Diabetes and the quality and outcomes framework: Diabetes needs reintegration of primary and secondary care

doi:10.1136/bmj.331.7528.1340

BMJ 2005;331:1340 (3 December), doi:10.1136/bmj.331.7528.1340

Letter

Diabetes and the quality and outcomes framework

Diabetes needs reintegration of primary and secondary care

The first 150 words of the full text of this article appear below.

EDITOR—Kenny analysed the way in which the care for peoplewith diabetes has developed in Britain over the past 15 yearsor so.¹ This primary sector concern for the welfare of peoplewith diabetes is a welcome but recent turn of events.¹ In thelate 1980s, the rising prevalence of diabetes drove two majordevelopments in hospital based diabetes care: the introductionof diabetes specialist nurses, and the creation of a countrywidenetwork of relatively open access, hospital based, diabetescentres.

The hope was that these developments would evolve into new collaborativecare networks where diabetes centres passed into the "jointownership" of primary care, the specialist teams, and theirconstituencies of patients. Any aspirations of a new, patientbased system were ended by the politicians, who opted for thehealth economists' view that the NHS could be made to work efficientlyonly by imposing a contestational structure . . . [Full text of this article]

Harry Keen, professor

Unit for Metabolic Medicine, King's College London, London SE1 9RT h.keen@ntlworld.com