Primary care

This section focuses on the primary care setting:

Introduction

The majority of people with diabetes are cared for in the primary care sector with referrals to hospital based care where necessary, for example because of problems with complications or with controlling blood glucose, blood pressure or cholesterol levels. 85 per cent of interventions undertaken in treating people with diabetes occur in general practice settings (MODEL group 2007).
 
Practice nurses have a key role in supporting self-management of diabetes through care-planning linked to annual reviews but all staff in the primary care team are involved in care. In some practices health care assistants are trained to help the practice nurse by taking routine measurements and assisting with other screening processes. Enhanced services are also enabled by General Practitioners with Special Interest (GPSI) services whereby GPs undertake additional training in specialist areas such as diabetes, and by working with community teams which include diabetes specialist nurses and other practitioners such as dietitians and podiatrists.
 
Diabetes UK has a Primary Care Network which can be signed up to for free. It aims to provide support to healthcare professionals for the management of diabetes in primary care. See details on the Diabetes Uk website at Primary Care Network.

The Quality Outcomes Framework (QOF) is used by general practice across the UK. It was introduced in 2004 as part of the General Medical Services Contract and acts as a voluntary incentive scheme. Under the scheme payments are made to General Practices according to points scored against a series of indicators. One of the indicators for diabetes includes the need to have a register of all patients aged 17 years and over specifying type of diabetes. Maintaining an up-to-date register is important alongside recognition that there will always be undiagnosed cases of diabetes which will need to be proactively sought.

The National Institute for Health and Clinical Excellence (NICE) and partnership organisations in this and the other UK countries, are responsible for reviewing and developing QOF indicators on an annual basis. You can read more on the NICE website about the Quality and Outcomes Framework. Detail of the indicators is available at the NICE menu of indicators.

Changes to and differences in the health care systems in all four countries of the UK influence how services are delivered. In Scotland Community Health Partnerships are the key mechanism for the planning and delivery of primary and community based services and integration with social care. The CHPs may work in different ways to achieve this and most are co-terminus with local authority boundaries. Managed Clinical Networks are based around patient groups with a specific condition and bring together health professionals, patients and carers often working across traditional boundaries. For further details see the websites of the Community Health Partnerships and information about the Diabetes Managed Clinical  Networks at Diabetes in Scotland.

In England High quality care for all (2008) put an even greater focus on quality of care as well as the continued emphasis on ‘convenient care closer to home’. NHS Diabetes have published a commissioning resource which aims to help deliver the vision set out in High quality care for all. It provides guidance which covers the entire patient journey promoting an integrated care pathway approach. For the guidance documents and related resources on the NHS Diabetes website see commissioning resource.

The changes of policy under the Coalition Government heralded by the 2010 White Paper Equity and excellence: Liberating the NHS and the 2011 Health and Social Care Bill are putting integration of health and social care at the heart of reform and creating new structures and different ways of working. Primary care trusts and  strategic health authorities are being organised into clusters until their proposed abolition by April 2013. Local authorities will have a greater responsibility for the provision of health care particularly the public health agenda. A new commissioning structure will mean that clinical commissioning groups will be responsible for local commissioning with leadership provided by the new NHS Commissioning Board.

A key challenge lies in ensuring accessibility to services particularly for groups that may be disadvantaged because of socio-economic reasons. These groups include people from black and minority ethnic (BME) communities, prisoners and homeless people with diabetes, refugees and asylum seekers. The accessibility issues have been highlighted in a report by the All Parliamentary Group for Diabetes and Diabetes UK  - see Diabetes and the disadvantaged: reducing health inequalities in the UK. 

For further information see also Key issues.

References

Full details of the bracketed citation in the text above and, in many cases, links to the actual documents are available in the reference list within this resource. Go to the Reference list.