The move to clinical commissioning under CCGs provides an opportunity to improve the quality of diabetes care but investment in extensive community services is vital, according to Professor Azhar Farooqi, co-chair of Leicester City CCG and a local GP.
He said the chronic shortage of GPs and disinvestment in primary care must be resolved if CCGs are to improve health outcomes in these patients, which are poor in some areas.
Recent figures suggest one in three people in the UK now have pre-diabetes, and Diabetes UK estimates more than 700 people a day are diagnosed with diabetes. Diagnosis rates are expected to soar in the coming years.
The challenge of improving diabetes care at a time of rising demands on NHS services and shrinking budgets was discussed at a Westminster Health Forum event in London on Wednesday.
Dr Bob Young, consultant diabetologist at Salford Royal Foundation Trust and clinical lead of the National Diabetes Audit, said figures showed huge variations between practices and CCGs in how many diabetes patients are treated to target on measures such as HbA1c and BP, and that this was contributing to premature death.
He said: 'Where should we focus our effort? Young people, people with type 1 diabetes, obesity management, BP management, improving poorly performing practices, encouraging best performing practices to innovate, because even the best performing ones are not achieving optimal care.'
Investment must be made
In his speech, Professor Farooqi said these challenges meant investing to improve the quality of care was 'absolutely vital'.
'One of the issues we've got in primary care is we have a huge shortage of GPs, a huge shortage of investment in primary care, so when CCGs develop their models for primary care-led diabetes, they have to make sure that investment is there.'
He said this investment also required specialist diabetes clinicians to work more in the community.
This approach has been trialled in his region, after figures showed many patients with diabetes in the city were not getting acceptable care from local services.
In response, the CCG followed a set of clinician-led recommendations around how to transform diabetes services, with an emphasis on community care, delivered mostly through GP surgeries. It also involved upskilling GPs and setting up a specialist service in the community for complex cases.
Upskilling GPs and practice staff
The CCG is investing £900,000 over three years so that every GP practice in Leicester has a Personal Development Plan (PDP) for diabetes. Professor Farooqi said: 'This could be doing an MSc in diabetes, or having mentorship, or doing specific modules; but each practice has had a visit, had their own PDP.'
He said 50% of practices are now upskilled to deliver an 'enhanced' level of diabetes care.
He told attendees at the event: 'The latest data that we have is that we are now going to be dealing with 96% of patients with diabetes managed in community setting with care delivered by generalists and specialists.'
Meanwhile, Lisa Anson, president of UK pharmaceutical giant AstraZeneca, told GP that adoption of existing gold standards on diabetes care could also improve outcomes and close the gap in practice performance.
She said: 'There is so much work we can see that we can do in the care pathway. For example, just implementing existing NICE guidance, not even changing guidance, just effectively implementing what we already have, we can see great impact with that.'
She added that the education of GPs on treatment options could also yield benefits. 'I think there's a huge educational challenge on a number of levels. One of the other things we do is we do run a lot of local meetings with practices around education on care pathways.'