the Hamworthy Club, Magna Road, Canford Magna, Wimborne BH21 3AP.

http://www.blackmorevale.co.uk/put-...group-at-agm/story-29461334-detail/story.html

Anyone who can attend might want to ask them about the proposal!


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