Sunday, January 31, 2016


With a flourish, the National Diabetes Audit made its annual appearance- and being part of the core audit group, I already knew what was coming. Messages were hard, stark- and perhaps worryingly, it was actually worse than previous years. I will just concentrate on Type 1 diabetes- and it makes pretty sobering reading- about 39% folks getting their basic care processes;if you were under 40, this was down to about 24%, huge variability across CCGs....but to me, the most worrying bit, the sharp decline in reporting from GP surgeries- down from 70% to about 57%

So in short, not only have the numbers worsened, we actually know even less of whats going on and not surprisingly, folks have reacted in different ways. Fingers have been pointed at each other- Lazy patients not having ownership; Lazy GPs not bothering with care; poor communication from hospitals to GPs resulting in poor data transfer....irony? Its exactly the same debate as last year; or the year before that..or the year before that- you get my drift, the figures have worsened, the debate hasn't moved on.

I don't blame anyone- I don't have type 1 diabetes, I don't have the foggiest idea what it involves living with it day in and day out, I don't have hypos, I don't have to worry about my eyes- so I am the last person to sit here and judge another person on why they haven't had their care process done or not attended an appointment for that. I am acutely aware reading blogs, meeting carers, talking to patients that its isn't a life that resembles a walk in the park and from behind a desk or a PC, as a health care professional, its easier to say "why can't you have your feet checked" rather than the "what is stopping you- do you need help".

I don't blame primary care either. I am not a GP- so won't pretend to understand what they could do differently. I do know that years of cock-eyed leadership have given them more to do without any resources. I do understand that politician (of all colours) whipped  expectations of the public have put them under huge strain- and diabetes is only a fraction of what they do. It is not their fault they had a multitude of things to do without back up and support. And why submit data- when all that results in public vilifying? A media storm better to just avoid any data. Some say about enforcing it- by all means try- all that brings is gaming- apart from a further disillusioned workforce- apart from a further drive into making Type 1 diabetes a tick box exercise. That's pretty much the last thing we need- ask us in acute sectors and the impact of a 4 hour target.

I actually blame ourselves. Specialists- us- Type 1 experts- we must learn to put our hands up a bit. Over my career I have heard many a reason- "the PCT/CCG made me do it; I have to do other stuff; Have other priorities etc etc".
Well, in a system where patient voices are more of a token tick box, I am not quite sure who else is supposed to fight the corner of Type 1 diabetes patients- apart from the ones specifically trained to do so. When I say "every single Type 1 doesn't need to be seen in a hospital", let me- again- make this clear- that does not mean "not seen by a specialist". It is up to the specialist to see them anywhere- be bold enough to break the rules and understand that a diabetologist isn't the sole preserve of an acute or community provider- he or she stands for the well being of the system- and yes, that should, even must, be the responsibility of making sure patients get their basic checks done.

I can't account for others- but have decided to focus on simple basics in our locality over next few years. Ladies & gentlemen, the responsibility is ours, not anyone else. It is within our gift to work with our patients and make it better. We, as a community, need to decide what our identity is- across the system or confined to one silo- and doing jobs at the expense of our specialist training.

I don't need to see yet another data set; I don't want to have primary care forced to submit data...I know we have a baseline which isn't good. Lets stop dithering, develop a bit of steel and try and improve it. I am willing to bet that it would be much appreciated by both our patients and our primary care colleagues. Let's not wait another year to berate each other over another data set.


  1. I do, in theory, admire the National Diabetes Audit. It manages to ask the same questions every year - a remarkable achievement in NHS data gathering. It makes a spirited attempt to collect data across both primary and secondary care.
    The figures for eight care processes rise and fall on the ACR measurement - being consistently around twenty percent behind. I suspect it is not so much the removal from QOF as from the associated alerts systems that has led to the decline. BMI has fallen as well, but it is hardly as if weight is not apparent to everyone in the room - recording the BMI is often simply telling the computer.
    The reasons for the decline in participation are probably more complex. There has been a change from an opt out system to opt in. Practices under a bombardment of requests for data are more aware of data protection - I suspect that did the audit no favours.
    Personally I believe its biggest problem is its irrelevance to practices. The NDA seems to make very little effort to engage practices on help them make changes. We never received a detailed report on out practice's patients. All that seems to happen is an annual bout of shroud waving (even if it is, as I said above a very well made shroud) and some newspaper headlines telling us what the problems were a year before. It was not even irrelevant, it seemed another stick to beat us with.
    If the NDA wants to increase participation rates it needs to consider what is in it for practices to participate.

    1. Hopefully the new GP level reporting is a good starting point to making the NDA relevant to GP practices. All data from participating GP practices is available via an interactive spreadsheet via this very long(!) URL -

      Feedback on how we can better engage with GP practices is always welcome.

      Laura Fargher - NDA Engagement Manager

    2. Great points made- appreciated. Am mulling something- if it comes to fruition, then GPs indeed will be folks i will speaking to- to understand how we could get this better.

    3. If you are able to get GP's more involved - and more knowledgeable - it would be a massive help for T1 patients and carers. I know I spend more time that I ought to visiting or phoning my GP surgery to explain why I do need the amount of test strips I've asked for, or why my daughter does need both types of Novorapid on her prescription repeats, in case a set fails and she needs injections. The system frequently kicks things off our presciption list without reference to me, and I then have to jump through hoops to get them back on. I do understand they are doing their best - mine is a pretty good practice - but it's full of glitches and added hassle for patients, because they simply don't understand the condition. They're massively overworked, so I'm not sure what the solution is, but it all serves to add to the strain that the patient is under; which in turn leads to burnout and the feeling of not wanting to bother with diabetes occasionally.