The epidemic of diabetes, with all its attendant cardiovascular risk, continues on apace. In the 1990s, an evidence base in diabetes care grew steadily, followed by the publication of the National Service Frameworks for diabetes. Those of us working in primary care saw that the diabetes clinical markers in the Quality and outcomes Framework (QoF) section of the nGMS contract were an important vehicle through which to deliver the essential interventions needed to prevent both the progression of diabetes and to address the additional cardiovascular risk associated with it.
A year has made a great deal of difference to how we approach diabetes care. While we may have been accused of practicing ‘data-centred’ care, our data recording in diabetes has progressed more in the past year than in the previous five. We have also made effective interventions across the 18 diabetes indicators, and it would appear that many practices have scored highly in diabetes, in spite of much discussion around the complexities and difficulties involved.
The comments on this page welcome these achievements in primary care, drawing attention to what can be accomplished. International commentators were quick to point out that many of the diabetes targets were ambitious – having never been achieved by any primary care organisation worldwide. Our achievement reflects well on the detailed computer records we have used to track, code, call and recall people with diabetes. In many practices this has been from a standing start.
Much has been made of the rewards offered to practices through targets and incentives. In real terms the contract has delivered ambitious targets in a very cost-effective manner. The Government has not chosen to accentuate this; rather choosing to stifle practice cash-flow by delaying the publication of the prevalence data needed for the complex formulae governing payments. While this may distract in the short term, in the long term the QoF will be seen as a success across the UK, proving a successful framework for practices from Aberdeen to Aberystwyth and Dover to Derry.
Historically, making practices responsible for meeting targets has been successful – from polio immunisation, through cervical screening, to the current frameworks. From any perspective, people with diabetes will be the ultimate winners. Family doctors and their teams have been increasing their knowledge and confidence in diabetes as they work through evidence-based guidelines, demonstrating their flexibility and willingness to engage in change. This will stand practices in good stead with further rounds of changes and additions to the contract just around the corner.
‘We have seen a far more pro-active and aggressive approach to the management of diabetes in all target areas. Alongside this we have seen a greater demand for education in primary care. Both of these aspects can only be of benefit to the patient.’
Lorraine Avery, Consultant Nurse in Diabetes
‘Let’s hope that the outcomes that matter are measured, published and show improvement and its not a case of plus ça change, plus c’est la même chose.’
David Kerr, Consultant Physician
‘There is huge enthusiasm within primary care to improve diabetes care and the nGMS provided the focus, and possible financial reward, for starting to get it right.’
Gwen Hall, Practice Nurse