Diabetes and the quality and outcomes framework

BMJ 2005; 331 doi: http://dx.doi.org/10.1136/bmj.331.7528.1340-a (Published 01 December 2005) Cite this as: BMJ 2005;331:1340

Integrated care is best model for diabetes

  1. Richard Greenwood, chairman (richard.greenwood{at}nnuh.nhs.uk),
  2. Ken Shaw, treasurer,
  3. Peter Winocour, secretary
  1. Association of British Clinical Diabetologists, c/o Norfolk and Norwich University Hospital NHS Trust, Norwich NR4 7UY
  2. Association of British Clinical Diabetologists, c/o Norfolk and Norwich University Hospital NHS Trust, Norwich NR4 7UY

    EDITOR—The Association of British Clinical Diabetologists (ABCD) welcomes Kenny's editorial on the impact of the quality and outcomes framework on diabetes management and supports his plea for supporting and strengthening secondary (specialist) care diabetes services.1

    The implementation of the updated contract for general medical services (GMS2) has resulted in a welcome increase in the monitoring of patients, especially those with type 2 diabetes, who have been comparatively neglected in the past. However, the need to improve glycaemic control to meet the target value of 7.5% for HbA1c has had some unforeseen consequences. In most specialist centres, referrals of patients treated with tablets for consideration of insulin treatment have increased, and many general practices do not feel confident with this. Simultaneously, it is not only extremely difficult for secondary care to attract additional resources, but there is actual “downsizing” of some specialist units by local primary care trusts, in line with the government's desire to transfer most, if not all, of chronic disease management from secondary to primary care.

    This is one of the main reasons for the increasing frustration and discontent among diabetologists, which has led to a decline in recruitment into the specialty and many unfilled consultant posts. If as a result specialist services are lost then it will be difficult to re-create them. There is general agreement that integrated care is the best model for diabetes. However, integrated care will work only if there is something to integrate with. Without diabetologists and their multidisciplinary teams, general practitioners will be left unsupported and access to specialists for patients with complicated, diabetes related problems will be reduced. Most consultant diabetologists also provide an endocrine service and make a substantial contribution to acute general medicine. These functions cannot be devolved into the community.

    ABCD therefore believes that the government and the Department of Health must rapidly reverse its present policy of downsizing hospital diabetes services if we are to avoid a serious deterioration in the quality of care for people with diabetes in the primary and secondary care sectors.


    • Competing interests None declared


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