# Coming to a surgery near you in Southampton (and probably everywhere else soon)...



## Northerner (Nov 4, 2014)

My consultant told me that, in Southampton soon, all diabetes patients are to be put back under the care of their GP. Any problems will then be communicated to the clinic team and they will visit the surgeries when needed (or not if the response can be made via telephone/email etc.). He said this is likely to be the case before too long with all CCGs so told me to expect quite a few messages on the forum to this effect from members up and down the country.

I gave him my views on this. Basically, I know a lot of people who currently attend a consultant-led clinic at a hospital will not be very happy to see their care put into the hands of a non-specialist, even if they do have an expert to call on. Many people do not believe their GP is knowledgeable enough to identify problems, and it sounds like it will be a case of Chinese whispers if problems and solutions are communicated via a middleman. I don't know the full details of how it will all operate, but it sounded like, in future, I will get an appoinment to see the GP for my reviews and only get to see the consultant if there is a specific problem they can not find a satisfactory answer to.

We'll have to wait and see, but I'm pretty sure that even the GPSI (GP with Special Interest) in diabetes at my surgery would draw a complete blank at most of the things I have just discussed with my consultant in my review this morning.


----------



## Redkite (Nov 4, 2014)

That is terrible news


----------



## AlisonM (Nov 4, 2014)

So, what will the redundant diabetes specialists be doing then, hanging around waiting for a GP to call, or retraining as plumbers? This is utterly unacceptable, there's no-one at my surgery with any real knowledge of diabetes and we all know what difficult time I have even with access to a consultant. This is all I need.


----------



## HOBIE (Nov 4, 2014)

So there will be lots of car park spaces at the hosp now & not all staff        Lucky my Gp is T1 & good bloke.


----------



## AJLang (Nov 4, 2014)

My diabetic consultant in Leicester said something similar a few months ago however I can't remember her exact wording but I think she said that non-standard diabetics (that is not the correct phrase I just can't think of a better one at the moment) e.g. those with complications such as gastroparesis would remain under the care of the hospital.  The hospital in Northampton has taken on four new diabetic consultants this year so not sure how that works if all care is transferring to GP practices - not sure how GP care would work for those on a pump??


----------



## Northerner (Nov 4, 2014)

AJLang said:


> My diabetic consultant in Leicester said something similar a few months ago however I can't remember her exact wording but I think she said that non-standard diabetics (that is not the correct phrase I just can't think of a better one at the moment) e.g. those with complications such as gastroparesis would remain under the care of the hospital.  The hospital in Northampton has taken on four new diabetic consultants this year so not sure how that works if all care is transferring to GP practices - not sure how GP care would work for those on a pump??



I suspect that, initially, a lot of people will get transferred back if they have any kind of unusual situation - I imagine most GPs wouldn't have a clue about a pump, or at least be able to keep up to speed with new developments in such a specialist area. I don't really see how it is going to save money, but the consultant said it probably won't become clear if it is working for a few years  I suppose, for someone like me (although I am weird!) there's no real reason for me to see a consultant every 6 months, so it would save on that. But how many people are there in Southampton with an HbA1c of 5.0% and in a similar situation?


----------



## Redkite (Nov 4, 2014)

How many people will even be put forward for pumps?  Most GPs have never even seen one, let alone understand their usefulness.  When I had to take my son to an out of hours GP for a cannula site infection a couple of years ago, the GP asked which hospital had removed the cannula!  He was incredulous when I said we insert and remove them ourselves every two days.  People with type 1 NEED access to specialist endocrinologists!


----------



## everydayupsanddowns (Nov 4, 2014)

Wow. I find this just staggering. Will wait to see what happens


----------



## Bloden (Nov 4, 2014)

That's pretty scary. Won't people's lives be put at risk? And what about T1 children?


----------



## trophywench (Nov 4, 2014)

I hate this idea and would really fight tooth and nail against it.  I was left once when I was really struggling, with no clinic visit at all for 2 years.  It's the reason I even joined a forum in the first place because my GP didn't have a clue why I couldn't get my BG to behave - it took a forum's worth of other diabetics to discover I was under stress, so that was the answer to my BG increases but of course that was only the start of me sorting my diabetes out.

It's because of that, that I'm even on a forum now - to try and repay the help I was given by helping someone else.  It wasn't this forum, it was Diabetes Insight (which you won't find know) which morphed into 'other' DSF.

What I'd like personally is say annual appointments (cos even on a pump I probably don't need 6 monthly) BUT with the opportunity to actually ring directly to the clinic should you think you have a problem.

Obviously newly diagnosed, change of insulin, change of treatment method, would all want more appointments but if all the 'me's were going less, presumably fitting that in would get easier.

They could ring-fence this by making 2 years (or whatever) the maximum length of time you could go, without 'someone who knows A from a bull's foot' to talk to.

I wouldn't even mind paying to see them when it wasn't my actual turn.  As long as they were available in my hour of need !


----------



## Northerner (Nov 4, 2014)

I'm not sure if this is intended to continue, but I was given a leaflet about the 'Diabetes Specialist Nursing Service', and I think that access to DSNs may be available over the phone, or by appointment. Also, I imagine minors will continue to attend a paediatric clinic, but that's just a guess.


----------



## jalapino (Nov 4, 2014)

Sounds like the care I get!...I even put my m.o.t (HbA1c) in the bin!...only because I no I can manage my own big D without there help!...the misses was not happy but my knee is more important at the moment!....and if I feel I need help I would only ask last resort!


----------



## happydog (Nov 4, 2014)

This does not sound good.  Don't know if anything can be done to make them change their minds.  Surely those with type 1 and type 2s with special problems should get expert help asap?  My GP surgery (who don't use the clinic anyway as it costs money) don't have much knowledge and the DSN is a joke.


----------



## Pumper_Sue (Nov 4, 2014)

Only special cases get to see a consultant in Cornwall or Devon. IE you have a pump or complications. That's been the case for a long time. It saves money so they think.


----------



## KookyCat (Nov 4, 2014)

Oh super, another joyous thing to look forward to then


----------



## trophywench (Nov 4, 2014)

I've thought about this a lot.

I think I'll probably be sarky if anyone says that to me, and then I'll start asking my GP for the latest news about Abbotts new type of CGM and the new Roche Insight pump - and if he doesn't know the answers I'll ask to be referred to someone that does!

I definitely think ALL T1s should ask that  (or whatever happens to be 'up and coming' at that time) if it happens to them!


----------



## gewoff (Nov 5, 2014)

As what seems to me to be a relative straightforward Type II in Cambridgeshire on metformin, gliclazide and background insulin, I wonder how this might affect me in the future if my condition becomes more problematic?

I've only seen my GP once since he diagnosed me eight years ago, and that was not connected to my Diabetes. During these eight years, my treatment has been progressed by the one of the Practice's non-specialist Nurses (and the occasional Dietician) who is doubtless overseen by my GP. When however, despite the Nurse's platitudes I became concerned at my steadily increasing HbA1c, at my 'insistence' I was referred to a part-time peripatetic Diabetic Specialist Nurse who works with several local GPs, who was excellent in every way, including motivation. I was immediately prescribed background insulin, but after six months when my HbA1c returned to an acceptable level, she told me that she had "no option but to 'ping' me back to the GP" - so that's where I am now..... Without wanting to be too personal, it seems to me that the non-specialist Nurse involved in my case is very 'laid back', and has repeatedly dismissed my concerns as minor in the context of other cases whom she has to manage - this aggravates me as being irrelevant to me, but perhaps I am being too assertive? And I've never seen a Consultant......

I guess that from recently monitoring this Message Board, my case is as I said above, reasonably straightforward and would not justify a Consultant's time, but am interested in what those more experienced readers might think....

Thanks in advance for any thoughts.......


----------



## Northerner (Nov 5, 2014)

gewoff, I certainly don't think you should accept the practice nurse's silly logic. It may be true that you are one of her best patients in terms of results, but of course that does not mean that you should therefore be regarded as safe from risk if your levels are higher than they should be 

Hopefully, if this sort of thing does occur in your area, then you will still have the services of a fully-fledged DSN available to you on request. I guess we'll all have to see how things pan out.


----------



## pippaandben (Nov 5, 2014)

Bearing in mind all the problems I have had from diagnosis to MDI in 30 months I am horrified. 

It was only with the help and support of this forum and recommended reading that I ended up telling the supposed DSN exactly what levels of basal and bolus insulin I should be on to start with!! She forgot to tell me that the insulin would have such an immediate effect so I was at panic stations after being in the 20s and low 30s for 2 months when after my first injection and 2 hours after my meal I was 8. 9pm Friday evening and no phone number except 111!!! In retrospect I should have known I suppose but my head was not exactly in a logical frame of mind at that time and the nurse was flying to USA on holiday on the Monday!

Even now after my latest test results apparently show one of the liver function tests is higher than the norm and my HBA1c has increased drasticallyand I asked yet again for a referral it has been refused. I have increased basal after overnight testing and am gradually increasing bolus ratio with no GP support whatsoever.

The supposed DSN left 15 months ago and at every appt with the practice nurse I seem to be the trainer!! I am to have further blood tests in 3 months.

Whatever happened to the Diabtes UK reps on the commissioning groups? And also the promised 3 levels of service that guaranteed referral to clinics if local practices were not able to provide expertise?


----------



## HOBIE (Nov 5, 2014)

When I was in the first couple of weeks into my pump. The set up needed adjusting.  My lovely Dsn phoned me on mobile/Bluetooth in van while at work. I adjusted pump & after a very short break was back at work & happy as a --- in -----. Makes a difference from30 yrs ago


----------



## HOBIE (Nov 5, 2014)

Tech is getting better all the time


----------



## Silmarillion (Nov 5, 2014)

It's already in force where I live


----------



## trophywench (Nov 5, 2014)

P & B - no that is NOT good enough.  

Make an appointment with your GP and ask him to explain to you in detail at what point an elevated Liver function test actually becomes a problem and why does that level apply to every human OR what.  And if it gets to that number do they refer you to hosp - Or What ?

If he can't - say you aren't satisfied and want to speak to someone who can explain it so you can understand !  

Having said that, don't rely absolutely on Googling it.  My husband had a higher than normal test result (for something totally unrelated to livers or diabetes) but when we looked it up, virtually everywhere said, well it's nowt to worry about at that level.

The same day he had that result to our surprise the surgery phoned him to come that afternoon and the GP said 'Now - we refer anyone with a level greater than whatever'  He was above that so got referred.  He's still being investigated for it at the hospital now so we don't know the outcome yet. 

I've got no idea about liver tests I'm afraid but I have to say - if mine were raised I'd be asking everywhere possible for every bit of info available anywhere.

Does anyone here in the forum know owt about it?


----------



## Amberzak (Nov 5, 2014)

West Sussex already do this, hence why I went to portsmouth instead. 

What are diabetes UK doing about this? Are there any protests etc? Letters to MPs? Etc. We need to campaign against this northerner.


----------



## Northerner (Nov 5, 2014)

trophywench said:


> ...I've got no idea about liver tests I'm afraid but I have to say - if mine were raised I'd be asking everywhere possible for every bit of info available anywhere.
> 
> Does anyone here in the forum know owt about it?



I tend to have higher than normal liver test results, due to an elevated level of bilorubin. However, my GP thinks this is something called Gilbert's Syndrome, and is benign


----------



## Mrs Mad Ronin (Nov 5, 2014)

This doesn't surprise me. I had to go to the doc monday, turns out my bad cold has gone to my chest. I didn't see my normal gp otherwise it wouldn't have been a problem but when i went to see this one, he was sitting there going, mmmm i'm not sure i can give you antibiotics, diabetics can't take them. They are dangerous to you. I don't know how to treat you. In the end he had to ring the DSN to ask her if antibiotics were ok. 

You might be thinking, maybe he is new. No he has 10 years experience under his belt :/


----------



## Northerner (Nov 5, 2014)

The whole point about GPs is that they are _general practioners_, they simply can't be expected to have anywhere near the depth of knowledge of a specialist. I suspect the main problems will be with those GPs who insist, despite all evidence to the contrary, that they know what they are doing


----------



## Mrs Mad Ronin (Nov 5, 2014)

Exactly and that's why when he started going on about my diabetes i said, let's leave that to the ones who know what they need to do. Otherwise god knows what i would have been told. They can't expect GP's to know in depth about specialist areas. That's the whole point of having consultants in those areas. So they need to leave it alone.


----------



## Northerner (Nov 5, 2014)

Mrs Mad Ronin said:


> Exactly and that's why when he started going on about my diabetes i said, let's leave that to the ones who know what they need to do. Otherwise god knows what i would have been told. They can't expect GP's to know in depth about specialist areas. That's the whole point of having consultants in those areas. So they need to leave it alone.



Quite. At my review yesterday my consultant was speculating on whether I was MODY. We decided it was highly unlikely, since there is no family evidence to strengthen the possibility - but would the notion have even entered the average GP's mind? It's pretty rare! I, of course, am unique!


----------



## KookyCat (Nov 5, 2014)

Northerner said:


> Quite. At my review yesterday my consultant was speculating on whether I was MODY. We decided it was highly unlikely, since there is no family evidence to strengthen the possibility - but would the notion have even entered the average GP's mind? It's pretty rare! I, of course, am unique!



my GP doesn't believe in late onset type 1 (nope just doesn't exist) so something as new fangled as MODY would blow his mind, and he's the specialist practitioner for diabetes....yep.  He barely batted an eyelash when I asked if he was actually a Doctor (couldn't help myself ).


----------



## Northerner (Nov 5, 2014)

KookyCat said:


> my GP doesn't believe in late onset type 1 (nope just doesn't exist) so something as new fangled as MODY would blow his mind, and he's the specialist practitioner for diabetes....yep.  He barely batted an eyelash when I asked if he was actually a Doctor (couldn't help myself ).



It's beginning to look like it's all going to end in tears!


----------



## KookyCat (Nov 5, 2014)

Northerner said:


> It's beginning to look like it's all going to end in tears!



I suspect he'll come off worse, I'm quite formidable


----------



## Northerner (Nov 5, 2014)

KookyCat said:


> I suspect he'll come off worse, I'm quite formidable



Actually, I did mean the GP's tears!


----------



## stephknits (Nov 5, 2014)

When I informed my gp that I was now type 1 he said he knew as I was on insulin, so therefore had to be type 1!  This all sounds terrible and surely is a false economy.


----------



## trophywench (Nov 5, 2014)

Oh I was told by my company's Occupational Health doctor that I was far too concerned about BG tests.  "After all -" he said, "I'm quite convinced by all my years in general practice that an HbA1c of anything up to 13 is perfectly OK and no-one will ever have any harm from running at that level.  Mark my words" he added, "this will all come out into the open in the next few years!"

As we left his office I shook his hand, said thank you and added that I was extremely pleased that he wasn't my GP because if he had been I'd be forced to make absolutely certain he got struck off !

That was only about 6 years ago and I've looked several times for his name on the GMC register, but have never ever been able to find it.


----------



## Mark T (Nov 5, 2014)

Northerner said:


> Quite. At my review yesterday my consultant was speculating on whether I was MODY. We decided it was highly unlikely, since there is no family evidence to strengthen the possibility - but would the notion have even entered the average GP's mind? It's pretty rare! I, of course, am unique!


Well theoretically it is still possible...

MODY must have been a random genetic mutation that occurred at some point otherwise you would have vast swathes of descendents showing the signs.  Yes, yea, I know you can pass on the genes, but I still think you would see larger groups of related people.

So not impossible that you got struck by a single random mutation.  After all, random mutations are what evolution is based on.

Unlikely, yes.


----------



## Amberzak (Nov 7, 2014)

I see a nurse at my GPs. I still see a proper diabetic nurse at portsmouth but I have to go along to these stupid sessions with this nurse who isn't even a diabetic nurse. She constantly says 'I will need to seek help with that' over every query I raise. I don't bother now. Don't even bother going.


----------



## Bloden (Nov 7, 2014)

Amberzak said:


> I see a nurse at my GPs. I still see a proper diabetic nurse at portsmouth but I have to go along to these stupid sessions with this nurse who isn't even a diabetic nurse. She constantly says 'I will need to seek help with that' over every query I raise. I don't bother now. Don't even bother going.



I found my initial sessions with the DSN (yes, the dbs-trained nurse) disappointing, cos I had tons of questions to which she didn't have the answer. In the end I stopped asking... 

I hope they iron out all the possible problems before they roll out their evil plan across the UK!


----------

