Diabetes screening plan 'will not hit GP workload', says NICE

NICE has refuted concerns that a drive to screen millions of patients for risk of type 2 diabetes will raise practice workload.

Dr Khunti: 'Diabetes screening plan dovetails really well with and complements the NHS Health Checks programme'
Dr Khunti: 'Diabetes screening plan dovetails really well with and complements the NHS Health Checks programme'

GPs will be expected to scan practice lists for patients at high risk of type-2 diabetes under guidance published by NICE on Wednesday.

The drive will encourage people to assess their own risk of diabetes using online and community-based risk assessments. Those deemed at high risk will be told to visit their GP for a blood glucose test.

Expert authors of the guidance warned that a ‘tsunami’ of diabetes threatens to consume the NHS budget and become 'unmanageable' unless these patients are identified earlier.

The move, which is likely to lead to hundreds of thousands of patients at high risk contacting their GP, prompted concern from the GPC in November.

GPC prescribing lead Dr Bill Beeby told GP magazine the plans would create a ‘substantial amount of work’ for some practices.

But Leicester GP Professor Kamlesh Khunti, lead author of the NICE guidance, said it would not place extra pressure on practice workloads.

Speaking at the launch of the guidance in London, he said: ‘As a GP, I don’t want to do more work. This dovetails really well with and complements the NHS Health Checks programme, which is being implemented at present.’

Professor Mike Kelly, director of the centre for public health excellence at NICE, said action was vital to tackle the problem. ‘Almost three million people are currently affected by diabetes, and it is likely to affect many more in the future.

‘This guidance will help people to identify their own personal risk and highlights that by losing weight, being more active and improving their diet, they can prevent or delay type 2 diabetes.’

Diabetes will 'become unmanageable'
Estimates suggest type 2 diabetes will affect around five million people in the UK by 2025.

Under NICE’s guidance, GPs and other providers should encourage all adults over 40 except pregnant women, those aged 25-39 in minority ethnic groups and people with conditions that heighten risk to have a risk assessment.

Patients should be directed to online assessment tools such as the Diabetes UK risk score to assess risk themselves. Risk assessments can also be offered in surgeries during regular consultations, and by community services such as pharmacies, workplaces and job centres.

GP practices will need to organise HbA1c or fasting oral glucose tolerance tests for all patients identified as high risk by these assessments.

GPs will need to refer patients with pre-diabetes – those with an HbA1c level of 42-47mmol (6-6.4%) – to a local intensive lifestyle-change programme. These will advise patients how to be more physically active, maintain a healthy weight and eat healthily.

CCGs 'must prioritise diabetes'
Local councils' health and wellbeing boards should work with clinical commissioning groups to prioritise type 2 diabetes prevention, the guidance says.

Jill Hill, a diabetes nurse consultant at Birmingham Community Healthcare Trust, said the NHS could not afford to ignore rising diabetes cases.

Care for the condition already creates huge workload for practices and costs the NHS £9bn a year.

She said the guidance would not put practices under more pressure. ‘This is people, not just GPs, being asked to assess their risk. If they’re high risk, they go to their GP for a blood test.

‘If they are in that high risk group that needs an intervention, it won’t be GPs and practices having to do that very intensive intervention.’

NICE said the push would encourage people who may not visit their GP or attend a health check to assess themselves for diabetes risk.

Christine Cottrell, clinical lead for diabetes at Education for Health in Warwick said: ‘Our chronic disease clinics are so overburdened, I just don’t know where we will be in the next 20 years because it will be unmanageable, so we have to start somewhere to prevent this condition.’

Barbara Young, chief executive of Diabetes UK, welcomed the integration of the guidance with the NHS Health Checks scheme.

However, she added: 'But we are concerned that while the NHS Health Check programme is great in theory, it has not yet been implemented properly. Only about three quarters of the expected number of people were offered a Health Check last year and only half of these offers were taken up.

'We hope that this guidance will spur the NHS across the country to improve the way it delivers the NHS Health Check.'

In addition to the three million people with diabetes in the UK, 15 million patients are thought to be at high risk of diabetes, while 850,000 have the disease but are undiagnosed.

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