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Nhs Care Plan

Mr_Pot

Well-Known Member
Messages
4,573
Location
Berkshire
Type of diabetes
Type 2
Treatment type
Diet only
The procedure for Diabetes Annual Reviews at my local doctors is as follows:
HCA takes sample of blood and you hand over a urine sample, she asks a few questions about smoking, alcohol etc. and weighs you. (which she did by asking me what it was!).
About a week later you get sent blood results with a useless explanatory leaflet.
About a week after that you get to see the DN to discuss the results.

The blood results also have a "care plan", and I have attached it.
People often complain that their reviews are minimal or non-existent, this seems to err in the other direction, is a DN really going to have time or expertise to help with all these things?

Does anybody get these and actually fill them in?

EDIT: File was too large, I will see what I can do....
 
Seems a little basic but I believe if you don't measure things they don't get managed. As a type 1 I don't get a scorecard other than the usual co morbidities checks which I find out about after the consulation except for HBA1c which I can discuss with my consultant.
What would you stop, start and continue?
I would take away weight and add waist measurement
I would take away total cho and add trigs/hdl ratio
This information should prompt a discussion about diet (this is where you get to re educate the hca/dsn...)
I would add exercise habits too but this should be given a lesser priority than waistline and smoking status.
Not sure about all the emotional stuff given the lack of time and counselling skills that the HCA/DSN may have.
 
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.
 


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!
 
I take it you are not 100% convinced about the benefits of statins then.

When my GP recommended statins, I said "run the QRisk again without saying I am diabetic" (HbA1c less than 42 at the time) Which he did and said "ok fair enough" and nobody has mentioned them again.
 

I've never seen such a thing, so obviously haven't filled one in.
 

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.
 

If I get one I am actually going to fill it in like this.
 
Rachox said:
I have actually filled it in in a much more constructive way
But ssshhhh I haven’t mentioned Statins
Click to expand...

Mum's the word.
 
Rachel you naughty girl! Anyone would think that you think they are going to suggest statins to you !! As if !!!
 
Mr_Pot said:
EDIT: File was too large, I will see what I can do....
Click to expand...

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 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.
 
I have never had any dietary advise except by the Dr I saw urgently at diagnosis, not my own GP and he just agreed with me when I asked “do I just cut down sugar?” That was before I hit the internet and found this forum! My GP agrees with my low carb eating but only when I mention it!
 

Strange, isn't it. Just how entrenched the old advice on diet is.

I hardly ever see my GP, and when I do he often is accompanied in the surgery by medical students, as he has managed to become a training GP. One time he mentioned to the two students in the room that I had impressed him by taking charge of my own health and 'reversing my T2, by Newcastle diet method'. Not wanting to be left out of the educator role, I whipped out a print out of Dr Unwin's journal article, and told them "This is my follow on plan, and it saved that GP a lot of money when he advised his patients that was the way forward". That captured the attention of them all.

I think we should never miss an opportunity to spread the word. (Though , alas, currently I'm not much of an example, but that is another story for another thread).

Edit to add Any advice on diet has come from an assortment of HCPs, nurses, dietitians, many not at GP surgery, but at various clinic appointments. The most interested person in how I manage my health is a receptionist at GP surgery who is training to become Health Care Assistant. Genuinely wanting to learn, and appreciative of patients owning their health. Hope she progresses, as she is a breath of fresh air.
 
When I was diagnosed my GP said I should try diet for 3 months and arranged an appointment with a dietitian. The dietitian asked me about my typical meals, which were broadly Eatwell, and she said that was excellent and I should carry on. So I was supposed to make a change to my BG by making no change?? After 3 months of low carb my GP said the diet was working and to carry on, which I did.
 
Yes my surgery do these forms

And I find it useful
 
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