GP Practice Diabetes Clinic

CatLadyNZ said:

Blimey the health system in the UK is paternalistic, isn't it? Sorry, not knocking you all or your fine country (which I love visiting, BTW. We don't do stately homes here - they are only 100 years old). I'm just empathising with you. Some of the things health services do appear as if they are treating you like children. It saddens me.

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Trust me I had some appalling situations with GP's and clinics when I lived in NZ a few years ago. I found them incredibly directive, i.e. you will do this you will do that etc and would then threaten to remove my driving licence if I didn't comply. Some of it was not far away from bullying really. Still there's good and bad all over the place although I have very very little regard for diabetes care anywhere really.

My latest GP here keeps insisting I see them for appointments when I am now on a pump which is something they have no knowledge of and they complain that they have none of my records. They say that my clinic doesn't forward them and I need to chase my clinic to do that. I wonder when I suddenly became an unpaid NHS messenger boy. I think if you want access to them you go and ask for them not me.

It does seem a waste of money. If the NHS has money to spare for diabetes care, I'd rather it funded more CGMs.

azure said:

I have to go to my GP and see the 'diabetic nurse' every year. I absolutely hate it as it's a patronising waste of time.

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Why is it that you have to go every year @azure, have you questioned why you need to be seen even though your under a hospital pump clinic, surely if they get copies of your results that should be sufficient, it's just seems a waste of their time and of course yours.

I feel bullied into it @noblehead I've asked not to go and I've also asked if I could just replace the visit with a quick chat on the phone if they want to make sure I'm ok, but they've said no. The 'diabetic nurse' seems to be in control of what's on my prescription and she got quite ratty when I asked for more strips. I feel like I have to pretend to be nice and cooperate else they'll refuse to have me as a patient. I live in a rural area so there's no choice of GP.

I go to the appointment and I learn absolutely nothing. It's infuriating. I only go to make sure they don't mess up my prescription or remove me from their books.

Thanks for the reply @azure, that's awful that you should feel bullied into attending these appointments even though you have good care under your hospital team.

I wonder if this is something that your Consultant could get involved in, perhaps if you discussed this with them they may write a letter to your gp surgery saying that there's no need for you to attend two appointments to discuss the same results, plus if your having difficulty getting enough test strips prescribed then this is definitely something that your hospital team can intervene in.

When on MDI my gp was disputing the amount of test strips I needed a months, he was adamant that 4 tests a day was sufficient to control type 1 diabetes despite my arguments to the contrary, in the end I just give up and mentioned this to my consultant who said his argument was ridiculous and thus wrote a letter to my gp to say I needed sufficient strips to manage my diabetes, after that nothing else was ever said.

That's an excellent idea @noblehead My surgery used to be ok, but then they had 'improvements' a few years ago and now they seem worse in every possible way.

I'm going to speak to my consultant when I see them next In my opinion, it's difficult enough managing diabetes without having to manage your local surgery too! Stress I could do without.

My GP periodically invites me to their clinic - I explain that I already attend one elsewhere and they are happy.

Auckland Canary said:

Trust me I had some appalling situations with GP's and clinics when I lived in NZ a few years ago. I found them incredibly directive, i.e. you will do this you will do that etc and would then threaten to remove my driving licence if I didn't comply. Some of it was not far away from bullying really. Still there's good and bad all over the place although I have very very little regard for diabetes care anywhere really.

My latest GP here keeps insisting I see them for appointments when I am now on a pump which is something they have no knowledge of and they complain that they have none of my records. They say that my clinic doesn't forward them and I need to chase my clinic to do that. I wonder when I suddenly became an unpaid NHS messenger boy. I think if you want access to them you go and ask for them not me.

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There are always a few bad eggs. Maybe the driving licence issue made things different, I don't know. 90% of the doctor's I've seen in NZ were respectful and asked and recommended rather than told me what to do. All the diabetes care I've had has been top notch, I'm lucky.

I don't see a diabetes consultant but I do see a gastroenterologist, sleep medicine specialist, pain specialist, and gynaecologist. Every visit with them results in a progress report letter sent back to my GP and often cc to me. The doctors contact each other whenever an issue arises affecting their are of my care. Sometimes the simplest solutions are the best ones.

The GPs have to hit certain criterias for QOF and DES payments. They have to review meds, they can also be used as a bonus to get extra hba1c's done, cholesterol, blood tests etc..

GPs have more conditions placed upon them to hit certain standards.. Even testing a urine sample is part of the targets set.

It isn't the GPs fault. Its NHS England.

Actually, I think I seem to have quite a decent DN. I have only seen her once so far but she was honest enough to tell me that she knew absolutely nothing about lymphoedema (which I suffer from) but that by the time I next saw her she would know everything there was to know about it, and how it impacts on diabetes and vice versa. Well anyway, I am way ahead of her. I really do think that these days you have to be your own advocate.

When I was diagnosed my GP asked me to go in and see him. He wanted to discuss the outcome from seeing the specialist etc.

He has been really good. He is also the surgery diabetes specialist and said the only thing he asks is I try to go to see him once a year.

Even though I am also under the care of the hospital I don't mind this. I get to discuss all the test results and he has never once questioned a prescription request.

If it was just seeing their nurse I might feel a bit different.

One thing that is different is that even though they have all my results they always do a fasting blood test which the hospital doesn't.

donnellysdogs said:

The GPs have to hit certain criterias for QOF and DES payments. They have to review meds, they can also be used as a bonus to get extra hba1c's done, cholesterol, blood tests etc..

GPs have more conditions placed upon them to hit certain standards.. Even testing a urine sample is part of the targets set.

It isn't the GPs fault. Its NHS England.

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It's a minefield how the funding works and I don't fully understand it tbh, but if you get your bloods taken at the gp surgery as I do and they are forwarded to the hospital for analysis (and review with your hospital team) then wouldn't they still meet these targets and receive their bonuses DD?

If you get them taken at the Practice the Practice would hit their targets...

Will find out the target drivers for hospitals for consultants in departments. Due to meet the CEO of our local hospital soon so will find out more detail how the hospitals are paid and how their payments are driven.

The GPs are the Primary Care givers and they are classified with targets because of that...for the primary basic checks to be done.

Hospitals are counted as secondary care...so their targets would be different.

Gets even worse when your hospital and GP are out of each other CCG areas because I always have to have my bloods done by GP, and ask for a hardcopy to take to my consultant!! If my consultant forgets to give me a form for my next appt then the GP will not do any blood tests for the hospital (me) at all. I have to phone hospital and ask them to send me blood forms!! Then the blood results will only go to the hospital!! - not the GP!

It is dire situation but the GPs are the ones as the Primary Care Givers that must hit the basics with their payments.

On top of this is other payments per patient.. Other payments that GP service used to get are being changed.. Our practice stand to lose £68,000 and threatening to stop loads of basic services such as spirometry tests, diabetics going from tablets to insulin, a list of about 20 services that will go due to them losing their revenue. NHS England and the CCGS haven't even got a an in place as yet to get these services into hospitals as the majority of our GP's in our CCG have all banded to gether and all going to stop these services in their practices.

The system of payments is absolutely dire... When it highlights GPs closing on TV this is for real.... It is dire.

I'm not in the UK anymore but when I was, and was registered for 20-odd years with a very good group practice, I also had to go in every year for a "review." This mostly involved me telling them how much insulin I was using and how many blood sugar sticks, and any other meds. It allowed them to maintain the repeat prescription system very well. Plus, they could double check that they were being informed properly by the diabetic clinic, and that I was actually doing what the clinic thought I was doing. When I stopped attending the diabetic clinic because I didn't like the consultant, my GP formally 'took over' my care for a while, which really meant I was looking after myself, and we both knew it. There are lots of 'non-compliant' diabetics out there, so the GP clinic once a year allows them an option they otherwise would not have, and also an opportunity to feedback on the clinic that they wouldnt otherwise have.