Diabetes services in primary care: are we prepared for the diabetes NSF?

Abstract

Aims

To conduct a survey examining issues relating to implementation of the diabetes NSF (National Service Framework) in primary care.

Methods

Fifty-two general practices were sent a questionnaire (14 questions) to investigate issues relating to implementation of the NSF for diabetes.

Results

A completed questionnaire was returned by 32 (≥ 60%) of practices. Of these, 30 (93.7%) had a practice register for diabetes, 18 (56.2%) had a screening policy for undiagnosed diabetes and 23 (71.9%) had specific diabetes clinics (SDC).

The practice nurse was at the front line of diabetes care, with the general practitioner, podiatrist and dietitian playing an increased role when patients had uncontrolled risk factors, or complications. In SDC lack of funding, specialist personnel and time were the main barriers to implementing the diabetes NSF.

In most practices holding SDC, patients with diabetes (65.2%) were not seen in the same clinics as patients with other cardiovascular risk problems, but without diabetes (34.8%). In those general practices not holding SDC, the majority reported they did not wish to develop these clinics (60%), due mainly to time restrictions. Only a minority (24%) of general practices referred patients with psychological problems, related to diabetes, to clinical psychology services.

Conclusion

Many general practices lack the necessary infrastructure to deliver comprehensive diabetes care and will struggle, without additional resources, to meet standards of care required, following NSF implementation.