PCT variations hit diabetes care

Variability of diabetes services between PCTs is hindering progress on NSF targets, the DoH has claimed.

More needs to be done to improve outcomes for the 20 to 40 per cent of diabetic patients who are not meeting targets in the quality framework, said DoH diabetes czar Dr Sue Roberts.

Her report on the progress made in diabetes care since the NSF for diabetes was introduced in 2003 praised GPs for improved detection of diabetes.

An extra 100,000 cases of diabetes were newly diagnosed last year according to quality framework prevalence data. As a result, the ‘missing million’ cases of diabetes in the UK is now more likely to be a missing half million, said Dr Roberts.

But analysis of 2005/6 quality framework data showed that although the majority of GPs are measuring HbA1c, BP and cholesterol, some are failing to improve outcomes in these clinical areas.

While HbA1c was measured in 97 per cent of patients, only 62 per cent reduced HbA1c to 7.4 or less. Ninety-eight per cent of patients had BP measured, but just 75 per cent had a last reading of 145/85mmHg. Similarly, 95 per cent of diabetic patients had cholesterol measured, but only 79 per cent had reached the target of 5mmol/l or less. Many of these low scores may be due to variation between PCTs.

Dr Neil Munro, chairman of Primary Care Diabetes Europe, was concerned that the shift of diabetes management to primary care could lead to fewer consultants to deal with the complexities of diabetes care.

‘Services aren’t being shifted; they’re being cut, then they’re being put into the quality framework,’ he said.

Leicester GP Dr Kamlesh Khunti, who has a special interest in type-2 diabetes, said that success in meeting HbA1c, BP and cholesterol targets was largely due to practice infrastructure.

Small practices in deprived areas particularly struggled and could benefit from community services to refer patients with hard-to-manage diabetes, he said.

Out-reach clinics managed by diabetes GPSIs, consultants or specialist nurses could help manage diabetic patients if they were not improving, he said.

A DoH-funded study based in Warwickshire and Leicestershire, and led by Dr Khunti, is about to start to access the value of this scheme.

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