Further NHS Diabetic Cutbacks - This Time It's The Diabetic Review Intervals

[Lazybones]

I reside in Hertfordshire, England. I was eventually declared as being a Type 2 in year 2000, since which time I have attended regular 6 monthly diabetic reviews to check and monitor my diabetic condition.
Last week I attended my GP's Surgery for what I had thought was the first stage of my regular FULL diabetic assessment, which has traditionally been undertaken by the Diabetic Practice nurse, which consisted until now of the standard Urine and Blood Sample test, together with a B/P measurement, height, weight, waist measurement, eye check (I'm unfortunately now registered as being blind) and the usual examination of my feet, and in the case of a Type 1 also their insulin injection sites.
Having initially undertaken all these basic but essential diabetic tests, the common practice was to then wait a week or so for the diabetic review test results to be returned before seeing their GP, where depending upon the test results and any other medical problems (diabetic or otherwise) a decision would then be made as to whether to change or adjust the diabetic patient's current medications.
For many years this has been the preferred practice that has served us diabetic patient's well, but not so any-more.
I was informed that from now on (at least in my locality, but I suspect it's likely to be rolled out nationally) the NHS has decided to cut back further on these regular diabetic reviews with the time interval between each diabetic review now being doubled. In other words those diabetic patients who formally had a FULL review at 3 monthly intervals, will now have their diabetic reviews extended to 6 monthly intervals, and those like myself who undertook a FULL diabetic review every 6 months, will now have their diabetic review interval extended to ONCE a year
Despite displaying my objections to this NHS decision all that was undertaken during my recent diabetic review was just the Urine, Blood Test (Lipids and HbA1c) together with just taking a Blood Pressure reading and not the former FULL diabetic review.
Also during this most recent encounter with my surgery's practice Diabetes Nurse, I enquired from her when could I book the follow up appropriate to see the GP, where upon I was informed that this was now no longer to be the standard practice, and that they (the surgery) would only contact a diabetic patient if in their opinion they felt it was necessary for that patient to see the GP following on from their most recent diabetic test results.
Since this incident I have taken the trouble to check with several other GP's practices in my locality, together with a number of personal contacts that I have within the NHS profession, and yes, it does indeed seem to be a new NHS directive to cut costs that's being sneaked in through the 'back door'.
I remember thinking of NHS diabetic cutbacks in the past, when at that particular time the availability of free prescription Blood/ Glucose test strips and lancets were withdrawn from us Type 2 diabetics and just how mean and lacking foresight the NHS was rapidly becoming, but just how far are they now prepared to go? They want all of us as diabetics to look after ourselves but they are simply not keeping their side of the bargain by supporting us and supplying us with the means to do so.

 

[noblehead]

An annual diabetes check-up is the norm unless someone is struggling or are newly diagnosed, so I don't think they can be much cause for objection to a once yearly check-up unless you are having difficulties with your diabetes.

 

[Minnie45]

Yep this has been the norm for T1s in my area for the last few years, T1s have annual reviews at hosputal clinics unless encountering difficulties then are seen more frequently, all are able to contact a DSN if needed. Again in my area T2s are seen at their GPs but more regularly routinely (every 6 months) but I understand this is now changing to once a year but there will be a community dietician and DSN specifically available to T2s.

T1s were being 'discharged' into the community but it quickly became apparent it wasn't working (mainly due to surgeries not having DSNs available for support/advice) as the local GPs referred the T1s back to the local hospitals.

 

[noblehead]

The following article from Diabetes UK explains what you level of care you should expect from your HCP's and what to do if you are not happy with the treatment you receive:

http://www.diabetes.org.uk/Guide-to-diabetes/Monitoring/15-healthcare-essentials/

 

[Patricia21]

My next appointment is a year,ok for me as I am looking after myself,diet ,moniter provided by me.
Its people who dont know how to look after themselves that are at risk.
Im so glad I have this forum,and all the good advice I have had.

 

[Randburg]

Hi, Whilst not in Britain, does this mean that you then only have one HbA1c test a year as well,?
I try and test Quarterly, as a type 2 but have to pay myself for the test

 

[Bluetit1802]

Hi, Whilst not in Britain, does this mean that you then only have one HbA1c test a year as well,?
I try and test Quarterly, as a type 2 but have to pay myself for the test

I am on 6 monthly reviews at the moment. I asked if I could have interim HbA1c tests without the follow up review for my own peace of mind. This was allowed without a problem.

 

[Daphne917]

My surgery do Diabetic reviews annually (in same month as your birthdsy) and my next one was going to be in August next year but, because I came off Sitagliptin, my DN wanted a review after 3 months, which I've just had, to check that there were no adverse effects so my next one is in 7-8 months time. However, I've not seen my GP about my diabetes since being diagnosed 3 years ago.

 

[Bluetit1802]

My surgery do Diabetic reviews annually (in same month as your birthdsy) and my next one was going to be in August next year but, because I came off Sitagliptin, my DN wanted a review after 3 months, which I've just had, to check that there were no adverse effects so my next one is in 7-8 months time. However, I've not seen my GP about my diabetes since being diagnosed 3 years ago.

I have never seen my GP about diabetes including on diagnosis. I have seen her about statins, but when I mentioned HbA1c etc she said ask the nurse!

 

[Patricia21]

I havent seen the GP,and the nurse isnt a diabetic nurse.

 

[poohtiggy]

My surgery is the same, once a year check up. My GP gave me the diagnosis in May but I haven't seen him since, concerning my diabetese. My diabetese nurse just said "will see you in a year unless you are concerned about anything" so I know I can see her if needed but as I am testing and managing to control my diabetese that seems ok to me.

 

[noblehead]

Hi, Whilst not in Britain, does this mean that you then only have one HbA1c test a year as well,?
I try and test Quarterly, as a type 2 but have to pay myself for the test

I was told that there has to be a gap of at least 12 weeks before a gp can request another Hba1c test, so 3 monthly would be fine if the gp thought it was necessary.

Although I'm under the care of a hospital diabetes clinic my own gp has said before they would do a Hba1c test in-between clinic appointments if I wanted to, but I suppose some people may not be so lucky.

 

[Daibell]

Hi. I think you have been lukcy and have had more attention at your surgery than others. I also live in Hertfordshire but before I went onto insulin I had annual checks based on my HBa1C being reasonable. I have always had my blood and urine done by the Phlebotomist or hospital path lab up to 2 weeks before the actual review so the results were available for that. I have traditionally been seen by the diabetes GP or sort-of DN. Once on insulin I have been managed by an experienced DN who sadly has now left so will be seen by a nurse who may have had very basic diabetes training. I'm still listed as T2 although actually a LADA so I get mid-way insulin attention. So, I think there is no need to see the GP unless there is no nurse avaialble with diabetes training or there are specific problems. I think annual checks are fine if you are known to be stable and have well-managed BS. I have never understood why some surgeries take blood at the review; seems daft to me to be honest and a waste of skilled GP/nurse time. Although I know there is a formal list of 14 things to check, I think some are a bit unnecessary unless you are known not to have well-managed BS. I also have my retinopathy done at the local hosptial annually so the surgery never check my eyes. Diabetes costs the NHS a small fortune so I look for treatment to be cost effective and tailored to the nneds of the patient. Some patients are truly awful at managing their condition and will have serious issues so need close monitoring. I like to think I'm well-managed and will raise health concerns if I have them at or between a review.

 

[Nuthead]

Another from Hertfordshire. My doctor has got his claws firmly into me and is not about to let go. I have also recently had an appointment with my DN after I phoned her. She has arranged an appointment with the diabetes consultant early in the new year. No complaints or issues from me.

 

[Ruth B]

My normal problem is that who ever books the appointments at the doctors is a bit over enthusiastic, its normal for me to get my 6 month review 5 months after the last one, and when the nurse wanted me to come in after 3 months a couple of times ago and insisted it should be at least 12 weeks to give the increased meds effect time to show up in the HBA1C the appointment was made for 9 weeks and I had to ring up and try and get them to understand it should be at least 12 weeks.

I normally get the appointment sent through with a reminder to book in for a blood test a couple of weeks before hand. How many HCP I see varies, normally a nurse (I don't know if she is a DN but she is the one that does it as well as other things)and then the doctor, however sometimes it is just the nurse and one time 2 nurses and one doctor, I never really know what to expect until I get there.

 

[donnellysdogs]

Mine as a T1 is done annually by GP. As I see my wonderful consultant 6 monthly my GP actually refused to test my hba1c because my consultant should have given me a form!! Talk about pennypinching between gp's and hospitals! My GP results do not get sent to my hospital either, I have to go in, ask for a print and email to my consultant.
At gp I can get my results printed easy.

As my consultant has now requested the bloods then those results go straight to hospital. Not even copied to GP unless my consultant email s me the results and I take them in printed and the printed paper results will then be scanned to my file.

Plain stupidity just between the costs of the blood tests being either logged against the GP or the hospital. To me as the Patient in this, its ridiculous. The NHS is the NHS but all the funding issues just add extra bureaucreacy and extra jobs somewhere along the line.

Pretty pathetic for the Patient, but grateful as a T1 that I do get **** good care.....

 

[Bluetit1802]

@donnellysdogs How strange. My GP's computer records are linked with the hospital computer records, so they each get the others results. It was my hospital oncologist that told me I was diabetic after seeing my GP's blood test results before my GP had chance to contact me!

 

[Nuthead]

@donnellysdogs How strange. My GP's computer records are linked with the hospital computer records, so they each get the others results. It was my hospital oncologist that told me I was diabetic after seeing my GP's blood test results before my GP had chance to contact me!

Same here in Hertfordshire. Does not seem to matter where you go or for what reason, your life history is on the screen.

 

[tim2000s]

For as long as I remember, if you were considered to be well controlled you got reviewed once a year. When it wasn't so good, every six months. Never seen anything like three months, and that is T1 care in both London and Warwickshire.

 

[Bluetit1802]

It is 3 months for newly diagnosed T2's because generally speaking on diagnosis we are given the news, told to lose weight if appropriate, possibly but not always a diet sheet of some sort, sent away with or without meds, and told to come back in 3 months for another HbA1c.