Nhs Care Plan

[rab5]

View attachment 27952

Yes, I just had an appt last week with HCA for annual review and had bloods and urine samples sent, plus weight, BP and feet checked, smoking, alcohol etc... I recently received my leaflet in the post, similar to yours. I think I may fill it in like this! Appt with GP on Friday to review it!

To be honest I think you should think about staying away from statins. Ha ha ha

 

[SaskiaKC]

I have nothing helpful to suggest, just want to say that I absolutely love your profile pic, Mr_Pot! Genius.

 

[Glucobabu]

Never seen one before. Thanks @Mr_Pot .
It could be useful, but would need time and commitment from both patient and nurse. Possibly could just be another box ticking exercise. Unless the patient insists on completing their part and insisting HCP complies. Used that way I think it could be an improvement on the current nothing I have and suspect that is the same for others too.

It is indeed a box ticking exercise. Once my nurse told me that the practice only gets paid by the NHS if the patient’s results meet the minimum standards. Hence the tick list! In my opinion all type 1s should be seen at the diabetic clinic in hospital. Seeing a practice nurse for Type 1 is a complete waste of time, especially when you see a clueless locum nurse!

 

[Brunneria]

Some time ago i remember reading that Care Plans were being introduced for some patients to see if they were helpful.
From memory (which may be wrong!) I think there was a financial incentive for surgeries to get Care Plans implemented.
Maybe they were shown to be effective and have now been rolled out further...?

I thought I’d better check the above and found this:
http://www.pulsetoday.co.uk/news/ne...o-achieve-20000-des-payments/20006342.article

For some reason I think @ally1 might have posted about having one. I hope I am not confusing you with someone else, Ally!

 

[Rachox]

Some time ago i remember reading that Care Plans were being introduced for some patients to see if they were helpful.
From memory (which may be wrong!) I think there was a financial incentive for surgeries to get Care Plans implemented.
Maybe they were shown to be effective and have now been rolled out further...?

I thought I’d better check the above and found this:
http://www.pulsetoday.co.uk/news/ne...o-achieve-20000-des-payments/20006342.article

For some reason I think @ally1 might have posted about having one. I hope I am not confusing you with someone else, Ally!

Thanks for the link Brunneria.
Mmm, I’m not sure I’m in the 2% of most vulnerable patients!

 

[Brunneria]

Thanks for the link Brunneria.
Mmm, I’m not sure I’m in the 2% of most vulnerable patients!

That was back in 2014
They’ve probably rolled it out much wider since then.
Presumably with more financial incentives, too...

 

[Rachox]

That was back in 2014
They’ve probably rolled it out much wider since then.
Presumably with more financial incentives, too...

Oh yes I hadn’t thought of it like that! Phew!

 

[Brunneria]

This March 2016
https://www.england.nhs.uk/wp-content/uploads/2016/04/core-info-care-support-planning-1.pdf

 

[prancer53]

I think I would have to write something about not eating the recommended carbs with every meal. Every conversation with dietitians and HCPs always includes them telling me wholemeal bread, pasta, and brown rice is fine, as the carbs are released slowly.

"Slow release carbs are fine".....if only it were that simple.....!!!

 

[prancer53]

It is indeed a box ticking exercise. Once my nurse told me that the practice only gets paid by the NHS if the patient’s results meet the minimum standards. Hence the tick list! In my opinion all type 1s should be seen at the diabetic clinic in hospital. Seeing a practice nurse for Type 1 is a complete waste of time, especially when you see a clueless locum nurse!

Oh, I so agree....one I used to have got unpleasant, personal & rude if I disagreed with her but she seemed to know very little at all about diabetes. Surgery got another DSN, only saw her once but she seemed very knowledgeable but has apparently left after only a few months.

 

[ally1]

Some time ago i remember reading that Care Plans were being introduced for some patients to see if they were helpful.
From memory (which may be wrong!) I think there was a financial incentive for surgeries to get Care Plans implemented.
Maybe they were shown to be effective and have now been rolled out further...?

I thought I’d better check the above and found this:
http://www.pulsetoday.co.uk/news/ne...o-achieve-20000-des-payments/20006342.article

For some reason I think @ally1 might have posted about having one. I hope I am not confusing you with someone else, Ally!

Yes you are right that I have a care plan at my surgery.
To be honest, I have no idea why now that the surgery have done it, as nothing has been done this having this.
Diabetes wise, I never really have a full diabetic check up once a year, I have to chase this up and then it's only a usual 10 minute check up with the nurse.
Funnily enough, I was only reading through it yesterday, since it was written 3ish years ago, I have now been diagnosed as bipolar, on the care plan, it just says, being seen by a psych.

 

[Glucobabu]

Oh, I so agree....one I used to have got unpleasant, personal & rude if I disagreed with her but she seemed to know very little at all about diabetes. Surgery got another DSN, only saw her once but she seemed very knowledgeable but has apparently left after only a few months.

She was probably too caring and took too long with her patients and thereby inefficient so was asked to move on! Something similar happened to a nurse at my practice too.

 

[dawnmc]

I know the one you mean (sorry, just seen the PDF, I know the one). It does document your results very well and should motivate people to be more involved in their care, not that we aren't already, that goes without saying.

I said my weight was a major issue, but with the food diaries I have provided them, they're stumped. Their only comment was "your metabolism is broken". No suggestions from DN/GP for improving the situation. I'm hoping Jason Fung has the answer, I have dieted and reduced calories for so long that my metabolism will only allow 1200 calories a day That's only a rough guess. Exercise doesn't necessarily increase metabolism although it may increase the amount of ghrelin (hormone increasing hunger).

I feel your pain. I would love to know why my body can't lose weight on an 800cal, less than 20g of carbs a day.

 

[DavidGrahamJones]

I would love to know why my body can't lose weight on an 800cal, less than 20g of carbs a day.

I do feel that I have more answers now after watching several videos with Dr. Jason Fung. What I liked about what he says is that it isn't just anecdotal he backs up his claims with research that has been done, sometimes up to 100 years ago.

I think in some people's case, they have dieted for so long and reduced their calorie intake gradually over many years and their metabolism has slowed down bit by bit over those years. Like you I quite often only consume 800 calories for weeks at a time but no weight loss.

I had always been told that exercise would give the metabolism a boost, I didn't find that to be true for me, on a weekly basis I would spend 1 hour with a PT, 5 X 500m - 1km swimming, 3 x 1 1/2 hour in the gym and a round a golf and all I did was ache a lot. Jason Fung mentions some proper empirical evidence that supports my anecdotal information.

 

[Pinkorchid]

I have reduced the resolution....

Yes that is pretty much the same as we get…husband and I both have T2 his is steroid induced mine is a mystery never been overweight or had a bad high starchy carb diet my GP was so suprised when I was diagnosed...I think it is the new NHS care plan so everyone soon will be dealt the same way at their reviews

 

[Mr_Pot]

I do feel that I have more answers now after watching several videos with Dr. Jason Fung. What I liked about what he says is that it isn't just anecdotal he backs up his claims with research that has been done, sometimes up to 100 years ago.

I think in some people's case, they have dieted for so long and reduced their calorie intake gradually over many years and their metabolism has slowed down bit by bit over those years. Like you I quite often only consume 800 calories for weeks at a time but no weight loss.

I had always been told that exercise would give the metabolism a boost, I didn't find that to be true for me, on a weekly basis I would spend 1 hour with a PT, 5 X 500m - 1km swimming, 3 x 1 1/2 hour in the gym and a round a golf and all I did was ache a lot. Jason Fung mentions some proper empirical evidence that supports my anecdotal information.

I don't really understand how a slow metabolism works. If your body is doing the same thing but with less energy input that means a much greater efficiency, is that really happening? Surely we would all want a slow metabolism in that case.

 

[zand]

I don't really understand how a slow metabolism works. If your body is doing the same thing but with less energy input that means a much greater efficiency, is that really happening? Surely we would all want a slow metabolism in that case.

Well yes it's efficient in one way....it runs on very few calories...but when you are overweight this means it's almost impossible to lose weight. You need a certain amount of calories to provide a healthy diet to ensure that you get a good mix of vitamins and minerals - so you have a choice.. eat less to lose weight and risk becoming ill or eat the same and stay fat and put up with all the comments from HCPs and the rest of the world. Or a third choice of trying to find out why your particular body doesn't work like everyone else's. I tried the first two and am now on the third one.

 

[Robbity]

@Mr_Pot That's what I get too.

I only ever attempted once to partially fill it in but it never gets discussed such - we just have a bit of a question & answer and a general conversation where I get asked if I have any issues/concerns.

I got initial dietary advice from my own GP regarding avoiding sugar and not drinking orange juice. and "You need to lose weight - try Atkins!" which led me to eating low carb... From DN on diagnosis I had the standard Eatwell plate advice, and to avoid foods labelled as diabetic, but having later seen my low carbing results she told me keep on doing what I was doing, and she lets me tell her if I have any particular issues to discuss.

Statins - I was on them for several years pre diabetes diagnosis and just accepted them, but then discovered that they will raise glucose levels. Initially another GP in our Practice was our (somewhat laid back) diabetes expert(?!) and he agreed to me cutting down on dose. And I shortly after just stopped reqaueting then via my online prescription repeat requests. Next review was with my own GP who is also now reponsible for me diabetes wise, and he's not taken issue over this! But we juggle with blood pressure meds instead...

He is also happy that I test and I sometimes give him a copy of my logs, but has admitted that he's not allowed (by Pracice Manager) to prescribe strips unless I'm ill.

Robbity

 

[Goonergal]

No I’m not at all keen on the idea of Statins, how did you guess?!
That’s my argument with the Q risk score too, when it asks about Diabetes it should also have the facility to put in an HbA1c score.

My qrisk score drops significantly just by taking out my postcode!

 

[Rachox]

My qrisk score drops significantly just by taking out my postcode!

Yes mine does too! It drops by 1.7 putting me under the all important 10.