Hounslow Cardio/Diabetes meeting - Tuesday November 27

[IanD]

7.00pm Open for Tea and refreshments

7.25pm Dr. P.K. Chatterjee, University of Brighton
The first speaker of the evening will be Dr. Chatterjee who gave a very interesting talk last year on the renal work being carried out at Brighton University. We are very grateful that he is coming back to update us on the progress.

A report on Dr Chatterjee's talk a year ago is on the forum.

8.15pm Our second speaker is Dr Chris Drew. Dr Drew is currently working with NHS North West London (NWL), under the Equalities Steering Committee advising to the NWL Shaping a Healthier Future proposals that went to consultation

9.05pm Raffle
9.15pm Close

Venue:
Montague Public Hall, 30 Montague Road, Hounslow TW3 1LD

Montague Road is just off Hounslow High Street on the corner with Holy Trinity Church. The Hall is opposite Hounslow Police Station. There is ample free parking after 6.30pm in public car parks in Montague Road and Alexandra Road

Cost
Our meetings are free, but we ask for a donation of £1 at the door to cover the cost of providing refreshments and buying a gift for the guest speaker.


Volunteering

We want to maintain the services we offer and plan to extend our work. If you would also like to see our group grow, and be more influential in lobbying to maintain local diabetes healthcare services in Hounslow, please offer to help us as a volunteer if you can, it would be greatly appreciated.


Email Addresses

Please let me have your email address if you (or a member of your family) have one. Sending newsletters by email will save us postage and printing costs.


We look forward to seeing you at all our meetings.

 

[IanD]

The meeting began with one of the organisers reporting the latest directive to GPs for test strips prescribing for T2s:
Metf & diet - none
Metf + another pill - one per week
Insulin - one per day
If a Dr prescribes more, it is our of his budget.
My comment - I understand Drs receive an allocation of £5,000 for diabetic patients. Surely that allows for all prescriptions & checks - including test strips, NOT to be pocketed.

Our second speaker is Dr Chris Drew. Dr Drew is currently working with NHS North West London (NWL), under the Equalities Steering Committee advising to the NWL Shaping a Healthier Future proposals that went to consultation

The intention is to concentrate facilities on fewer hospitals, with the effect that e.g. A&E, & other services will no longer be provided at some of the hospitals. It seems to be a cost saving exercise that will cost a fortune.

I'll report Dr Chatterjee in detail later. I did take lots of notes, & record it.

 

[phoenix]

Ian, where do you get that figure of £5000 from? I've read similar figures before but where do they come from?****

I've put down what I could find out. Sorry it's long winded but you may be able to spot something I've missed
First the way they calculate the income for a GP practice is horrendously complicated so never do you find something that says that they get paid so much for each patient with diabetes.

I found that in a study of just under half English GP practices

showed that practice income range for £65 to £320 per patient with much of the variation down to performance rewards under the quality and outcomes framework, and practices providing services beyond core contract requirements.

But HSJ found that when performance rewards and additional services were excluded from calculations, the variation was about £30-£300.

http://www.healthcare-today.co.uk/news/ ... ome/23084/
http://www.hsj.co.uk/news/primary-care/ ... 57.article
The quality frameworks gives 92 points for diabetes. These are only achieved if the practice achieves the target for a certain percentage of patients. I understand (and I may be wrong) that
a) the percentage achievement is easily achieved ie it's low and it's over 15 months not a year. Most practices get 100%
b) that 1 point this year earns the practice about £130.51 so a total of £12006 for 100%
http://www.gponline.com/News/article/11 ... e-2012-13/
Unless the practice only has 3 people with diabetes, I can't see them getting anything like £5000 per patient.

This BBC interview also describes the process and says that the practice derives £2000 from 17 points for HbA1c. I remember the interview and also remember people thinking that this applied per patient but ( it's not terribly explicit) reading the transcript along with the other things I've read I don't think that's the case
http://news.bbc.co.uk/2/shared/bsp/hi/p ... abetes.pdf
Dr Briffa also mentions the payments for targets being given to the practice (rather than per patient) here:
http://www.drbriffa.com/2009/03/13/are- ... than-good/

Lastly I found a study which estimated costs.The total direct cost of diabetes to the NHS was projected by an LSE study to be in 2010 .
T1, £3233
T2, £3717
This is an average which includes average in patient costs and of course most diabetics don't go into hospital each year. The costs of complications which require such care increases the average cost considerably.
The out patient costs without drugs were.
T1.£304
T2 £367
The in patient cost was
T1 £1807
T2 £2552
The average cost for medications (which I assume but don't know includes strips)
T1, £1,122
T2, £798
http://www2.lse.ac.uk/LSEHealthAndSocia ... an2012.pdf

Edit another member has pointed this article to me. Maybe this is where the 'info' came from.
http://www.pulsetoday.co.uk/revealed-dh ... LYep-T7KSo
This is about a proposed change bundling the 9 healthcare processes for diabetes into one. This would it says give each practice 39 points so about £5000 but they wouldn't get any of it if a high enough percentage of patients didn't get the checks. (there are other QOF indicators for diabetes beyond for the 9 care processes)

 

[IanD]

Ian:
I understand Drs receive an allocation of £5,000 for diabetic patients. Surely that allows for all prescriptions & checks - including test strips, NOT to be pocketed.

Phoenix:
Ian, where do you get that figure of £5000 from? I've read similar figures before but where do they come from?****

Thanks for that, Phoenix. Your info looks better than my hearsay.

It's a figure I've seen somewhere - but I've probably misunderstood or been misinformed.

 

[phoenix]

It's like a game of Chinese whispers . I've read various figures in various places on this forum and on blogs. I read of people getting very angry about it. If it were true then they would be right to be angry. (perhaps we should ask a GP outright!)
I do think that the fact that GP practices can achieve these QOF targets quite easily means there is no particular incentive to reach out to those who are perhaps less motivated/in denial/less educated etc and make sure that they have the checks, attempt to reach the targets. These people may need reaching out to if they are going to avoid long term complications.

I'm a bit of an outside observer(pay tax in the UK though). I think that there are things that are wrong with NHS diabetes care (there is here too... and you wouldn't get many strips here either) . What worries me is that if people decide to use the idea that each diabetic patient comes with a large pot of money as an argument (maybe with their GP or when lobbying MPS) and if this is wrong then they are likely to have all their arguments dismissed out of hand.

At the moment, I think a lot of GPs have their hands tied by PCT constraints. It would be interesting to hear what a representative of your PCT says about the DVLA rules on insulin/oral meds that produce hypos and drivers because these people are required to test ; 1 strip a day/week isn't enough to fulfil that requirement.

 

[JoDec60]

I would be interested in attending the next meeting in Hounslow. Are there any 2013 dates arranged yet?