Partha Kar

Diabetes: it is within our gift to work with our patients and make it better

With a flourish, the National Diabetes Audit has made its annual appearance – and being part of the core audit group, I already knew what was coming.

The messages were hard, stark and – worryingly – worse than previous years.

I will just concentrate on Type 1 Diabetes. About 39% of folks are getting their basic care processes; if you were under 40, this was down to about 24%. There was huge variability across CCGs, but for me the most worrying bit was the sharp decline in reporting from GP surgeries – down from 70% to about 57%.

So, not only have the numbers worsened, we actually know even less of what’s going.

Fingers have been pointed at each other: is it lazy patients not having ownership, or lazy GPs not bothering with care, or poor communication from hospitals to GPs resulting in poor data transfer?

It’s exactly the same debate as last year; or the year before that. The figures have worsened, but the debate hasn’t moved on.

I don’t blame anyone – I don’t have T1DM; I don’t have the foggiest idea what it involves living with it day in and day out; I don’t have hypos, so I am the last person to sit here and judge another person on why they haven’t had their care process done nor attended an appointment for that.

I appreciate that it is easy to sit behind a desk as a healthcare professional and say “why can’t you have your feet checked?” rather than “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 extra resources. I do understand that politicians (of all colours) 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 lead to public vilification? A media storm ensures, so better to just avoid any data.

Some say enforce it, but then that leads to gaming or disillusionment.

I actually blame diabetes specialists. We must learn to put our hands up. Over my career I have heard many a reason: “the PCT/CCG made me do it”, “I have to do other stuff”, “I have other priorities”.

Well, I am not quite sure who else is supposed to fight the corner of T1DM patients – apart from the ones specifically trained to do so. When I say every single T1DM patient doesn’t need to be seen in a hospital 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 wellbeing of the system – and ‘yes’, that should include the responsibility of making sure patients get their basic checks done.

I have decided to focus on simple basics in our locality over next few years. 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 do 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.

Let’s 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.


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