Community diabetes consultants: the case for additional training

Abstract

On behalf of all diabetes consultants working in the community—whether employed through primary care or hospital trusts—we are writing in response to the letter in the March issue which suggested that additional training for community consultants was unnecessary.1 We agree that diabetes is the same condition whether it is managed in the hospital or community setting—or in specialist or primary care—but would like to point out a few of the challenges for consultants leading services for people who do not attend traditional ‘secondary care’, and where additional training is helpful to consultants who are considering working in this environment. Strong leadership skills are needed to develop diabetes services in the rapidly changing environment of primary care (e.g. getting to grips with General Medical Services, Quality and Outcomes Framework and Practice Based Commissioning). ‘Our health, Our care, Our say’ encourages most diabetes manage-ment to be undertaken in local community settings or primary care. Clinics in the hospital setting are increasingly focusing on patients with highly complex or subspecialty diabetes needs. The community diabetologist has an important role in leading services for people who do not meet the criteria for such hospital clinics but who have more complex needs than those the GP can manage. The development of high quality services that have ‘economies of scale’ to cope with large numbers of patients (particularly in patient education, group consultations etc) will be essential. Community diabetol-ogists are increasingly working alongside public health specialists, epidemiologists and statisticians on issues such as prevention and increas-ing the ascertainment of diabetes, whilst acquiring knowledge of techniques such as social marketing! Clinically, community consultants are more likely to see patients who are not seen in a hospital clinic—e.g. those who are housebound, living in a nursing home, travellers, and psychiatric patients who all have particular diabetes needs. Community consultants need to develop new ways of working due to the fact that they also see patients who do not attend hospital clinics because the system there does not work for them. Although many hospital-based diabetes care teams have always been involved with the education of GPs and practice nurses, the community consultant's role includes not just delivering training but also ensuring it is embedded into the local diabetes management framework (e.g. Local Enhanced Services) which they have developed. The consultant may be working in environments very different from those of hospital clinics (e.g. commu-nity centres, GP surgeries, mosques, even supermarkets!) with different computer systems and organisation of care. Multidisciplinary team working is as important as it is in secondary care, but there are different levels and disciplines in the community (e.g. local pharmacists, nursing home staff, district nurses, and case managers). Community consultants are an important link between primary and specialist care. Experienced commu-nity diabetes consultants can see diabetes issues from both primary and specialist care perspectives and, with appropriate skills, can facilitate integrated care and partnership in the challenging NHS in which we are all working. Gillian Hawthorne Community Diabetes Consultants committee, Waqar Malik Community Diabetes Consultants committee, Felix Burden Community Diabetes Consultants committee, Chris Walton Community Diabetes Consultants committee, Jill Hill Community Diabetes Consultants committee