Type 2 Opting Out of Diabetic Check Ups

[CarbsRok]

Perhaps you might think about changing your GP practice or putting your thoughts on the NHS Choices surgery review site - if enough people complain the CQC will almost certainly see it.

No idea why you think I should change my GP or practice as they are excellent.
It's my choice as to whether I have this completely useless check or not. I've lived for almost 52 years with type1 diabetes. If I have a problem I ask my GP end of story.

 

[Robbity]

I've put yes for this. As much as I 100% agree that all diabetics should attend their reviews, if they don't want to then that is entirely their choice.

There is no point in sending out letters with proposed dates for appointments, etc if they have no intentions on attending. It not only wastes time and money, but it makes it harder to schedule appointments for those who actually want them.

I entirely agree - in principle! However I can't really see that people who're not prepared to attend a checkup are particularly going to be prepared to fill in such a form and return it.

Recently our practice has been putting up on their notice boards the numbers of people each month who don't attend for their booked appointment, or who don't pick up their prescription - and it's more than just a handful...

However I've not voted in the poll because to me the wording implies that people are being requested to opt out, not whether or not they prefer to.

Robbity

 

[ukuleleplayer]

Can I assume that they think you're managing your diabetes well and can be left to get on with it?
If so, their ignorance of diabetes is frightening.
Of course you need regular checks....3, 6 or 12 monthly is normal. Must say though, I had to ask my surgery for an HbA1c test after 9 months. The hospital eye clinic are much more on the ball and invite me in for checks.
Serious issues can arise quite quickly....feet, eyes etc.
I've not heard of any plans to cut check ups for diabetics. Hope this isn't a growing trend.

 

[Brunneria]

I am all of a dither on this one.

Ignorance is definitely NOT bliss and denial is self destructive.
But if we are monitoring closely at home, then personally I take my bg readings as a far better indication of how things are going than the HbA1c which seem to bear little relation to my home readings across time!
By opting in, the surgery gets a bit of income, and spends it on me, which I don't need because I am self monitoring.
By opting out, the NHS still keeps the money, and presumably it will get spent somewhere, hopefully more usefully, if I am already monitoring my own situation well at home.
People who don't turn up, or who don't respond to the letter, are very unlikely to be self monitoring, but at least the surgery has shown willing, and can prove that deterioration in the patient's condition isn't due to negligence by the surgery.
If T2 is (as the NHS believes) an ongoing deteriorating condition leading inevitably to complications, then regular checks are VITAL, even if they may only slow the downward spiral.
If T2 is (as I believe) hugely controllable, with care, diet, monitoring and NHS assistance (when needed), then those regular checks may not be nearly as necessary.

Can't really see a clear path.

 

[debz48]

I have just received my Diabetic Annual Check appointment from my GP Surgery and attached to the letter is a form asking me if I wish to opt out of checkups. I think that this is the "thin end of the wedge" for the patient and not something that I am happy about and I was wondering if anyone else had been asked this?
Clearly, it is a way for the surgery to meet their responsibilities and still get paid for a service that they are not carrying out - any thoughts would be appreciated.

I also got asked this whilst in an appointment. Howerver due to attending the hospital appointments every 3 to 4 months a year, I have opted out of attending the GPs for Diabetic Reviews. The reason being I have so many other health issues and going to the GPs for general appointments, I felt constrained in the amount of appointments I was attending. But everyone has their own choice and opinion on this situation.

 

[GrantGam]

I entirely agree - in principle! However I can't really see that people who're not prepared to attend a checkup are particularly going to be prepared to fill in such a form and return it.

Yeah you're probably right there @Robbity. Is there a way for an "opt in" system to work though? Maybe a compulsory first annual diabetic review, send the diabetic away with a couple pre-paid envelopes and attached forms to complete. Then post the forms back to the clinic in around 10 months time to arrange a next annual appt?

 

[CarbsRok]

I entirely agree - in principle! However I can't really see that people who're not prepared to attend a checkup are particularly going to be prepared to fill in such a form and return it.

The apt and form is sent to me in the post, I look on line cancel the apt so it's left free for someone else and return the form declining the offer to waste my time.

 

[tim2000s]

I opted out as I don't need the regular check-ups with the GP as the clinic handles those. It seems sensible that I do it that way as the practice gets the money any way.

And besides, the Diabetes specialist GP works his ass off to do the Diabetic reviews, often in the office till 10pm making phone calls for the review. As a result, I do not begrudge the practice the QOF payments one iota. They are working hard for them, and that, in my book, is a virtue.

 

[alanfcox]

I have now received a reply from Diabetes UK and this states,
One of our Policy Analysts responded:

I’ve never seen this before either. (the opt out form)

It may be designed to ‘exception report’ patients from QOF on the basis that they have refused treatment. According to QOF guidance you can ‘except’ “Patients who have been recorded as refusing to attend review who have been invited on at least three occasions during the preceding twelve months”. OR people can be excepted, “Where a patient does not agree to investigation or treatment (informed dissent), and this has been recorded in their medical records.”

For the former, people must have received an invite specific to them (not just a blanket invite) three separate times. For the latter, “personal contact or discussion should be documented in the patient's record for this criteria to apply. This can include face-to-face, video conferencing or telephone contact between a health professional and the patient”. I.e. presumably just filling in the below slip would not suffice.


We are not confident this is a reasonable way to exception report, if that is what they are doing


As an organisation I don’t think we’d be happy with people being removed from the recall register for 12 months – although it would be worth a conversation with the practice to understand their rationale for doing so."

This is what I will do as I intend to raise the issue at the next PPG meeting.

 

[alanfcox]

Can I assume that they think you're managing your diabetes well and can be left to get on with it?
If so, their ignorance of diabetes is frightening.
Of course you need regular checks....3, 6 or 12 monthly is normal. Must say though, I had to ask my surgery for an HbA1c test after 9 months. The hospital eye clinic are much more on the ball and invite me in for checks.
Serious issues can arise quite quickly....feet, eyes etc.
I've not heard of any plans to cut check ups for diabetics. Hope this isn't a growing trend.

I did mention this to a friend today who is also Type 2 and at another practice and he told me that he had a verbal request to drop out 12 months ago and he rejected this immediately.

 

[Robbity]

The apt and form is sent to me in the post, I look on line cancel the apt so it's left free for someone else and return the form declining the offer to waste my time.

I perhaps wasn't clear enough about what I actually meant - I was thinking of people who don't or can't be bothered to turn up for an appointment rather than someone who would make it known that an offer of an appointment was not required.

Robbity

 

[alanfcox]

I opted out as I don't need the regular check-ups with the GP as the clinic handles those. It seems sensible that I do it that way as the practice gets the money any way.

And besides, the Diabetes specialist GP works his ass off to do the Diabetic reviews, often in the office till 10pm making phone calls for the review. As a result, I do not begrudge the practice the QOF payments one iota. They are working hard for them, and that, in my book, is a virtue.

If the GP surgery does not do the health checks it does not get the money unless they can show on that persons records that they have tried to contact them 3 times.

 

[alanfcox]

I opted out as I don't need the regular check-ups with the GP as the clinic handles those. It seems sensible that I do it that way as the practice gets the money any way.

And besides, the Diabetes specialist GP works his ass off to do the Diabetic reviews, often in the office till 10pm making phone calls for the review. As a result, I do not begrudge the practice the QOF payments one iota. They are working hard for them, and that, in my book, is a virtue.

If the GP is the person "often in the office till 10pm making phone calls for the review" then this is a poor use of his time because this is something that should be done by admin staff. I know that my wife (GP Practice Manager) has often said to doctors "you doctor - I manage" which of course is how it should be.

 

[tim2000s]

If the GP is the person "often in the office till 10pm making phone calls for the review" then this is a poor use of his time because this is something that should be done by admin staff. I know that my wife (GP Practice Manager) has often said to doctors "you doctor - I manage" which of course is how it should be.

Sorry, I wasn't clear. This isn't the calls to set up appointments. Due to being the prescribing surgery, even with care being run under the clinic, they do have to do an annual prescription review. Those of us who have opted out have the option of doing this over the phone as it doesn't require any physical checks. That's what he was doing at 10pm.

 

[alanfcox]

I am all of a dither on this one.

Ignorance is definitely NOT bliss and denial is self destructive.
But if we are monitoring closely at home, then personally I take my bg readings as a far better indication of how things are going than the HbA1c which seem to bear little relation to my home readings across time!
By opting in, the surgery gets a bit of income, and spends it on me, which I don't need because I am self monitoring.
By opting out, the NHS still keeps the money, and presumably it will get spent somewhere, hopefully more usefully, if I am already monitoring my own situation well at home.
People who don't turn up, or who don't respond to the letter, are very unlikely to be self monitoring, but at least the surgery has shown willing, and can prove that deterioration in the patient's condition isn't due to negligence by the surgery.
If T2 is (as the NHS believes) an ongoing deteriorating condition leading inevitably to complications, then regular checks are VITAL, even if they may only slow the downward spiral.
If T2 is (as I believe) hugely controllable, with care, diet, monitoring and NHS assistance (when needed), then those regular checks may not be nearly as necessary.

Can't really see a clear path.

I monitor at home as well but what about the other functions that are tested as part of HbA1c, cholesterol, kidney function, feet and eye examination - do you do these? I know that you said that you feel that your bg readings are a far better indication but how do you know that your meter is accurate - have you had it checked?

 

[alanfcox]

Sorry, I wasn't clear. This isn't the calls to set up appointments. Due to being the prescribing surgery, even with care being run under the clinic, they do have to do an annual prescription review. Those of us who have opted out have the option of doing this over the phone as it doesn't require any physical checks. That's what he was doing at 10pm.

I am informed that it is normal practice for the patient to be in attendance with the GP for this to be carried out in case any additional checks are required.

 

[tim2000s]

I am informed that it is normal practice for the patient to be in attendance with the GP for this to be carried out in case any additional checks are required.

It may be, but when you are receiving a twice annual or annual check from the diabetes clinic, and your only medication is diabetes related, they don't need to have you in the presence of the GP to do it. As an aside, the clinic notes that are provided to the GP by Guys are very thorough, so they are happy (and able) to allow the secondary care team to manage that aspect.

 

[Brunneria]

I monitor at home as well but what about the other functions that are tested as part of HbA1c, cholesterol, kidney function, feet and eye examination - do you do these? I know that you said that you feel that your bg readings are a far better indication but how do you know that your meter is accurate - have you had it checked?

Is this some kind of brainwashing by interrogation? Where you try and wear people down to your way of thinking by asking endless questions on the minutiae of their opinion?

As I said, I am in two minds as to whether it is necessary/appropriate for me to attend the checks.
I did not say which decision I had made.

Besides, your original question was 'Should patients be asked to opt out of Diabetic Checks'
Which is a very different question from the ones you now seem to be pursuing.

However to answer your latest dogged queries:
I place no reliance on my cholesterol tests having any relevance to my health
I have a home bp monitor
Eye exams are done at a clinic, not in the surgery, so they are not relevant to this discussion since the discussion has focussed on gp care
I don't see any special skills needed for the foot checks that I can't do myself when I bathe, clip my nails and apply foot cream

And as for the meter, I have a Freestyle Libre which I compare with a normal glucometer. And since I am T2, I am looking for trends and overall control, not the kind of accuracy needed for insulin dosing.

If I detected any issues I would straight round to the surgery.

 

[Energize]

Is this some kind of brainwashing by interrogation? Where you try and wear people down to your way of thinking by asking endless questions on the minutiae of their opinion?

As I said, I am in two minds as to whether it is necessary/appropriate for me to attend the checks.
I did not say which decision I had made.

Besides, your original question was 'Should patients be asked to opt out of Diabetic Checks'
Which is a very different question from the ones you now seem to be pursuing.

However to answer your latest dogged queries:
I place no reliance on my cholesterol tests having any relevance to my health
I have a home bp monitor
Eye exams are done at a clinic, not in the surgery, so they are not relevant to this discussion since the discussion has focussed on gp care
I don't see any special skills needed for the foot checks that I can't do myself when I bathe, clip my nails and apply foot cream

And as for the meter, I have a Freestyle Libre which I compare with a normal glucometer. And since I am T2, I am looking for trends and overall control, not the kind of accuracy needed for insulin dosing.

If I detected any issues I would straight round to the surgery.

I agree with Brunneria. Before this thread was started, after my most recent annual review (another thread) I felt I didn't need to be seen by the nurse for Review, although would still expect the usual blood tests to be done. If I had any queries regarding my diabetes, or any indications that all was not well, I would make an appointment to then see the nurse, or the GP, whichever was the most appropriate at the time.

As Brunneria, I also have Freestyle Libre and monitor my glucose levels carefully

 

[alanfcox]

Is this some kind of brainwashing by interrogation? Where you try and wear people down to your way of thinking by asking endless questions on the minutiae of their opinion?

As I said, I am in two minds as to whether it is necessary/appropriate for me to attend the checks.
I did not say which decision I had made.

Besides, your original question was 'Should patients be asked to opt out of Diabetic Checks'
Which is a very different question from the ones you now seem to be pursuing.

However to answer your latest dogged queries:
I place no reliance on my cholesterol tests having any relevance to my health
I have a home bp monitor
Eye exams are done at a clinic, not in the surgery, so they are not relevant to this discussion since the discussion has focussed on gp care
I don't see any special skills needed for the foot checks that I can't do myself when I bathe, clip my nails and apply foot cream

And as for the meter, I have a Freestyle Libre which I compare with a normal glucometer. And since I am T2, I am looking for trends and overall control, not the kind of accuracy needed for insulin dosing.

If I detected any issues I would straight round to the surgery.

Sorry, if I have offended you - I'm just trying to be helpful.