Thursday, 15 September 2011

Specialist Diabetes Care at Your Doctor's?

A recent diabetes journal for health professionals discussed the issue of increasing demands on the NHS and on diabetes services in particular. These discussions highlighted the changing NHS and the proposals now going through Parliament, for services to be provided in general practice where possible, rather than people being referred to specialist services in hospitals.

The journal highlighted four different models that had been developed in different areas of England. They all have commonalities, for example they all emphasise working in partnership with other health professionals to ensure services are integrated, and they all recognise that up until now, services have mainly been organised around the hospital-based system.

Where the models differ is in their approaches. For example, one of them offers a ‘top-down’ approach that talks about key services that should always be provided by a specialist team, and thereafter focuses on the relationship and support services that their specialist diabetes team provide to primary care colleagues.

Another is presented from the point of view of people with diabetes, who found that their care providers were too authoritarian, and that the model of care did not support self-care or shared decision making.

A third is written from the perspective of a limited company of general practitioners (GPs) providing an integrated diabetes service for their local population.

A fourth and final model is written from the hospital specialist team’s perspective but based on the local vision of ensuring that care is of good quality and equally available to all people with diabetes.

So which is the right approach? How diabetes services are organised has been debated for at least 20 years, mainly among health professionals, and mainly from an ‘opposite sides’ point of view, with both specialist services and general practice both arguing that no-one else can provide care in the way that they do. The result has been that within these services, people with diabetes have at times been bewildered and left with very little explanation about their local system of care, or why they see who they see.

The last decade or more has seen the Government’s health policy firmly pointed towards greater accessibility of services locally, alongside holding managers and commissioners to account for how money is spent on services and how best value for money can be achieved without reducing quality of care.

Assuming there is no one model that fits everywhere – and the NHS has consistently failed to provide a single system of care which works throughout the country – how can you tell if your local diabetes service is delivering what it should? We believe you should be able to get the answers locally, whichever country in the UK you live in, to the following questions:

í    What objective information can you be provided with to tell you why you are being seen by the specific health professionals that provide your care?
í    Can your diabetes service explain exactly what their model is?
í   Are there additional diabetes-related services on offer that you could take advantage of?
í    Where can you find information about the design of your local diabetes service, with information about when or where you might expect to need expertise from outside your ‘usual’ diabetes team?
í    How are decisions made about the design of your local diabetes services, and how can you have a say in those decisions?
í    How well are people with diabetes, their families and carers represented in the decision-making system – for example is there a token ‘person with diabetes’ among a vast panel of health professionals and managers, or is a more equal voice apparent, such as a representation group or discussion forum for people living with diabetes?

The answers to these questions may of course lead you to want to know even more of course, as the answers may be complex and potentially difficult to find. But you have the right to know not only what care you should expect, but what your local healthcare managers are doing to make sure you get it.  The government has vowed that we all experience an NHS where there is ‘no decision about me, without me’ and in our view, this applies as much to the design of services as to their delivery.

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