The ABCD lecture. The diabetes NSF—what is the role of the consultant physician‐diabetologist?

Abstract

Sue Roberts thought there had never been a better time to help improve the lot of people with diabetes. She acknowledged that it did not always feel like that to those who were working in the specialist diabetes services so she wanted to make clear that she thought it would be impossible to deliver the Diabetes NSF if diabetes specialists were not properly valued. On the negative side, there were problems with recruitment, the stress and strain of having to balance the service demands of general medicine and diabetes, the long wait for the NSF, and concerns about the shifting of focus to primary care and the impending European Working Time Directive. But diabetes could surely capitalise on new DoH thinking about the importance of chronic disease management (CDM) and self-management. Systematic care, originally developed by specialist diabetologists, was seen to be capable of handling very large populations and had taken on a life of its own, away from hospital-based diabetologists. The reasons were of course the epidemic of diabetes and the huge variations in services and outcomes, particularly in ethnic and lower socio-economic groups. NSF targets for systematic care had to be delivered by 2013. Systematic care meant traditional and familiar surveillance and intermediate outcome programmes. The patient-centred approach was reflected in the requirement that every patient should have a named contact, structured education and a care plan. How was the vast task to be addressed? Dr Roberts felt the first thing to do was to set up a Local Implementation Team. This would comprise all those involved in diabetes care in a natural community, including patients, primary care and of course the diabetes specialist. Dr Roberts thought that there would be a wide variety of diabetes networks set up round the country but they would only be successful if they got the power relationships within the NHS right. Specialist care must reconfigure to acknowledge the fact that within 10 years 85% of CDM would be carried out in primary care. New models were being developed already in different parts of the country. These included hospital-led intermediate care outreach programmes and PCT-led initiatives of community diabetologists and GPs with a special interest in diabetes. In terms of the patient's life journey through diabetes, it was obvious that the specialists worked very largely at the expensive end. It would be better to put efforts and resources into the other end. Specialists within a new integrated system would continue to assess the most complex multi-dimensional problems and to manage specialist disease areas such those arising in children and pregnancy. Specialists would co-ordinate and quality assure all the programmes and would run education and training, help to get evidence into practice, co-ordinate joint evaluation and take part in research and development. Above all, they could contribute leadership. Thanking Sue Roberts for her very informative talk and answers to questions, Dr Greenwood said it would have been obvious to her that there was enormous apprehension and anxiety amongst ABCD members about the NSF and the possible dumbing down of the specialist service. Would it be of use if the Association were to provide examples of what was happening? Dr Roberts said she would be very interested in receiving such information. She had no direct powers but could work on the DoH environment so as to improve the chances of better local solutions.