Views & Reviews If I Ruled the NHS

Improving diabetes care: six simple suggestions

BMJ 2015; 350 doi: (Published 06 January 2015) Cite this as: BMJ 2015;350:g7848
  1. Partha Kar, consultant (diabetes and endocrinology), Portsmouth Hospitals NHS Trust
  1. partha.kar{at}

One provider, one budget—Too many cooks: you always have that feeling, don’t you? Acute trust, community trust, primary care . . . it’s time to have a fused budget to help deliver care seamlessly within and outside the hospital, seven days a week. Could we even abolish use of Payment by Results for a long term condition such as diabetes? Or reduce perverse incentives for acute care trusts to do more unnecessary outpatient activity and instead use block contracts for the whole pathway of diabetes care? What’s a “community diabetologist” but a tautology? The hospital is part of the community, not separate. One budget, one team, one provider. Can we be even bolder …

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