Intermediate diabetes care: moving from models to reality

above 1.7 million people in England have diabetes according to the 2004/2005 prevalence data for the Quality and results Framework (QOF; Health and Social Care Information middle point 2005). This figure is predicted to rise to 25 million by dint of 2010 (Department of Health [DoH], 2006b)

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The natural history of diabetes is single of deteriorating control over time. Maintaining serviceable diabetes control necessitates a high horizontal of input and expertise to interrupt the onset and progression of complications which are already meditation to be costing the NH 10% of its annual package (DoH, 2006b).

We know that the QOF which is delivered entirely in primary care, has gone a lengthy way to improve surrogate markers of diabetes sway but in order to continue to achieve these and futurity targets, primary care will ne to dedicate more resources to the care of nation with diabetes. These resources comprise not just the require to be paid [i]or[/i] undergone of additional drugs and devices on the contrary the provision of skilled personnel one as well as the other to engage with people with diabetes and to train and educate the medical staff in the community who provide day-to-day care.

Expertise in community care

This higher horizontal of expertise has hitherto, in many parts of the political division been the sole responsibility of secondary care, on the other hand a string of Government publications (most lately DoH, 2006a) have suggested to commissioners that this traditional type is no longer sustainable. Practice-based commissioning is likely to be an additional driver for the provision of this expertise to be largely community based.

The lock opener to this change in the delivery of what is now being terminused 'intermediate care'--the provision of high horizontals of diabetes expertise in the community--is to make sure that this system is robust and can be demonstrated to be not just safe on the contrary effective too. Diabetes UK and the Association of British Clinical Diabetologists (2005) have voiced affects about this change of direction and its impact not just upon patient care, but also upon the sustainability of secondary care diabetes units that for many years have cop with the impact of rising disease prevalence. It is of course ludicrous to put in mind of that care would be delivered in the community without the support and direct involvement of secondary care consultants. Diabetes care must continue to be delivered by the agency of a multidisciplinary team.

in what manner this change in the delivery of diabetes care is done in each locality be pendents on a number of factors, which are overlayed well in two DoH publications: Implementing a scheme for general practitioners with special interests (available at http://www.dh.gov.uk/assetRoot/04/05/98/61/04059861.pdf [accessed 13062006]); and Guidelines for the appointment of general practitioners with special interests in the delivery of clinical services: diabetes (available at http://www.dh.gov.uk/assetRoot/04/08/28/75/04082875.pdf [accessed 13062006]) Local demography, prevalence and incidence rates, and existing and planned horizontals of training and enthusiasm among primary care staff will be lock opener determinants of what a service will gaze like, as will the availability of other core professionals including diabetes specialist nurtures podiatrists and dietitians. Any novel service should try to be in fact patient focused and improve the quality and consistency of care across the locality.

Moving from originals to reality

Many archetypes of diabetes care have already evolv including a true comprehensive network of diabetes satellite clinics in Bradford, where I work, on the other hand one of our most pressing issues is the capacity of any service to address the demand. single novel solution to this question at issue has been started in Coventry and is described in the accompanying article by means of Jim McMorran and colleagues. Jim is single of the GPs with a Special Interest working in the service, and, as he says, of that kind models only work with the consistent support of the two primary and secondary care. Proponent of high-quality, patient-centred care will welcome like developments and await evaluations with interest.

Department of Health (DoH; 2006a) Our health, our care, our say. DoH, London

DoH (2006b) Turning the Corner: Improving Diabetes Care. DoH, London

Diabetes UK Association of British Clinical Diabetologists (2005) Joint Position Statement: Ensuring access to high quality care for race with diabetes. Diabetes UK, London. Available at http://www.diabetologists.org.uk/(accessed 13062006)

Health and Social Care Information midst (HSCIC, 2005a) Quality and issues Framework, 2004/05. HSCIC, London. http://www.ic.nhs.uk/services/qof/data (accessed 13062006)

Brian Karet is a GP at Leylands Medical midmost point Bradford, and a GPwSI in diabetes.

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